Access the full text.
Sign up today, get DeepDyve free for 14 days.
L. Kleinman, E. Norton (2009)
What's the Risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression.Health services research, 44 1
D. Wijeysundera, W. Beattie, P. Austin, J. Hux, A. Laupacis (2010)
Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort studyThe BMJ, 340
A. Auerbach, Mladen Rasic, N. Sehgal, Brigid Ide, B. Stone, J. Maselli (2007)
Opportunity missed: medical consultation, resource use, and quality of care of patients undergoing major surgery.Archives of internal medicine, 167 21
V. Chopra, S. Flanders, J. Froehlich, W. Lau, K. Eagle (2010)
Perioperative Practice: Time to Throttle BackAnnals of Internal Medicine, 152
G. Sharma, Y. Kuo, J. Freeman, Dong Zhang, J. Goodwin (2010)
Comanagement of hospitalized surgical patients by medicine physicians in the United States.Archives of internal medicine, 170 4
J. Huddleston, K. Long, J. Naessens, D. Vanness, D. Larson, R. Trousdale, M. Plevak, M. Cabanela, D. Ilstrup, R. Wachter (2004)
Medical and Surgical Comanagement after Elective Hip and Knee ArthroplastyAnnals of Internal Medicine, 141
D. Wijeysundera, P. Austin, W. Beattie, J. Hux, A. Laupacis (2010)
Outcomes and processes of care related to preoperative medical consultation.Archives of internal medicine, 170 15
Meredith Ford, W. Beattie, D. Wijeysundera (2010)
Systematic Review: Prediction of Perioperative Cardiac Complications and Mortality by the Revised Cardiac Risk IndexAnnals of Internal Medicine, 152
S. Salerno, F. Hurst, Stephanie Halvorson, D. Mercado (2007)
Principles of effective consultation: an update for the 21st-century consultant.Archives of internal medicine, 167 3
Andrew Gonzalez, J. Dimick, J. Birkmeyer, A. Ghaferi (2014)
Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue.JAMA surgery, 149 2
M. Haymart, M. Banerjee, A. Stewart, R. Koenig, J. Birkmeyer, J. Griggs (2011)
Use of radioactive iodine for thyroid cancer.JAMA, 306 7
S. Cohn, G. Smetana (2004)
Update in Perioperative MedicineAnnals of Internal Medicine, 147
K. Hinami, J. Feinglass, Darlene Ferranti, Mark Williams (2011)
Potential role of comanagement in "rescue" of surgical patients.The American journal of managed care, 17 9
L. Iezzoni, J. Daley, T. Heeren, S. Foley, E. Fisher, C. Duncan, J. Hughes, G. Coffman (1994)
Identifying Complications of Care Using Administrative DataMedical Care, 32
Ariana Pichardo-Lowden, R. Gabbay (2012)
Management of Hyperglycemia During the Perioperative PeriodCurrent Diabetes Reports, 12
Kevin Chung, Melissa Shauver, H. Yin, H. Kim, O. Baser, J. Birkmeyer (2011)
Variations in the use of internal fixation for distal radial fracture in the United States medicare population.The Journal of bone and joint surgery. American volume, 93 23
A. Ghaferi, J. Birkmeyer, J. Dimick (2009)
Variation in hospital mortality associated with inpatient surgery.The New England journal of medicine, 361 14
S. Weingart, L. Iezzoni, R. Davis, R. Palmer, Michael Cahalane, M. Hamel, K. Mukamal, R. Phillips, Donald Davies, N. Banks (2000)
Use of administrative data to find substandard care: validation of the complications screening program.Medical care, 38 8
J. Birkmeyer, C. Gust, O. Baser, J. Dimick, J. Sutherland, J. Skinner (2010)
Medicare payments for common inpatient procedures: implications for episode-based payment bundling.Health services research, 45 6 Pt 1
Grace Lin, R. Dudley, F. Lucas, D. Malenka, E. Vittinghoff, R. Redberg (2008)
Frequency of stress testing to document ischemia prior to elective percutaneous coronary intervention.JAMA, 300 15
L. Goldman, T. Lee, P. Rudd (1983)
Ten commandments for effective consultations.Archives of internal medicine, 143 9
David Miller, C. Gust, J. Dimick, N. Birkmeyer, J. Skinner, J. Birkmeyer (2011)
Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs.Health affairs, 30 11
D. Wijeysundera, P. Austin, W. Beattie, J. Hux, A. Laupacis (2012)
Variation in the Practice of Preoperative Medical Consultation for Major Elective Noncardiac Surgery: A Population-based StudyAnesthesiology, 116
Thomas Lee, Edward Marcantonio, Carol Mangione, Eric Thomas, C. Polanczyk, E. Cook, D. Sugarbaker, Magruder Donaldson, R. Poss, Kalon Ho, Lynn Ludwig, Alex Pedan, L. Goldman (1999)
Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.Circulation, 100 10
T. Breslin, A. Morris, N. Gu, S. Wong, E. Finlayson, M. Banerjee, J. Birkmeyer (2009)
Hospital factors and racial disparities in mortality after surgery for breast and colon cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 27 24
ImportancePayments around episodes of inpatient surgery vary widely among hospitals. As payers move toward bundled payments, understanding sources of variation, including use of medical consultants, is important. ObjectiveTo describe the use of medical consultations for hospitalized surgical patients, factors associated with use, and practice variation across hospitals. Design, Setting, and ParticipantsObservational retrospective cohort study of fee-for-service Medicare patients undergoing colectomy or total hip replacement (THR) between January 1, 2007, and December 31, 2010, at US acute care hospitals. Main Outcomes and MeasuresNumber of inpatient medical consultations. ResultsMore than half of patients undergoing colectomy (91 684) or THR (339 319) received at least 1 medical consultation while hospitalized (69% and 63%, respectively). Median consultant visits from a medicine physician were 9 (interquartile range [IQR], 4-19) for colectomy and 3 for THR (IQR, 2-5). The likelihood of having at least 1 medical consultation varied widely among hospitals (interquartile range [IQR], 50%-91% for colectomy and 36%-90% for THR). For colectomy, settings associated with greater use included nonteaching (adjusted risk ratio [ARR], 1.14 [95% CI, 1.04-1.26]) and for-profit (ARR, 1.10 [95% CI, 1.01-1.20]). Variation in use of medical consultations was greater for colectomy patients without complications (IQR, 47%-79%) compared with those with complications (IQR, 90%-95%). Results stratified by complications were similar for THR. Conclusions and RelevanceThe use of medical consultations varied widely across hospitals, particularly for surgical patients without complications. Understanding the value of medical consultations will be important as hospitals prepare for bundled payments and strive to enhance efficiency.
JAMA Internal Medicine – American Medical Association
Published: Sep 1, 2014
Read and print from thousands of top scholarly journals.
Already have an account? Log in
Bookmark this article. You can see your Bookmarks on your DeepDyve Library.
To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one.
Copy and paste the desired citation format or use the link below to download a file formatted for EndNote
Access the full text.
Sign up today, get DeepDyve free for 14 days.
All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.