INTRODUCTION

The hospitalist movement was born in the mid-1990s in response to cost pressures on hospitals, time constraints on primary care physicians, and ambition for improved clinical outcomes. A group of internal medicine physicians honed new skills to care for acutely ill patients and navigate the inpatient arena, forging a path as quality improvement and patient safety experts, paving the way for both pediatric and adult hospitalists. Three decades later, hospitalists face a similar inflection point. Aging population growth, hospital capacity constraints, staffing shortages, and rising health care costs are incentivizing a shift in acute and transitional care to more cost-effective and patient-friendly settings, and catalyzing the development of programs that support patients in their homes.^1-3 Recent widespread telehealth adoption and digital innovations create potential opportunities for more cost-effective and scalable care models. This landscape is fertile ground for hospitalists to again lead a new chapter in health care delivery by expanding their practice into innovative, high-value care models.

In this perspective, we argue that given their expertise in management of acutely ill patients, complex care navigation and coordination of multispecialty care, hospitalists are primed to lead the way in advancing home-based acute and transitional care. Here, we outline the skills hospitalists must develop to be successful clinicians and leaders in the acute and transitional care of the future.

中文翻译：

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医院外的住院医师：为新的护理服务环境做好准备

介绍

住院医生运动诞生于 20 世纪 90 年代中期，是为了应对医院的成本压力、初级保健医生的时间限制以及改善临床结果的雄心。一群内科医生磨练了护理急症患者和驾驭住院领域的新技能，开辟了一条作为质量改进和患者安全专家的道路，为儿科和成人住院医生铺平了道路。三十年后，住院医生面临着类似的拐点。人口老龄化、医院容量限制、人员短缺和医疗费用上涨正在促使急性和过渡性护理转向更具成本效益和对患者友好的环境，并促进在家中支持患者的计划的发展。^1-3最近远程医疗的广泛采用和数字创新为更具成本效益和可扩展的护理模式创造了潜在机会。这一前景为住院医师提供了肥沃的土壤，让他们能够将实践扩展到创新的高价值护理模式，从而再次引领医疗保健服务的新篇章。

从这个角度来看，我们认为，鉴于住院医生在急症患者管理、复杂护理导航和多专科护理协调方面的专业知识，他们准备好在推进家庭急症和过渡护理方面发挥带头作用。在这里，我们概述了住院医师要成为未来急症和过渡护理领域成功的临床医生和领导者必须具备的技能。