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  1. Article ; Online: Hospitalists outside the hospital: Preparing for new settings of care delivery.

    Judson, Timothy J / Longhurst, Christopher A / Horman, Sarah F

    Journal of hospital medicine

    2024  

    Language English
    Publishing date 2024-03-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.1002/jhm.13323
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  2. Article ; Online: Finding the time: Hourly variation in average daily census on a hospital medicine service.

    Pierce, Logan / Judson, Timothy J / Mourad, Michelle

    Journal of hospital medicine

    2023  Volume 19, Issue 2, Page(s) 108–111

    Abstract: Monitoring the average daily census (ADC) is crucial for managing patient flow and allocating resources. This study analyzed hourly fluctuations in the ADC on a hospital medicine service at an academic medical center. Data from 8342 encounters and 6178 ... ...

    Abstract Monitoring the average daily census (ADC) is crucial for managing patient flow and allocating resources. This study analyzed hourly fluctuations in the ADC on a hospital medicine service at an academic medical center. Data from 8342 encounters and 6178 unique patients were collected over a year. The ADC peaked at 11 a.m. (164.1 patients/day) and was lowest at 7 p.m. (155.0 patients/day), accounting for a variation of up to 9.1 patients (5.5% of peak census) depending on the time of day the measurement was taken. Understanding how ADC changes throughout the day will help hospital medicine programs to partner with administrators to optimize resource allocation and staffing. Measuring ADC at midnight, as traditionally done, may underestimate workload and therefore contribute to staffing shortages and physician burnout. Hospitals should consider measuring ADC at its peak, between 7 a.m. and 11 a.m., to ensure adequate staffing and high-quality patient care.
    MeSH term(s) Humans ; Hospital Medicine ; Censuses ; Workload ; Hospitals ; Workforce ; Personnel Staffing and Scheduling
    Language English
    Publishing date 2023-11-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.1002/jhm.13233
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  3. Article ; Online: Building a Targeted Automatic e-Consult (TACo) Program.

    Judson, Timothy J / Mourad, Michelle / Wachter, Robert M

    Joint Commission journal on quality and patient safety

    2021  Volume 48, Issue 2, Page(s) 114–119

    Abstract: Driving forces: Traditional specialty consults are resource intensive and may be delayed or omitted if the treating physician does not recognize the need for specialty advice. Targeted automatic e-consults (TACos) address these limitations by ... ...

    Abstract Driving forces: Traditional specialty consults are resource intensive and may be delayed or omitted if the treating physician does not recognize the need for specialty advice. Targeted automatic e-consults (TACos) address these limitations by prospectively identifying patients using the electronic health record (EHR) and presenting pertinent information on a dashboard, enabling consultants to provide a virtual consult with written recommendations. The TACo model may improve value by facilitating more expert input without a proportional increase in cost.
    Building a taco: Through our experience developing a TACo program, we have identified four key steps. First, identify appropriate conditions that have support from the health system and from frontline clinicians. Second, design the digital infrastructure, including lists and dashboards. Third, create a funding plan to support the consultant's time, either through internal grants, external grants, e-consult billing codes, or some combination of the three. Fourth, pilot on a select number of services, iterate, and scale.
    Challenges: Funding for TACos has been a major barrier to adoption. Fortunately, new e-consult billing codes may make it possible to recoup as least part of the program's cost. Technological hurdles also exist, particularly in building real-time lists within the EHR to prospectively identify patients based on complex criteria.
    Next steps: We look for this model to gain popularity as evidence of clinical and operational benefit mounts. We anticipate reimbursement policies may be updated to support this type of consult. Finally, we expect machine learning to play a role in identifying patients and providing recommendations in the future.
    MeSH term(s) Electronic Health Records ; Humans ; Referral and Consultation
    Language English
    Publishing date 2021-10-30
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1189890-2
    ISSN 1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
    ISSN (online) 1938-131X ; 1549-425X
    ISSN 1553-7250 ; 1070-3241 ; 1549-3741
    DOI 10.1016/j.jcjq.2021.10.007
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  4. Article ; Online: The Decline of Comprehensiveness and the Path to Restoring It.

    Judson, Timothy J / Press, Matthew J / Detsky, Allan S

    Journal of general internal medicine

    2019  Volume 35, Issue 5, Page(s) 1582–1583

    MeSH term(s) Comprehensive Health Care ; Humans
    Language English
    Publishing date 2019-10-24
    Publishing country United States
    Document type Editorial
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-019-05357-0
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  5. Article ; Online: Reimagining Specialty Consultation in the Digital Age: The Potential Role of Targeted Automatic Electronic Consultations.

    Wachter, Robert M / Judson, Timothy J / Mourad, Michelle

    JAMA

    2019  Volume 322, Issue 5, Page(s) 399–400

    Language English
    Publishing date 2019-06-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2019.6607
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  6. Article ; Online: Patient Perceptions of e-Visits: Qualitative Study of Older Adults to Inform Health System Implementation.

    Judson, Timothy J / Subash, Meera / Harrison, James D / Yeager, Jan / Williams, Aimée M / Grouse, Carrie K / Byron, Maria

    JMIR aging

    2023  Volume 6, Page(s) e45641

    Abstract: Background: Electronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations ... ...

    Abstract Background: Electronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations may worsen health disparities. To date, no study has attempted to qualitatively assess perceptions of e-visits in older adults.
    Objective: In this qualitative study, we aimed to understand patient perceptions of e-visits, including their perceived utility, barriers to use, and care implications, with a focus on vulnerable patient groups.
    Methods: We conducted a qualitative study using in-depth structured individual interviews with patients from diverse backgrounds to assess their knowledge and perceptions surrounding e-visits as compared with unbilled portal messages and other visit types. We used content analysis to analyze interview data.
    Results: We conducted 20 interviews, all in adults older than 65 years. We identified 4 overarching coding categories or themes. First, participants were generally accepting of the concept of e-visits and willing to try them. Second, nearly two-thirds of the participants voiced a preference for synchronous communication. Third, participants had specific concerns about the name "e-visit" and when to choose this type of visit in the patient portal. Fourth, some participants indicated discomfort using or accessing technology for e-visits. Financial barriers to the use of e-visits was not a common theme.
    Conclusions: Our findings suggest that older adults are generally accepting of the concept of e-visits, but uptake may be limited due to their preference for synchronous communication. We identified several opportunities to improve e-visit implementation.
    Language English
    Publishing date 2023-05-26
    Publishing country Canada
    Document type Journal Article
    ISSN 2561-7605
    ISSN (online) 2561-7605
    DOI 10.2196/45641
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  7. Article ; Online: Evaluation of technologies approved for supplemental payments in the United States.

    Judson, Timothy J / Dhruva, Sanket S / Redberg, Rita F

    BMJ (Clinical research ed.)

    2019  Volume 365, Page(s) l2190

    MeSH term(s) Centers for Medicare and Medicaid Services, U.S./economics ; Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence ; Health Expenditures ; Humans ; Insurance Coverage/economics ; Medicare/economics ; Quality Assurance, Health Care ; Social Security/economics ; Technology Assessment, Biomedical ; United States
    Language English
    Publishing date 2019-06-17
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.l2190
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  8. Article: Using near-surface temperature data to vicariously calibrate high-resolution thermal infrared imagery and estimate physical surface properties.

    Titus, Timothy N / Wynne, J Judson / Jhabvala, Murzy D / Cabrol, Nathalie A

    MethodsX

    2022  Volume 9, Page(s) 101644

    Abstract: Thermal response of the surface to solar insolation is a function of the topography and the thermal physical characteristics of the landscape, which include bulk density, heat capacity, thermal conductivity and surface albedo and emissivity. Thermal ... ...

    Abstract Thermal response of the surface to solar insolation is a function of the topography and the thermal physical characteristics of the landscape, which include bulk density, heat capacity, thermal conductivity and surface albedo and emissivity. Thermal imaging is routinely used to constrain thermal physical properties by characterizing or modeling changes in the diurnal temperature profiles. Images need to be acquired throughout the diurnal cycle - typically this is done twice during a diurnal cycle, but we suggest multiple times. Comparison of images acquired over 24 hours requires that either the data be calibrated to surface temperature, or the response of the thermal camera is linear and stable over the image acquisition period. Depending on the type and age of the thermal instrument, imagery may be self-calibrated in radiance, corrected for atmospheric effects, and pixels converted to surface temperature. We used an experimental instrumentation where the calibration should be stable, but calibration coefficients are unknown. Cases may occur where one wishes to validate the camera's calibration. We present a method to validate and calibrate the instrument and characterize the thermal physical properties for areas of interest. Finally, in situ high-temporal-resolution oblique thermal imaging can be invaluable in preparation for conducting overflight missions. We present the following:•The use of oblique thermal high temporal resolution thermal imaging over diurnal or multiday periods for the characterization of landscapes has not been widespread but poses great potential.•A method of collecting and analyzing thermal data that can be used to either determine or validate thermal camera calibration coefficients.•An approach to characterize thermophysical properties of the landscape using oblique temporally high-resolution thermal imaging, combined with in situ ground measurements.
    Language English
    Publishing date 2022-04-02
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2830212-6
    ISSN 2215-0161
    ISSN 2215-0161
    DOI 10.1016/j.mex.2022.101644
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  9. Article ; Online: Using near–surface temperature data to vicariously calibrate high-resolution thermal infrared imagery and estimate physical surface properties

    Timothy N. Titus / J. Judson Wynne / Murzy D. Jhabvala / Nathalie A. Cabrol

    MethodsX, Vol 9, Iss , Pp 101644- (2022)

    2022  

    Abstract: Thermal response of the surface to solar insolation is a function of the topography and the thermal physical characteristics of the landscape, which include bulk density, heat capacity, thermal conductivity and surface albedo and emissivity. Thermal ... ...

    Abstract Thermal response of the surface to solar insolation is a function of the topography and the thermal physical characteristics of the landscape, which include bulk density, heat capacity, thermal conductivity and surface albedo and emissivity. Thermal imaging is routinely used to constrain thermal physical properties by characterizing or modeling changes in the diurnal temperature profiles. Images need to be acquired throughout the diurnal cycle – typically this is done twice during a diurnal cycle, but we suggest multiple times. Comparison of images acquired over 24 hours requires that either the data be calibrated to surface temperature, or the response of the thermal camera is linear and stable over the image acquisition period. Depending on the type and age of the thermal instrument, imagery may be self-calibrated in radiance, corrected for atmospheric effects, and pixels converted to surface temperature. We used an experimental instrumentation where the calibration should be stable, but calibration coefficients are unknown. Cases may occur where one wishes to validate the camera's calibration. We present a method to validate and calibrate the instrument and characterize the thermal physical properties for areas of interest. Finally, in situ high-temporal-resolution oblique thermal imaging can be invaluable in preparation for conducting overflight missions. We present the following: • The use of oblique thermal high temporal resolution thermal imaging over diurnal or multiday periods for the characterization of landscapes has not been widespread but poses great potential. • A method of collecting and analyzing thermal data that can be used to either determine or validate thermal camera calibration coefficients. • An approach to characterize thermophysical properties of the landscape using oblique temporally high-resolution thermal imaging, combined with in situ ground measurements.
    Keywords Using nearsurface temperature data to vicariously calibrate high-resolutionthermal infrared imagery and estimate physical surface properties ; Science ; Q
    Subject code 670
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
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  10. Article ; Online: Reimagining the inpatient palliative care consult: lessons from COVID-19.

    Ganeshan, Smitha / Humphreys, Jessi / Judson, Timothy

    The American journal of managed care

    2021  Volume 27, Issue 7, Page(s) e215–e217

    Abstract: As the number of inpatients with advanced age and chronic conditions rises, so too does the need for inpatient palliative care (PC). Despite the strong evidence base for PC, less than 50% of all inpatient PC needs are met by inpatient consults. Over the ... ...

    Abstract As the number of inpatients with advanced age and chronic conditions rises, so too does the need for inpatient palliative care (PC). Despite the strong evidence base for PC, less than 50% of all inpatient PC needs are met by inpatient consults. Over the past several months in epicenters of the COVID-19 pandemic, PC providers have responded to the increased need for PC services through innovative digital programs including telepalliative care programs. In this article, we explore how PC innovations during COVID-19 could transform the PC consult to address workforce shortages and expand access to PC services during and beyond the pandemic. We propose a 3-pronged strategy of bolstering inpatient telepalliative care services, expanding electronic consults, and increasing training and educational tools for providers to help meet the increased need for PC services in the future.
    MeSH term(s) COVID-19/epidemiology ; COVID-19/therapy ; Humans ; Inpatients/statistics & numerical data ; Palliative Care/methods ; Patient Care Team/organization & administration ; Referral and Consultation/statistics & numerical data ; Telemedicine/methods
    Language English
    Publishing date 2021-07-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2035781-3
    ISSN 1936-2692 ; 1088-0224 ; 1096-1860
    ISSN (online) 1936-2692
    ISSN 1088-0224 ; 1096-1860
    DOI 10.37765/ajmc.2021.88704
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