May 8, 2023

Special Issue: HOMERuN Updates, Successes, and Collaboration

The Hospital Medicine Reengineering Network (HOMERuN) is a national network of Hospital Medicine investigators at 12 academic medical centers (AMCs) and 50 affiliated sites.

Executive Committee The EC focuses on how to promote HOMERuN's mission and vision through supporting scholarship in Hospital Medicine.

Achievements: Facilitated access to HOMERuN data sets and supported surveys led by junior faculty. Collaborated with NASEM and national stakeholders to support creation of a report on the state of Hospital Medicine and to promote Hospital Medicine research. Began strategic planning for a Hospitalist Scholar program to provide remote mentoring, National Grand Rounds, and partnerships with SHM Academic Hospital Medicine and Research Committees to enable mentoring and collaborative opportunities. Completed an interview project speaking with senior leaders in health care organizations via Zoom to understand how hospitalists supported health systems during the COVID-19 pandemic and how strategies to expand organizational capacity may have changed over time. The manuscript for this project is in preparation for submission. Began strategic planning to update HOMERuN's Mission and Vision. Launched the first annual HOMERuN survey of Academic Hospital Medicine Division/Section Chiefs to compare and benchmark Academic Hospital Medicine Programs and held a meeting at SHM to discuss preliminary results and plan for future survey enhancement.

Sponsored Research Programs

Utility of Predictive Systems in Diagnostic Error (UPSIDE) Study is the largest study of inpatient diagnostic errors to date. Achievements: Completing final year of work Completed analyses of 2,510 chart reviews Manuscript of findings drafted Planning sub-analyses of data Diagnostic Errors Among Patients Under Investigation for COVID-19 Study  Achievements: Completed study work Completed analyses of 257 chart reviews Manuscript: Auerbach AD, Astik GJ, O'Leary KJ, et al. Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19. J Gen Intern Med. 2023 Mar 23:1-9.

Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT) Study seeks to create a learning health system which integrates diagnostic error and process assessments into existing quality and safety programs, shares data, infrastructure, and expertise to catalyze improvement in diagnostic performance, and lays the groundwork for efforts which will last beyond the duration of the grant. Achievements: IRB at central site approved Completed training for 68 chart reviewers among 16 participating sites Established "Pods" with assigned mentors for sites

Identification and Prevention of Potentially Inappropriate Inter-hospital Transfers Study seeks to accurately define and estimate the incidence and patient safety impact of potentially inappropriate inter-hospital transfers among medical patients who have undergone transfer to a large network of US hospitals, characterize and identify at-risk patients, and develop a toolkit of best practices to reduce potentially inappropriate inter-hospital transfers for future dissemination (e.g., by replacing it with safer alternatives).  Achievements: IRB at central site and collaborating sites completed for Aim1 focus group work 3 focus groups completed and analysis is underway IRB at central site in progress at central site for Aims 2 and 3 chart review work Chart review tool in development

HOMERuN Collaborative Updates

The Collaborative work groups are composed of more than 100 people across 55 hospitals that lead inquiry and collaboration within areas of high shared interest by HOMERuN sites.

Discharge Planning led by Jeffrey Schnipper

The group has updates on two major projects: Study of clinical criteria for stability for discharge after hospitalization for COVID-19 (based on HCA data but externally validated with data from 7 HOMERuN hospitals) is complete and will be submitted for publication in the next two weeks. Study of results from HOMERuN survey of post-discharge monitoring after hospitalization for COVID-19 is complete and is about to be submitted for publication. Next steps include the following: Consideration of a multi-site retrospective comparative study of the impact of post-discharge monitoring on patient care in patients with COVID-19 Possible rapid qualitative study of how sites are reacting to hospital pressure to improve throughput (e.g., early discharges), how much is in our control, what sites are trying, whether they have been successful, etc. We are open to suggestions on what directions to take our group, so please join us! Reach out to Tiffany.Lee@ucsf.edu if you are interested in joining this group.

Workforce Management led by Luci Leykum, Marisha Burden, Angela Keniston

The group is currently working on: Strategic planning for workforce (mission, vision, values, and 1 year plan) APP practices and collaboration focus groups are under analysis; anticipate paper submission within the month Impact of COVID-19 on Women in Hospital Medicine focus groups manuscript is under review at JGIM Jeopardy Policies survey and rapid qualitative analysis of Jeopardy focus groups is complete; manuscript in progress Third-wave COVID adaptations focus groups manuscript in progress Perspective piece on workforce affinity group is nearing submission to JHM Supporting parental leave focus groups manuscript is in preparation Leadership and hospitalist safety and well-being focus group manuscript is in progress, SGIM presentation "Parental Leave in Hospital Medicine" SGIM poster Completed work from this group: SHM Converge 2023 Presentation: "Don't be a Lone Ranger: Creative Ways to Expand Academic Opportunities through Multi-Center Networks" SHM Converge 2023 Poster: "Parental Leave in Hospital Medicine: We Can Do Better" SHM Converge 2023 Poster: "A Necessary Evil: Multi-Institutional Rapid Qualitative Analysis of Jeopardy Systems"

Provider Wellness led by Krishna Chokshi, Elizabeth Murphy

The group is currently working on: Summarizing recent focus groups on wellness measurement for a future newsletter A literature review of wellness measurement strategies Combining the above efforts to create recommendations for wellness measurement best practices for hospitalists Creating a Professional Meaning component of this workgroup. Please consider joining this work if you have an interest in faculty development (reach out to Tiffany.Lee@ucsf.edu)

Medical Education led by Amit Pahwa and Jack Badawy

The group is working on two major projects: Faculty onboarding survey to describe the process that division directors use to onboard faculty and to determine what is considered standard practice when hiring physicians to academic divisions. Use rapid qualitative methodology to analyze professional development focus groups. We aim to describe what faculty at academic institutions think the goals of professional development should be, and include potential barriers and solutions to those barriers.

Antiracism, Diversity, and Equity led by Areeba Kara and Ashley Jenkins

The group is currently focused on three major projects: We conducted an assessment to crystallize the group's vision and are committed to building a community that furthers DEIJ through collaborative scholarship. Open-ended comments received on a national survey of Division chiefs and hospitalists eliciting views on diversity, equity, inclusion and justice were analyzed and the insights gleaned were shared as an abstract at the SHM Converge conference. This work will also be presented at the upcoming national SGIM conference. The group plans to carry their abstract through to a manuscript. The group is also engaged in supporting Dr. Ashley Jenkin's work on individualized care plans in patients with sickle cell disease. They also led the effort to get signatories urging the FDA to correct skin color-based errors in pulse oximetry devices, ultimately garnering the support of 161 individuals from across the country. Dr. David Sterken also provided testimony at the FDA meeting, summarized the meeting for a HOMERuN newsletter, and has been invited to speak at the IU School of Medicine Department of Medicine's summer DEIJ series.

And this group's previous workgroup lead, current member, Dr. Archna Eniasivam received SHM's award for diversity — awarded in recognition of her efforts to advance health equity.

Patient Communication led by Nicole Curatola and James Harrison

The group is currently brainstorming with the HOMERuN Patient and Family Advisory Council (PFAC) regarding potential topics to focus. The working group plans to come to a Friday collaborative call in early summer.

Addiction Committee led by Rebecca Jaffe

This group is newly launched and still gathering members; reach out to Tiffany.Lee@ucsf.edu if you would like to join this group.

Collaborative Achievements

41 collaborative calls held, each of which included real-time focus groups and qualitative research, followed by rapid turnaround knowledge dissemination through newsletters, feedback to sites, and publications. At last count, 10 peer reviewed publications in print, 6 research abstracts accepted as posters, more submitted/in press, 25 newsletters published.

HOMERuN Patient and Family Advisory Council (PFAC)

The HOMERuN PFAC is composed of 10 members who represent patients, families, and caregivers from across the US. The PFAC partners with investigators to ensure the patient voice and perspective are included in the development, design, implementation, and dissemination of projects. The HOMERuN PFAC continues to provide their expertise on many HOMERuN supported research projects and initiatives. We thank the PFAC for their ongoing commitment to HOMERuN and elevating the patient perspective and improving research. The PFAC has been involved in the following projects over the last few months: Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT) Study Sharing the patient experiences of positive diagnostic experiences. Providing input on patient information sheet and interview guide   Identification and Prevention of Potentially Inappropriate Inter-hospital Transfers Study Feedback on the study's patient engagement plan. Review of Inter-hospital transfer cases in preparation for focus groups Input on focus group questions   Patient Communication Workgroup Brainstorming and prioritizing topics for the workgroup to focus on The HOMERuN PFAC can help with study brainstorming, study planning, study implementation, data collection approaches, review of patient facing materials, and study finding dissemination. If you are interested in presenting to our PFAC, please reach out to Tiffany.Lee@ucsf.edu or James.Harrison@ucsf.edu.

Publications

Postdischarge Planning: Greysen RS, Auerbach AD, Mitchell MD, et al; for the HOMERuN Collaborative Working Group. Discharge practices for COVID-19 patients: rapid review of published guidance and synthesis of documents and practices at 22 US academic medical centers. J Gen Intern Med. 2021;36(6):1715-1721. Workforce Management: Keniston A, McBeth L, Astik G, et al. Practical applications of rapid qualitative analysis for operations, quality improvement, and research in dynamically changing hospital environments. Jt Comm J Qual Patient Saf. 2023;49(2):98-104. Workforce Management: Kulkarni S, Keniston A, Linker A, et al. Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field. J Hosp Med. 2023;18:329-336. Workforce Management: Keniston A, Sakumoto M, Astik GJ, et al. Adaptability on shifting ground: a rapid qualitative assessment of multi-institutional inpatient surge planning and workforce deployment during the COVID-19 pandemic. J Gen Intern Med. 2022; 37(15):3956-3964. Workforce Management: Linker AS, Kulkarni SA, Astik GJ, et al; on behalf of the HOMERuN COVID-19 Collaborative Working Group. Bracing for the wave: a multi-institutional survey analysis of inpatient workforce adaptations in the first phase of COVID-19. J Gen Intern Med. 2021;36(11):3456-3461. Workforce Management: Keniston A, Sakumoto M, Astik G, et al. Sign of the times: Part 1: Hospitalists are indispensable in healthcare system COVID-19 responses. SGIM Forum. November 2021. Patient Communication: Harrison JD, Weiss R, Radhakrishnan NS, et al. A patient-centered environmental scan of inpatient visitor policies during the COVID-19 pandemic. J Patient Exp. 2021;8:23743735211049646. Medical Education: Holzer H, Salib S, Wray C, Santhosh L. Reimagining the Learner–Employee Dyad: Trainees as "Essential Learners." Acad Med. 2022;97(11):1579-1580. Medical Education: Guo MZ, Allen J, Sakumoto M, Pahwa A, Santhosh L. Reimagining undergraduate medical education in a post-COVID-19 landscape. J Gen Intern Med. 2022;37:2297-2301. Medical Education: Wang S, Santhosh L, Wray C. Leadership & Professional development: how to teach when you don't know. J Hosp Med. 2021;16(9):556. PFAC: Evans P, Rogers B, Symczac G, et al; HOMERuN PFAC. Earn our trust: the perspectives of patients and caregivers. J Hosp Med. 2022;17(4):313-315.

View HOMERuN Publications

Our next meeting will be on May 12, 2023.

Check out the our website for more details. If you would like to join the HOMERuN Collaborative calls, please reach out to Tiffany.Lee@ucsf.edu.