Gregory Misky

Background: Studies have identified higher risk of readmission for patients with Medicaid compared to those with private insurance. Postdischarge follow‐up is utilized as an intervention to reduce readmissions in the Medicare population, but it is unclear whether follow‐up reduces risk of readmission for patients with Medicaid.Objective: To assess whether follow‐up within 30 days of discharge reduces risk of readmission and mitigates readmission disparities based upon insurance status.Methods: This retrospective cohort study used Cox proportional hazard and competing risk models to estimate associations between sociodemographic and clinical characteristics, follow‐up, and readmission.We analyzed data from 4281 patients aged 21–64 years with Medicaid or private insurance who were hospitalized from January 2017 to December 2019 for one of five conditions associated with high risk of readmission.Outpatient follow‐up within 30 days of discharge and 30‐day all‐cause readmission were outcomes.Results: Overall risk of readmission was similar for Medicaid and privately insured patients in this cohort (13.7% and 14.5%, respectively). Patients with Medicaid were 23% points less likely to complete outpatient follow‐up within 30 days compared to patients with private insurance (p < .001). However, outpatient follow‐up before readmission within 30 days of discharge was not associated with a significant difference in readmission rate (hazard ratio: 1.10, 95% confidence interval: 0.91–1.32) in the overall sample or in analysis stratified by payer.Conclusions: We found similar rates of readmission for Medicaid and privately insured patients despite significant disparities in postdischarge follow‐up. Timely follow‐up care alone may not be sufficient as an intervention to reduce readmissions.

Although homelessness is associated with increased acute healthcare utilization and poorer health outcomes, the prevalence of homelessness and housing insecurity in hospitalized patients is poorly characterized. We conducted an in‐person survey to determine the prevalence of housing insecurity and homelessness among hospitalized patients at two hospitals in metropolitan Denver in conjunction with the Housing and Urban Development point‐in‐time count on January 24, 2022. Of the 271 surveyed patients, 79 (29.2%) reported experiencing either housing insecurity (17.3%) or homelessness (11.8%). Of those experiencing housing insecurity or homelessness, 69.6% reported chronic health conditions, 55.7% reported multiple hospitalizations in the preceding year, 38% reported mental health concerns and 39.2% reported substance use. The prevalence of homelessness among a hospitalized patient population was over 20‐fold higher than community prevalence estimates. Housing insecurity also impacted a substantial proportion of hospitalized patients and was associated with high rates of co‐morbid conditions.

This scoping review sought to identify and describe the state of academic faculty development programs in hospital medicine and other specialties. We reviewed faculty development content, structure, metrics of success including facilitators, barriers, and sustainability to create a framework and inform hospital medicine leadership and faculty development initiatives. We completed a systematic search of peer-reviewed literature and searched Ovid MEDLINE ALL (1946 to June 17, 2021) and Embase (via Elsevier, 1947 to June 17, 2021). Twenty-two studies were included in the final review, with wide heterogeneity in program design, program description, outcomes, and study design. Program design included a combination of didactics, workshops, and community or networking events; half of the studies included mentorship or coaching for faculty. Thirteen studies included program description and institutional experience without reported outcomes while eight studies included quantitative analysis and mixed methods results. Barriers to program success included limited time and support for faculty attendance, conflicting clinical commitments, and lack of mentor availability. Facilitators included allotted funding and time for faculty participation, formal mentoring and coaching opportunities, and a structured curriculum with focused skill development supporting faculty priorities. We identified heterogeneous historical studies addressing faculty development across highly variable program design, intervention, faculty targeted, and outcomes assessed. Common themes emerged, including the need for program structure and support, aligning areas of skill development with faculty values, and longitudinal mentoring/coaching. Programs require dedicated program leadership, support for faculty time and participation, curricula focused on skills development, and mentoring and sponsorship.