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After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World

After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World

Most women aged 65 and older have incontinence, associated with high healthcare costs, institutionalization, and negative quality of life, but few seek care. Mind over Matter: Healthy Bowels, Healthy Bladder (MOM) is a small-group self-management workshop, led by a trained facilitator in a community setting, proven to improve incontinence in older women.

The main objective of the study by HIP Investigator, Dr. Heidi Brown et al. was to quantify and understand barriers to and facilitators of implementation, adoption, and maintenance of the MOM intervention. The secondary objective was to engage study communities and Wisconsin Institute for Healthy Aging (WIHA) staff in the development of a partner‐focused implementation package for MOM.

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Priorities and Outcomes for Youth-Adult Transitions in Hospital Care: Perspectives of Inpatient Clinical Leaders at US Children's Hospitals

Priorities and Outcomes for Youth-Adult Transitions in Hospital Care: Perspectives of Inpatient Clinical Leaders at US Children's Hospitals

Adults with chronic conditions originating in childhood experience ongoing hospitalizations; however, efforts to guide youth-adult transitions rarely address transitioning to adult-oriented inpatient care. A group of authors including HIP Investigator, Dr. Ryan Coller identified the perceptions of clinical leaders on important and feasible inpatient transition activities and outcomes, including when, how, and for whom inpatient transition processes are needed.

Authors found that children's hospital clinical leaders rated inpatient youth-adult transition activities and outcome measures as important and feasible; however, feasibility may ultimately drive implementation.

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Child in hospital with IV

The Intersection of Complex Care and Hospital Medicine: Opportunities to Advance Health for Chronically Ill Populations

The Intersection of Complex Care and Hospital Medicine: Opportunities to Advance Health for Chronically Ill Populations

Children with medical complexity (CMC) are a high-need, high-cost population representing 1% of all children yet accounting for nearly one-third of all child health-related costs. Parents of CMC take responsibility for the vast majority of caregiving and face many challenges in doing so. Caregivers themselves experience physical and mental health problems that can compromise their ability to effectively perform caregiving tasks. Additionally, direct clinical encounters for CMC in health care settings are often inefficient and poorly coordinated.

Pediatric hospitalists have an essential role to play in the development of innovative solutions to improve care for CMC. In response, hospitalists have been integral in refining and studying structured complex care programs for CMC. In this article, HIP Investigator, Dr. Ryan Coller et al. evaluated complex care program efforts to improve care for CMC.

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Codesign and Usability Testing of a Mobile Application to Support Family-Delivered Enteral Tube Care

Codesign and Usability Testing of a Mobile Application to Support Family-Delivered Enteral Tube Care

Enteral tubes are prevalent among children with medical complexity (CMC), and complications can lead to costly health care use. Using a human-centered codesign process, authors including HIP Investigator, Dr. Ryan Coller, created a highly usable mobile application to support enteral tube caregiving at home. Future work involves evaluating the feasibility of longitudinal use and effectiveness in improving self-efficacy and reduce device complications.

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Daily medications

Workflow Barriers and Strategies to Reduce Antibiotic Overuse in Nursing Homes

Workflow Barriers and Strategies to Reduce Antibiotic Overuse in Nursing Homes

Antibiotics are among the most commonly prescribed medications in nursing homes (NHs), being prescribed to two‐thirds of residents annually. Although often beneficial, their overuse is associated with avoidable adverse effects.

This article by HIP Investigator, Dr. Edmond Ramly et al. seeks to characterize the workflows performed in NHs before a prescriberʼs decision to prescribe antibiotics. By analyzing the preprescribing workflow across NHs, authors sought to identify barriers to reducing antibiotic overuse and strategies to address them to improve antibiotic prescribing.

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Implementing parity for mental health and substance use treatment in Medicaid

Implementing parity for mental health and substance use treatment in Medicaid

Rates of mental health and substance use disorders (MHSUDs) in the adult Medicaid population are higher than for adults with Medicare or private health insurance. In this publication, HIP Investigator, Dr. Marguerite Burns et al. estimates the association between the implementation of parity in coverage for mental health and substance use disorder (MHSUD) services within the Medicaid program and MHSUD service use.

The authors' findings suggest that parity implementation in Medicaid could increase access to effective MHSUD services in a high‐need population.

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Ambulatory Quality, Special Health Care Needs, and Emergency Department or Hospital Use for US Children

Ambulatory Quality, Special Health Care Needs, and Emergency Department or Hospital Use for US Children

Hospital and emergency department (ED) visits are measures of health and chronic disease control. Reducing hospital and ED use is a family‐centered goal and can lower health care spending. However, a key unknown is whether and how ambulatory care quality predicts ED and hospital utilization in children by underlying chronic illness. HIP Investigator, Dr. Ryan Coller et al. sought to identify associations between parent‐reported ambulatory care quality and pediatric ED or hospital visits and evaluated how these relationships vary among children with different levels of medical complexity.

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Bandaging amputee

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Over 30 million people in the United States have diabetes, and up to 25% of them will develop a diabetic foot ulcer (DFU). Specific to DFUs, rural patients face 50% higher odds of major (above-ankle) amputation and 40% higher odds of death compared to their urban counterparts. A group of authors including HIP Investigators, Dr. Meghan Brennan and Dr. Christie Bartels sought to understand what health system factors contribute to the rural disparity in diabetic foot ulcer outcomes.

The authors concluded that future interventions focusing on mitigating the poor connections across rural and urban healthcare systems could reduce the rural disparity in major amputations.

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Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive

Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive

Smoking doubles the risk of developing rheumatoid arthritis (RA) and additionally contributes to cardiovascular, pulmonary, and oncologic diseases, the main causes of death in patients with RA. While patients are more likely to quit smoking after diagnosis of a smoking-related chronic disease, research shows most will continue to smoke.

HIP Investigator, Dr. Christie Bartels et al. identified predictors of smoking cessation in patients with RA in two health systems to guide future intervention implementation efforts. Authors found that emphasizing smoking cessation with new or seropositive RA patients and leveraging health system interventions could improve smoking cessation and outcomes in RA.

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Skilled Nursing Facility Differences in Readmission Rates by the Diagnosis-Related Group Category of the Initial Hospitalization

Skilled Nursing Facility Differences in Readmission Rates by the Diagnosis-Related Group Category of the Initial Hospitalization

The US Health and Human Services Office of the Inspector General report on nursing homes found that skilled nursing facilities (SNFs) exhibit wide differences in overall hospital readmission rates. Because evidence has been found that hospital readmission rates can be lowered by discharging to specific SNFs, policy makers have started using hospital readmission rates by SNFs as a measure of quality of care patients receive at these facilities.

In a letter to the editor, a group of authors featuring HIP Investigator Dr. Maureen Smith, examined whether SNFs differed substantially in their readmission rates by the DRG category of the initial hospitalization (ie, medically uncomplicated, surgically uncomplicated, medically complicated, or surgically complicated). The authors’ results suggest considerable differences in readmission rates across SNFs by DRG category of the initial hospitalization, despite similar overall readmission rates.

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