(Press-News.org) The use of medical consultations for surgical patients varied widely across hospitals, especially among patients without complications, in a study of Medicare beneficiaries undergoing colectomy (to remove all or part of their colon) or total hip replacement (THR).
Internists and medical subspecialists are frequently called on to assess surgical patients and to help manage their care. As payers move toward bundled payments, hospitals need to better understand variations in practice and resources used during patient care.
The authors examined hospital medical consultations for surgical patients, the factors that influenced their use and practice variation across hospitals. The study used Medicare claims data for 91,684 patients who underwent colectomy at 930 hospitals and 339,319 patients who had THR at 1,589 hospitals from 2007 through 2010.
More than half of the patients undergoing colectomy or THR (69 percent and 63 percent, respectively) had at least one medical consultation while hospitalized. The median number of consult visits was nine for colectomy patients and three for THR. Hospital variation in the use of medical consultations was greater for colectomy patients without complications (47 percent – 79 percent) vs. among those with complications (90 percent – 95 percent). Hospital variation was similar for THR (36 percent – 87 percent among patients without complications vs. 89 percent – 94 percent among those with complications). Nonteaching and for-profit hospitals had greater use of medical consultations for colectomy patients and larger hospitals had greater use of consultations for THR patients.
"Medical consultations are a common component of episodes of inpatient surgical care. Our findings of wide variation in medical consultation use – particularly among patients without complications – suggest that understanding when medical consultations provide value will be important as hospitals seek to increase their efficiency under bundled payments."
In a related commentary, Gulshan Sharma, M.D., M.P.H., of the University of Texas Medical Branch, Galveston, writes: "Over the past 20 years, the role of the medical consultant for surgical patients has transformed substantially, from consultant to comanager."
"While medical consultation has many anticipated benefits, there are downsides as well, including the potential for confusion when multiple opinions are sought; the challenge of decision making when multiple decision makers are included; lack of ownership when problem arises; and the costs associated with soliciting additional input," he continues.
"There is no one fit for all. Decisions on routine use of medical consultation for highly reimbursed procedures should be driven by institutional data on quality and cost," Sharma concludes.
INFORMATION:
Author: Lena M. Chen, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues.
JAMA Intern Med. Published online August 4, 2014. doi:10.1001/jamainternmed.2014.3376.
An author made a conflict of interest disclosure. This work was supported by funding from the National Institute of Aging and a University of Michigan MCubed grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
JAMA Intern Med. Published online August 4, 2014. doi:10.1001/jamainternmed.2014.1499.
Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Medical consultations for surgical patients examined amid payment changes
2014-08-04
ELSE PRESS RELEASES FROM THIS DATE:
Identifying kids, teens with kidney damage risk after first urinary tract infection
2014-08-04
Bottom Line: Children and adolescents with an abnormal kidney ultrasonography finding or with a combination of a fever of at least 102 degrees and infection with an organism other than E.coli appear to be at high risk for renal scarring with their first urinary tract infection (UTI).
Author: Nader Shaikh, M.D., of the Children's Hospital of Pittsburgh, and colleagues.
Background: UTIs are a common and potentially serious bacterial infection in young children. UTIs can lead to permanent renal scarring in up to 15 percent of cases in this population. Significant scarring ...
Study examines midlife hypertension, cognitive change over 20-year period
2014-08-04
Bottom Line: Hypertension in middle age (48 to 67 years) was associated with a greater, although still a modest, decline in cognition over a 20-year period compared with individuals who had normal blood pressure.
Author: Rebecca F. Gottesman, M.D., Ph.D., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues.
Background: Evidence suggests hypertension is a risk factor for cognitive change and dementia and midlife hypertension may be the stronger risk factor.
How the Study Was Conducted: Authors used the Atherosclerosis Risk in Communities ...
Higher chance of hospital death found in areas where emergency departments have closed
2014-08-04
In the first analysis of its kind, UC San Francisco research shows that emergency department closures can have a ripple effect on patient outcomes at nearby hospitals.
In a study of more than 16 million emergency admissions to California hospitals between 1999 and 2010, researchers found that patients who were admitted to facilities located in the vicinity of an emergency department (ED) that had recently closed experienced 5 percent higher odds of dying than patients admitted to hospitals that were not near a recently closed ED.
The odds of dying were even higher for ...
Poor people with diabetes up to 10 times likelier to lose a limb than wealthier patients
2014-08-04
It's no secret that poverty is bad for your health. Now a new UCLA study demonstrates that California diabetics who live in low-income neighborhoods are up to 10 times more likely to lose a toe, foot or leg than patients residing in more affluent areas of the state. Earlier diagnosis and proper treatment could prevent many of these amputations, the researchers say.
The study authors hope their findings, published in the August issue of Health Affairs, will motivate public agencies and medical providers to reach out to patients at risk of late intervention and inspire ...
Cost-saving effort in health care falls short of goals, study finds
2014-08-04
A pilot program intended to implement and test a cost-saving strategy for orthopedic procedures at hospitals in California failed to meet its goals, succumbing to recruitment challenges, regulatory uncertainty, administrative burden and concerns about financial risk, according to a new RAND Corporation study.
The outcome represents a disappointing effort to widely adopt bundled payments, a much-touted strategy that pays doctors and hospitals one fee for performing a procedure or caring for an illness. The strategy is seen as one of the most-promising ways to curb health ...
An embryonic cell's fate is sealed by the speed of a signal
2014-08-04
VIDEO:
To visualize cells' responses to the signals that ultimately lead them to choose a fate, the researchers engineered a protein involved in this response, Smad4, to glow. In response to...
Click here for more information.
When embryonic cells get the signal to specialize the call can come quickly. Or it can arrive slowly. Now, new research from Rockefeller University suggests the speed at which a cell in an embryo receives that signal has an unexpected influence on that ...
Scientists uncover combustion mechanism to better predict warming by wildfires
2014-08-04
Scientists have uncovered key attributes of so-called "brown carbon" from wildfires, airborne atmospheric particles that may have influenced current climate models that failed to take the material's warming effects into account. The work was described by a collaborative team of researchers from Los Alamos National Laboratory, Carnegie Mellon University and the University of Montana in the journal Nature Geosciences this week.
"Biomass burning and wildfires emit fine particulates that are toxic to humans and can warm or cool climate. While their toxicity is certain, their ...
Fires not slowing around Yellowknife
2014-08-04
Fires and the resultant smoke that comes from them are both just as widespread and heavy as they were in the month of July. Hundreds of fires dot the landscape and the Northwest Territories Live Fire map shows the extent of the wildfires and hot spots that have been reported. Fire danger around this area of the Northwest Territories remains in either the high or extreme range. On the live fire map, notated detections of new fires number in the dozens. These fires are ones having been detected within the last 24 hours. Residents of Yellowknife were witness to red lightning ...
'I cant figure out how to do this!'
2014-08-04
"Physics summer work, please help!!!," a post on Yahoo! Answers begins. "I cant figure out how to do this anywhere!!! Best answer awarded? Need help immediately!!!!!."
Most of the science and math queries on Yahoo! Answers resemble this one, although some are less hysterical. But they all make people who love science and teaching science cringe. It's not that they think the students are "cheating" by trying to google the answer, but rather that they know students who ask this kind of question are learning nothing and probably confirming a secret conviction that they're ...
Speedier diagnosis of diseases such as cancer likely thanks to new DNA analysis technique
2014-08-04
Researchers from McGill University and the Génome Québec Innovation Centre have achieved a technical breakthrough that should result in speedier diagnosis of cancer and various pre-natal conditions.
The key discovery, which is described online this week in the Proceedings of the National Academy of Sciences (PNAS), lies in a new tool developed by Professors Sabrina Leslie and Walter Reisner of McGill's Physics Department and their collaborator Dr. Rob Sladek of the Génome Québec Innovation Centre. It allows researchers to load long strands of DNA into a tunable nanoscale ...