Observational studyJournal of general internal medicine2015
Variation in Inpatient Consultation Among Older Adults in the United States.
Observational study in Journal of general internal medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed.
- Investigation of Consultations Requested by Dermatology Inpatient.Clinical, cosmetic and investigational dermatology · 2025Article
- Validation of Quality Assessment Measures for Inpatient Gastroenterology Consults on Oncologic Patients in Non-teaching Services at a Cancer Center: A Cross-Sectional Study.Digestive diseases and sciences · 2024Article
- Factors Associated With Inpatient Subspecialty Consultation Patterns Among Pediatric Hospitalists.JAMA network open · 2023Article
- Inpatient Gastroenterology Consultation and Outcomes of Cirrhosis-Related Hospitalizations in Two Large National Cohorts.Digestive diseases and sciences · 2022Article
- An Electronic Communication Workflow Optimization for Inpatient Specialist Consultation at an Academic Health Care System.Applied clinical informatics · 2022Article
- Patient and Clinician Perceptions of Factors Relevant to Ideal Specialty Consultations.JAMA network open · 2022Article
- Opportunities to improve the quality of inpatient consultation: one hospital's investigation but an age old struggle.Israel journal of health policy research · 2022Article
- Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan.International journal for equity in health · 2021Article
- Article
- Describing Variability of Inpatient Consultation Practices: Physician, Patient, and Admission Factors.Journal of hospital medicine · 2020Article
- Association of Variation in Consultant Use Among Hospitalist Physicians With Outcomes Among Medicare Beneficiaries.JAMA network open · 2020Article
- Enhancing the Inpatient Consultation Learning Environment to Optimize Teaching and Learning.Rheumatic diseases clinics of North America · 2020Review
- Association of Medicare Spending With Subspecialty Consultation for Elderly Hospitalized Adults.JAMA network open · 2019Article
- Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists.JAMA internal medicine · 2017Article
- Communication Skills Training for Physicians Improves Patient Satisfaction.Journal of general internal medicine · 2016Observational
- Capsule Commentary on Stevens et al., Variation in Inpatient Consultation Among Older Adults in the United States.Journal of general internal medicine · 2016Article
- ICUs after surgery, mortality, and the Will Rogers effect.Intensive care medicine · 2015Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDifferences among hospitals in the use of inpatient consultation may contribute to variation in outcomes and costs for hospitalized patients, but basic epidemiologic data on consultations nationally are lacking.
objectiveThe purpose of the study was to identify physician, hospital, and geographic factors that explain variation in rates of inpatient consultation.
designThis was a retrospective observational study. SETTING AND
participantsThis work included 3,118,080 admissions of Medicare patients to 4,501 U.S. hospitals in 2009 and 2010. MAIN MEASURES: The primary outcome measured was number of consultations conducted during the hospitalization, summarized at the hospital level as the number of consultations per 1,000 Medicare admissions, or "consultation density." KEY
resultsConsultations occurred 2.6 times per admission on average. Among non-critical access hospitals, use of consultation varied 3.6-fold across quintiles of hospitals (933 versus 3,390 consultations per 1,000 admissions, lowest versus highest quintiles, p < 0.001). Sicker patients received greater intensity of consultation (rate ratio [RR] 1.18, 95% CI 1.17-1.18 for patients admitted to ICU; and RR 1.19, 95% CI 1.18-1.20 for patients who died). However, even after controlling for patient-level factors, hospital characteristics also predicted differences in rates of consultation. For example, hospital size (large versus small, RR 1.31, 95% CI 1.25-1.37), rural location (rural versus urban, RR 0.78, CI 95% 0.76-0.80), ownership status (public versus not-for-profit, RR 0.94, 95% CI 0.91-0.97), and geographic quadrant (Northeast versus West, RR 1.17, 95% CI 1.12-1.21) all influenced the intensity of consultation use.
conclusionsHospitals exhibit marked variation in the number of consultations per admission in ways not fully explained by patient characteristics. Hospital "consultation density" may constitute an important focus for monitoring resource use for hospitals or health systems.
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