Farah Acher Kaiksow

Background: Postoperative delirium (POD) remains a significant, costly complication. Despite increasing awareness in medical specialties, understanding among surgical providers remains unknown. Objective(s): We aimed to (1) understand surgical providers’ self-perceived knowledge of and confidence in identifying and managing POD, and (2) define the perceived importance of POD among surgical providers, relative to other complications. Methods: An anonymous electronic survey was distributed to surgical providers across three hospitals in an academic medical system. Results: Seventy-six of 267 (28.5%) responded. The majority were somewhat (n=48, 63%) or very confident (n=12, 16%) identifying POD, however, few used validated tools (n=18, 24%). Most were somewhat (n=40, 52.6%) or very confident (n=9, 11.8%) managing POD. Few consulted geriatrics or other fields for co-management (n=23, 30.2%). Among six common complications, delirium consistently ranked third or fourth in importance. Conclusions: Future work should focus on increasing the use of validated tools and building interdisciplinary initiatives for co-management.

Nearly 2 million people are incarcerated in US jails and prisons, where they experience disproportionate burdens of chronic disease, mental illness, substance use disorders, and infectious diseases. Although many receive specialty or acute care in community hospitals, incarceration status is rarely captured in clinical or administrative data, rendering this population largely invisible to quality-improvement efforts, research, and health equity initiatives. Existing identification strategies—including International Classification of Diseases (ICD) codes capturing social determinants of health or institution-specific electronic medical record workarounds—are inconsistently used, lack specificity, and offer little reimbursement incentive, resulting in incomplete and nonstandardized data. Here we review current gaps in documenting incarceration within community medical centers and propose policy and infrastructure reforms to improve measurement and accountability, including reclassifying incarceration-related codes as reimbursable comorbid conditions to incentivize documentation, developing consensus guidance from professional societies to standardize practices, pairing data collection with ethical safeguards to mitigate stigma and misuse, and incorporating incarceration status into national administrative datasets to enable population-level research.

Background: The incarcerated population in the United States is underserved and aging rapidly; there is a dearth of information regarding their health, including hospital care. Epidemiological information is crucial to guide policymakers’ planning. This analysis provides comparison data on the admissions of incarcerated and nonincarcerated patients. Objectives: Identify differences in inpatient care between incarcerated and nonincarcerated patients by comparing 10 years of data at an academic medical center that serves as the largest single provider of hospital care for the state's Department of Corrections. Methods: Ten‐year cohort study comparing all admissions of incarcerated males ( n = 4525) to a matched cohort of nonincarcerated ( n = 13,575) at an academic medical center serving as the largest provider of hospital care for the state's Department of Corrections. We included patients ≥18 years old and admitted to the hospital while in custody of the Department of Corrections between January 1, 2010, and December 31, 2019. Primary outcomes were patient characteristics, including demographics and comorbidities, and hospitalization characteristics, including length of stay and diagnosis. Results: Compared with the nonincarcerated cohort, the incarcerated patients were more likely to be Black (33.4% vs. 6.6%, p < 0.05), Hispanic/Latine (6.1% vs. 2.1%, p < 0.001), admitted to a general medicine service (33.4% vs. 22.6%, p < 0.01), and less likely to be admitted to neurological/psychiatric services (5.2% vs. 9.1%, p < 0.01). The incarcerated cohort had a higher mean Charlson Comorbidity Index (3.83 vs. 3.65, p < 0.001), with statistically significant differences observed among patients aged 40–59. Conclusion: In this cohort study, there were differences in patient and hospitalization characteristics between incarcerated and nonincarcerated patients that may have clinical implications. Policymakers and researchers must work toward improving both the health and health care of this marginalized population.

There are significant racial and ethnic disparities in the incarcerated population in the USA, with individuals from racial and ethnic minoritized groups more likely to be incarcerated. There are also disparities in the health and health care received by different racial and ethnic groups in the USA. The information on the health care received by incarcerated individuals is lacking, including particularly limited data on hospitalization rates. This paper aims to identify potential racial and ethnic differences in hospital care provided to patients who are incarcerated. Differences in care during incarceration may worsen pre-existing disparities between racial and ethnic groups.

Patients who reside in areas of high neighborhood disadvantage have poorer health outcomes; the mechanisms for this disparity are complex. We sought to determine if there was an association between neighborhood disadvantage and diagnostic error among a cohort of adult inpatients who experienced either an ICU transfer or in‐hospital death. Using a sample of 527 patients from seven geographically diverse academic medical systems, we compared diagnostic error rates to patients' neighborhood disadvantage levels as measured by the Area Deprivation Index, a validated composite measure of socioeconomic status. In contrast to previous studies that found differences in hospital care based on socioeconomic status, we found no difference in diagnostic error rate between patients based on neighborhood disadvantage. Once a patient reaches the hospital, their risk of diagnostic error is not related to the neighborhood in which they live.