Curbside consultations. A closer look at a common practice

Manian, Farrin A.; Janssen, David A.

doi:10.1001/jama.275.2.145

Cited by 47 publications

(38 citation statements)

References 3 publications

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“…An evaluation of the potential revenue lost to curbside consultations by a gastroenterology group suggested that a 0.2% full-time physician equivalent could have been supported [22]. Informal consultations have been referred to as the "invisible" part of patient care management [4,20,26]. They are not recognized by health care organizations and therefore are not credited to the specialist's work effort [20].…”

Section: Discussionmentioning

confidence: 99%

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The Complexity, Relative Value, and Financial Worth of Curbside Consultations in an Academic Infectious Diseases Unit

et al. 2010

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Section: Discussionmentioning

confidence: 99%

“…They are commonly requested of infectious diseases specialists both in private and academic practice [4][5][6][7]. Although textbooks and literature searches are available to the provider to answer questions, providers are more likely to use informal consultations with a specialist to answer their questions [8][9][10].…”

mentioning

confidence: 99%

The Complexity, Relative Value, and Financial Worth of Curbside Consultations in an Academic Infectious Diseases Unit

et al. 2010

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“…It is likely that the shared experience of patient care in local communities, through formal educational exposure, referrals for testing or informal "curbside" consultations, 22 influences the overall care of the population with coronary artery disease. Multispecialty meetings, such as grand rounds or morbidity and mortality reports, engender cross-specialty learning.…”

Section: Discussionmentioning

confidence: 99%

Do Physicians Do What They Say?: The Inclination to Test and Its Association with Coronary Angiography Rates

Wennberg

Dickens

Biener³

et al. 1997

J GEN INTERN MED

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OBJECTIVE: Efforts to evaluate variations in cardiac procedures have focused on patient factors and differences in health care delivery systems. We wanted to assess how physicians' inclination to test patients with coronary artery disease influences utilization patterns. SETTING AND SUBJECTS:Physicians and the populations of Maine, New Hampshire, and Vermont. DESIGN:We conducted a survey of 263 family practitioners, internists, and cardiologists residing in 57 hospital service areas in Maine, New Hampshire, and Vermont. Using patient scenarios, we assessed the clinicians' inclinations to test during the evaluation of patients with coronary artery disease. Self-reported testing intensities were used to create three indices: a Catheterization Index, an Imaging Exercise Tolerance Test (ETT) Index, and a Nonimaging ETT Index. Using administrative data, age-and gender-adjusted populationbased coronary angiography rates were calculated. Physicians were assigned to low (2.9/1,000), average (4.2/1,000), and high (5.8/1,000) coronary angiography rate areas, based on where they practice. Analysis of variance techniques were used to assess the relation of the index scores to the population-based coronary angiography rates and to physician specialties. RESULTS:There was a positive relationship between the population-based coronary angiography rates and the self-reported scores of the Catheterization Index (p Ͻ .005) and the Imaging ETT Index (p ‫؍‬ .01), but none was found for the Nonimaging ETT Index (p ‫؍‬ .10). These relationships were evident in subanalyses of cardiologists and internists, but not of family practitioners. CONCLUSIONS: Self-reported testing intensity by physicians is related to the population-based rates of coronary angiography. This relationship cuts across specialties, suggesting that there is a "medical signature" for the evaluation of patients with coronary artery disease. fforts to explain the observed variation in cardiac procedures 1,2 have focused on numerous components of care. Patient factors, such as race and gender, 3-5 and health care delivery system factors, such as insurance status and characteristics of the hospital, 6-8 have been found to play a role. Less attention has been placed on how the decisions physicians make in the evaluation of patients with coronary artery disease influence utilization patterns. Recent studies, using standardized clinical scenarios, revealed differences in how physicians would treat patients with coronary artery disease. 9,10 However, there was no assessment of the relationship between the clinician's answers to these scenarios and actual practice.We surveyed family practitioners, internists, and cardiologists in Maine, New Hampshire, and Vermont to assess their inclination to test patients with chest pain and coronary artery disease. The association between their responses and the population-based utilization rates of coronary angiography was measured in order to answer two questions. Given a standardized clinical scenario, is there a relationship between cl...

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“…4 Interestingly the subspecialists most commonly consulted were not dermatologists but cardiologists, gastroenterologists, and infectious disease specialists. [5][6][7][8][9] Curbside consultations have become even more common with the advent of e-mail. In dermatology, it has become routine for a primary care physician to send a photographic attachment of the clinical problem to the dermatologist when seeking a second informal opinion.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 We advocate rendering an opinion to a colleague as a professional and collegial courtesy if the consult is brief and without complexity or confounding factors. If the case has a detailed history or requires physical examination, we recommend that the approached consultant offer to see the patient formally in their office expeditiously so that they can better assist their friend and colleague in the care of this patient.…”

Section: Analysis Of Case Scenariomentioning

confidence: 99%