Hospitals and homes

This issue looks at inpatient-level care at home, social determinants of health screening, contrast risks for kidneys, and more.

The idea that hospital-level care could be provided in patients' homes has been around for decades. Pilot projects have over the years shown that it can be a less costly, more comfortable way for lower-acuity patients to receive care. But the model never really caught on—until now, that is, as this month's main story reports. The article explains how payers, including CMS, are looking more seriously at the concept, in part because telemedicine has increased its feasibility. Clinicians involved in these early projects predict what a shift in care settings could mean for hospitalists.

Of course, such care requires a safe, comfortable home. Social determinants of health, like housing and food security, are an increasing focus of the health care system. A feature article in this issue looks at the role of hospitalists and hospitals in screening patients for these social needs, describing potential benefits and downsides.

Acute kidney injury (AKI) has been a concerning potential downside of contrast for years. An article gathers expert opinions, and the evidence, on whether to worry about AKI when ordering a scan. A sidebar to the story offers details on a method for detecting the complication when it does occur.

Speaking of detecting, alert critical care specialists were some of the first to figure out electronic cigarette or vaping product use-associated lung injury (EVALI) when it began causing hospitalizations last year. Our article tells the tale of the outbreak, from its beginnings as a mysterious flu-like illness striking young people to the identification of a likely culprit (vitamin E acetate in illicit vaping products) and publication of CDC guidance.

This month's Brief Case feature brings you the usual crop of unusual diagnoses, including pheochromocytoma, Kikuchi-Fujimoto disease, and more, in a group submission from the Medical College of Wisconsin, plus an individual case about polyendocrinopathy with lithium use from the University of Utah. Also check out this month's bonus online-only Brief Case from The Ohio State University Medical Center.

Stacey Butterfield