Publish, publish, publish: Success within the academic and research environment is crucial to being viewed as equal among subspecialties.
Perceptions of our field improve with each paper published in Pediatrics and the Journal of Hospital Medicine and each plenary presentation at a national meeting. Within our professional community, writing articles for The Hospitalist and the AAP Section on Hospital Medicine newsletter and presenting our work in poster form or hospitalist platform presentation advances knowledge and creates group identity.
Additionally, these activities promote the pediatric HM group and the authors. Some of us have made a career out of LISTSERV postings.
Continue to grow PRIS: We must all contribute to the growth of PRIS over the next decade.
Ultimately, PRIS promises to answer clinical questions faced by hospitalists the same way the Vermont Oxford Network helps neonatology and the Pediatric Emergency Care Applied Research Network helps pediatric emergency medicine. Academic hospitalists can use PRIS to pursue their research interests. Community hospitalists can pick and choose from available projects to identify a study relevant and suitable for them. We all must participate.
My hope is that in 10 to 20 years PRIS will coordinate randomized, controlled clinical trials and universal, integrated, HIPPA-compliant, electronic medical record systems that facilitate real-time analysis of outcomes and practice variation.
Own our diseases: Defining The Core Competencies in Hospital Medicine: A Framework for Curriculum Development, creating a research base, and publishing must lead to the recognition of pediatric hospitalists as the experts for a core set of illnesses.
Potential starting points include bronchiolitis, the ruling out of sepsis in less than 30 days, apparent life-threatening events (ALTE), and the medically complex/technologically dependent child. We’ll know we’ve hit it big when the nationally recognized speakers and authors on these topics identify themselves as hospitalists rather than infectious disease physicians or pulmonologists. For this to occur, hospitalists must participate in research efforts, speak at regional and national meetings, and participate on national consensus panels.
On a purely local program level, individual physicians within a hospital medicine group should cultivate areas of clinical, administrative, and educational expertise. This is particularly valuable in community hospital settings where pediatric infectious disease or pulmonary specialists may not be available—but is equally important to career development in larger academic centers where hospitalists are ideal for quality improvement, safety, and educational roles.
Identify and publicly report national benchmarks: Our adult colleagues suffer and benefit from the public reporting mandated by the Centers for Medicare and Medicaid Services. One hopes the adult tribulations with data collection, attribution, and risk adjustment will make pediatric public reporting easier.
The wide variation in management of ALTE, osteomyelitis, and complicated pneumonias documented by Pediatric Health Information System researchers at the Toronto Pediatric Academic Societies meetings is a clarion call for evidence-based medicine. Parents have a right to make an informed choice about where and how their child is treated based on reliable data. Rational expenditure of limited State Children’s Health Insurance Program (SCHIP) funds requires practicing evidence-based medicine
Pediatric quality measures and standards are being developed through the National Quality Forum as well as the Alliance for Pediatric Quality. This movement will significantly affect pediatric HM. On the positive side, reporting will require that more resources be devoted to pediatric quality improvement (QI) efforts. Pediatric hospitalists are ideally suited to lead inpatient QI efforts. Creation of a hospitalist physician specialty identification code will facilitate comparison of hospitalist with non-hospitalist care in large multicenter data sets. These studies will be key descriptors of the cost and quality outcomes of pediatric HM programs.