Social determinants of health (HRSN) significantly impact health outcomes, prompting mandates from the Centers for Medicare and Medicaid Services (CMS) for health system screening and reporting. Although health systems are rapidly implementing HRSN screening, the quality of the data collected has not been reported. Evaluate aspects of data quality for inpatient HRSN screening tool implemented within an integrated health network of 18 hospitals, heterogeneity in screening performance, and explore clinical outcomes. Observational study using electronic health record (EHR) data from May to December 2024. Adult patients admitted to 18 hospitals in the Atrium Health System (Southeastern United States). We evaluated data quality of inpatient HRSN screening assessments using a data quality framework, including variation in screening performance by hospital site, assessed HRSN domain correlation, and finally explored the clinical outcomes of patients who screened positive for HRSN using descriptive statistics and mixed-effects logistic regression modeling. HRSN assessment responses demonstrated conformance, completeness, and plausibility in the data quality framework. Of 197,305 eligible inpatient encounters, 172,519 (87.4
Diabetes and heart failure are strongly correlated, and people with diabetes are more likely to rapidly transition to overt heart failure and develop symptoms. Early identification and management of heart failure can improve outcomes. Elevated concentrations of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) cardiac biomarker are associated with increased risk of cardiovascular events and mortality in people with diabetes, and measurement of this biomarker is now recommended for early detection of Stage B heart failure (asymptomatic cardiac dysfunction), according to American Diabetes Association (ADA) guidelines. While several countries have published local consensus statements on how to address heart failure risk in diabetes, this assessment has not yet been universally adopted in practice. A multidisciplinary group of experts from ten countries (Ireland, Italy, Lithuania, Portugal, Slovenia, Spain, Switzerland, Turkey, India, and the USA) convened to discuss their experience of implementing ADA guidelines in clinical practice. This review reports their experiences in context with existing literature on the subject, providing updated guidance on how local caregivers and multidisciplinary teams can effectively implement and manage NT-proBNP-based early detection of heart failure risk in people with diabetes at a national level. Country-specific implementation efforts must consider multiple parameters for any early detection program, including: 1) The patient pathway; 2) The availability of resources; 3) The educational needs of clinicians; and 4) Cost-effectiveness. A multipronged approach with a clear pathway for evaluation, diagnosis, and treatment is therefore required to facilitate the implementation of NT-proBNP programs for early heart failure detection on a global level. This review discusses the approaches proposed in different countries, fine-tuning the population in scope and the thresholds for biomarker interpretation and subsequent action, to achieve sustainable programs for early heart failure identification and management.
This study aimed to explore perceptions of the potential implementation of osteoporosis screening among stakeholders, including service recipients, physicians, and policymakers, in Hong Kong. This qualitative study involved one-on-one, in-depth interviews with key stakeholders relevant to osteoporosis screening in Hong Kong. Interviews explored perceptions of the feasibility and implementation of osteoporosis screening. The updated Consolidated Framework for Implementation Research (CFIR) was employed to guide the development of the interview guide and data analysis, focusing on five domains: Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process. A total of 35 participants were included, comprising 12 service recipients, 19 physicians, and 4 policymakers. Within the Innovation domain, the relative advantages of osteoporosis screening were widely recognized by service recipients and physicians, its evidence-based nature was emphasized by physicians. However, policymakers and some physicians raised concerns about the absence of local evidence. In the Outer Setting, financial concerns were consistently identified across stakeholder groups, whereas subsidies and affordable access were viewed as key facilitators of implementation. Within the Inner Setting, service recipients and policymakers reported insufficient dissemination of information, while physicians highlighted the primary barriers related to resource constraints within the clinical setting. At the Individual level, risk awareness and motivation for disease management facilitated participation among service recipients, while policymakers highlighted insufficient awareness about screening and the disease as a barrier. In the Implementation Process domain, service recipients emphasized community-based promotion, physicians highlighted the importance of multi-stakeholder collaboration and professional education, and policymakers identified limited coordination, unclear referral pathways, and difficulties in reaching vulnerable populations as barriers. This study identified perceived facilitators and barriers to implementing osteoporosis screening in Hong Kong, with the absence of local evidence, financial concerns, resource constraints, and low public awareness as major challenges despite recognized benefits. Overcoming these requires coordinated efforts across sectors, including policy support, public–private partnerships, and culturally tailored education to enhance access and participation. Future research should build on these findings to develop context-specific implementation strategies for osteoporosis screening in Hong Kong. Not applicable.
Internal medicine (IM) education in resource-limited hospitals is constrained by heavy workloads and imaging limited to plain radiography. Point-of-care ultrasound (POCUS) supports experiential learning and diagnostic reasoning, yet no rounds-integrated IM curricula have been described in Latin America, and most programs stop short of practice-based bedside assessment. To implement and evaluate a rounds-integrated POCUS curriculum in a resource-limited IM setting. Hospital Nacional de Coatepeque (228-bed Guatemalan public hospital). Eight final-year medical students without formal ultrasound training. The curriculum combined flipped-classroom prework, a 2-day course focused on pleural and abdominal fluid detection, and a 2-month longitudinal program embedding POCUS into daily rounds, with Butterfly Cloud portfolio review, WhatsApp-based feedback, and designation of three learners as local “champions” in a train-the-trainer model. Knowledge and confidence gains largely persisted at 2 months. Hands-on performance was strongest for pelvic/bladder view acquisition, artifact recognition, and image optimization, and lowest for spine sign recognition and probe orientation and manipulation. Barriers included probe scarcity and limited institutional support; champions emerged as key drivers of peer learning. Rounds-integrated POCUS training is feasible in resource-limited settings and may support early skill development when paired with longitudinal mentorship and local champion development.
The fellowship application process represents a critical step in the pathway to a subspecialty career for internal medicine residents. Understanding applicant factors associated with successful entry into fellowship can inform application strategies and fellowship selection processes. To investigate internal medicine resident applicant factors associated with successful entry into fellowship. Repeated cross-sectional study of all single-time applicants to the eight largest internal medicine subspecialties from 2008 to 2020 utilizing nationwide data. Applicants to cardiovascular disease, endocrinology, gastroenterology, hematology/oncology, infectious disease, pulmonary/critical care medicine (PCCM), nephrology, and rheumatology. Applicant characteristics included demographics (age, sex, and underrepresented in medicine [URiM] status), publication count, chief resident status, graduate degree, medical school setting (Doctor of Medicine, Doctor of Osteopathy [DO], and International Medical Graduate [IMG]), and residency program setting/size. Applicants were defined as successful if they applied to fellowship and were subsequently documented as fellows in that subspecialty the next year. Out of 38,179 applicants, 32,091 (84.1
Deprescribing effectively reduces overprescribing but remains underused in clinical practice. Education is key to improving uptake, yet limited research has examined how future healthcare professionals are being prepared. To evaluate the extent to which current education prepares future Belgian healthcare professionals for deprescribing and to identify factors associated with higher self-perceived competency. Cross-sectional online survey between April and June 2024. Undergraduate and postgraduate students in medicine, pharmacy, and nursing from Belgian universities and nursing schools. Self-perceived competencies (7 items), knowledge and skills (19 items) were assessed using items from Farrell’s framework, and attitudes were measured using 25 items from a Theoretical Domains Framework-based questionnaire. Data were analyzed using descriptive statistics and linear regressions, with composite competency scores as outcomes and curriculum level, clinical experience, and deprescribing exposure as predictors. Open-ended responses were thematically coded. A total of 1777 responses were included (509 in medicine, 792 in pharmacy, and 476 in nursing). Exposure to deprescribing within the curriculum was common in medicine and pharmacy but rare in nursing. Among medicine and pharmacy students, greater self-reported exposure to deprescribing and more advanced academic level were significantly associated with higher self-perceived competency scores (p < 0.001). Across all groups, students reported higher confidence in the early steps of the deprescribing process and lower confidence in assessing the deprescribing potential of individual medications and implementing deprescribing plans. Attitudes were generally positive, with strong intentions to deprescribe, perceived benefits, and alignment with professional identity. Barriers included patient reluctance, competing priorities, and time constraints. Students recommended more practical and interprofessional education, introduced earlier and more broadly in the curriculum. Findings highlight encouraging self-reported competencies and reveal opportunities to strengthen deprescribing education, particularly in nursing programs, with greater emphasis on the later stages of the deprescribing process.
Understanding the clinical, self-management, and resource needs of low-income, multilingual, racially and ethnically diverse safety-net patients with hypertension can guide interventions to improve outcomes in under-resourced communities. Explore barriers and contributors to equitable hypertension care. We conducted semi-structured virtual focus groups during April 2022 to April 2023. Los Angeles safety-net patients with hypertension (or their caregivers) self-identifying as Latino, Black/African American, Filipino, Korean, and Chinese were eligible; these groups had the lowest blood pressure control rates within a large public safety-net healthcare system. We analyzed transcripts using reflexive thematic analysis. Nine focus groups (43 hypertensive participants) across 5 racial/ethnic groups and 5 languages included three Latino (n = 13), two Black (n = 11), two Chinese (n = 12), one Filipino (n = 4), and one Korean (n = 3) groups. Most patients (70
Graduate medical education (GME) on social drivers of health (SDOH) is critical to prepare residents in providing comprehensive clinical care but is usually delivered as standalone teaching on health equity. To examine faculty educators’ preparedness to integrate SDOH into core didactics of the residency curriculum, identify barriers, test the effect of brief tailored interventions on faculty’s willingness to incorporate SDOH into teaching, and capture resident perspectives on SDOH education. This mixed-methods educational research was conducted from 5/2024 to 5/2025 in an Internal Medicine residency program, and consisted of a qualitative needs assessment, a tailored faculty development intervention, and quantitative evaluation of faculty and learner outcomes. Content expert faculty joined pre-didactic interviews and focus groups to discuss knowledge, comfort, and barriers to incorporating SDOH, which were addressed with brief tailored interventions. Thematic analyses of transcripts were performed. Post-didactic faculty surveys assessed incorporation of SDOH. Residents completed pre- and post-curriculum surveys evaluating impact. Twenty-eight faculty experts across multiple subspecialties participated. Five themes emerged: uncertainty about integration, conflation of race with SDOH, discomfort defining race, limited awareness of SDOH literature, and effective attention to SDOH-integrated patientcare. Tailored interventions prompted engagement and provided feasible teaching approaches. Most (26/28) faculty experts subsequently incorporated SDOH into lectures, citing improved knowledge about SDOH. Among 157 residents, 46
Limited research documents feasibility of deploying health coaches to extend primary care into medically underserved neighborhoods. To assess early experience implementing the Neighborhood Health Hub Model, an innovative, person-centered, place-based, neighborhood-level approach for providing convenient access to essential preventive services. Memphis/Shelby County, Tennessee Adults seeking care from January 2022–June 2024 at Neighborhood Health Hub facilities. Hubs are staffed by lay health coaches recruited from the community, trained in motivational interviewing, and supervised by a telehealth-connected health professional. Services include: 1) screening for obesity, hypertension, diabetes, and social determinants; 2) individual/group health coaching for chronic disease management; 3) referrals for medical, behavioral, and social needs. A total of 1,252 clients were served, 1,151 received health coaching, and 383 (31
Patients at high-risk for hospitalization require care coordination across their multiple conditions. Few studies, however, document performance of specific care coordination activities that together comprise care coordination for these patients. To evaluate whether and how five geographically diverse primary care intensive management teams delivered care coordination to high-risk patients, and to assess the construct validity of the Agency for Healthcare Research and Quality (AHRQ) care coordination framework for identifying and categorizing the identified care coordination elements. Participants included 29 primary care intensive management team members and 51 patients from five demonstration sites in five different states. Primary qualitative content analysis of semi-structured interviews from the Patient Aligned Care Team (PACT) Intensive Management (PIM) national Veterans Health Administration (VHA) demonstration project evaluation identified activities meeting a broad definition of care coordination. We conducted a secondary qualitative analysis of interviews containing care coordination content to test whether the identified activities could be categorized based on the AHRQ framework. Qualitative data validated the importance of all nine AHRQ domains as critical components of the care PIM delivered, with six of the nine AHRQ domains garnering mention by interviewees at each of the five sites. No activities proved challenging to classify into one of the nine AHRQ care coordination domains. PIM teams and their patients identified a wide variety of activities that could be classified as related to care coordination. Further secondary qualitative evaluation showed that the AHRQ framework successfully identified and classified the key activities that intensive management teams and their patients considered to be critical advantages of intensive primary care management of high-risk patients.
Inter-visit care (IVC), including test result management and asynchronous patient communication, is a growing component of ambulatory practice. Despite its clinical importance, IVC is inconsistently taught, supervised, and assessed in residency programs. Prior interventions address either educational or structural aspects of IVC in isolation, limiting understanding of how integrated approaches support both learning and patient care. To evaluate the educational and clinical impact of an integrated curricular and structural intervention to improve IVC practices in an internal medicine residency clinic. Multimethod evaluation using a retrospective pre-post survey of educational outcomes and chart review of matched resident cohorts before and after implementation for patient communication outcomes. Thirty-two internal medicine residents in an academic continuity clinic during the 2023–2024 academic year. A combined intervention consisting of (1) a firm-based inbox coverage system to ensure continuity of test result follow-up and supervision and (2) a longitudinal IVC curriculum addressing electronic health record efficiency, clinical reasoning in inter-visit decision-making, and professional responsibility. Educational sessions were aligned with clinical supervision through shared faculty oversight and inbox office hours. The primary educational outcome was residents’ self-reported confidence in IVC-related skills. Clinical outcomes included clinic-level and resident-level rates and timeliness of test result communication before and after the intervention. Survey results showed improvements in residents’ perceived confidence across IVC skill domains. Clinic-wide, the proportion of test results communicated increased from 57 to 76
Teach-back has been identified as a high-quality clinical communication strategy. Our aim was to synthesize current literature on teach-back effectiveness. We searched MEDLINE, Embase, and CINAHL Complete databases to identify relevant studies published between 2018 and 2026. We also included pre-2018 studies identified in prior systematic reviews. Studies were eligible for inclusion if they involved adult patients and/or care partners, delivered teach-back in a single encounter, had a comparator group, and reported proximal/intermediate patient outcomes (as defined in our conceptual model). Two independent investigators screened each citation at the title/abstract and full-text levels and assessed risk of bias. Study characteristics and results were extracted. When meta-analysis was performed, we used standardized mean differences (SMD) to estimate summary effects. We assessed certainty of evidence (COE) using Grading of Recommendations Assessment, Development and Evaluation (GRADE) domains. Our systematic review included 18 randomized controlled trials (RCTs) involving 1985 participants. Across 9 RCTs assessing knowledge acquisition, conceptual inconsistencies precluded meta-analysis. Overall, there was no clear pattern of the effect of teach-back on knowledge (very low COE). In a meta-analysis of 5 RCTs assessing self-efficacy (416 participants), we found that teach-back interventions led to a large increase in self-efficacy relative to usual care (SMD = 2.40; 95
Heart failure (HF) is a leading cause of hospitalization and death for older Americans, with an approximately 50
Code status discussions (CSDs) are essential in clinical practice yet training modalities are often resource-intensive and not widely available. To evaluate whether artificial intelligence (AI)-driven simulation can enhance CSD training. A public safety-net hospital affiliated with an academic medical center. Postgraduate year (PGY)-2 and PGY-3 internal medicine residents. Residents attended a lecture on effective CSDs. Post-randomization, intervention residents completed 1 h of supervised CSD practice with ChatMD, a novel AI chatbot, with faculty debriefing, followed by 1 h of independent practice. Controls continued with usual clinical training. Eight weeks (SD ± 2 weeks) later, enrolled residents completed a blinded standardized-patient encounter graded on a modified, validated checklist. Thirty-one of 41 eligible residents enrolled; 25 completed the study. Intervention residents scored higher than controls on overall CSD performance (72.5
