Research Inpatient consultation by specialists is the primary mechanism by which specialist care is provided to hospitalized patients. More than 90% of Medicare patients have at least one consultation. Despite the prevalence of this practice, there has been very little research into the process of consultation and its outcomes. Further, in previous research performed by the applicant among 3.1 million admissions to 4,501 hospitals, the scope of variation in inpatient consultation use across U.S. hospitals was substantial - there was nearly a 3.6-fold difference in consultation use across quintiles of hospitals. Research to understand and quantify the value of consultation to patients and providers would allow for a more rational approach to the use of consultation nationally and has the potential to affect the inpatient care of millions of patients. In this career development proposal, the objective of this proposal is to advance knowledge of inpatient consultation in three ways: by defining the characteristics of beneficial consultations from multiple perspectives, including those of patients and families; by investigating novel non-clinical factors that drive consultation for reasons other than patient or family need; and by quantifying the relationship between inpatient consultations and patient outcomes and costs. In the first phase of her research, the applicant proposes to engage patients and providers through a mixed-methods approach to identify characteristics of beneficial consultations (Aim 1). She will then propose and pilot-test markers of consultation benefit that are available in electronic data. In the second phase of her research, she will use two large secondary data sources, Medicare claims and the granular clinical and administrative data available through the Beth Israel Deaconess Medical Center. She will investigate novel non-clinical drivers of variation in the use of inpatient consultation, distinct from the clinical eed of patients (Aim 2). Finally, she will incorporate these drivers into models that quantify the impact of consultation on patient outcomes and costs (Aim 3). The successful completion of this research will significantly advance our understanding of how this nearly ubiquitous intervention affects patient-centered outcomes. Additionally, this proposal will lead to future interventions to moderate consultation over-use. Candidate The applicant's long-term career goal is to become an independent patient-centered outcomes researcher focused on quantifying and improving health care delivery to acutely ill and hospitalized patients. She has extensive experience prior to this proposal with a range of research methods, including expertise using highly granular clinical and administrative data. In order to achieve her long-term goal, she has the following career objectives: to obtain additional didactic training in qualitative methods, econometrics and propensity scores, and hierarchical modeling; to obtain practical skills in clinical trial development and management of a research team; to develop a collaborative network of patients, families, and investigators; and to transition to independence in the next 5 years. This will be accomplished through coursework at Harvard School of Public Health, Harvard Kennedy School, the Research Data Assistance Center (ResDAC), and Harvard Catalyst (CTSA); close collaboration with a multidisciplinary, multistakeholder advisory and mentorship panel; attendance at national and institutional conferences; and the completion of the research proposal described above with a wide array of methods. This will result in her development as a critical care physician armed with highly sophisticated quantitative and qualitative methods and ready to achieve independence from her mentorship team. Environment The applicant will perform her research and career development activities at world-renowned academic, research, and clinical institutions. The division that she will join as an Instructor of Medicine in July, 205, has an excellent track record in mentorship, is collaborative and supportive in research and the development of junior faculty, supports a wide field of research, and serves as a national leader in pulmonary and critical care. The applicant's chair of medicine and chair of her division has made investing in her success a priority and will make available all the facilities, resources, and equipment necessary to achieve the success of her proposal and career. The applicant's mentors are national experts in health care payment and delivery design, measures of heath care value, and econometrics. Her advisory panel includes experts in qualitative research, national leaders in clinical trials in critical care, biostatistics, and hierarchical modeling. Furher, she will collaborate with individual patients and families who have been instrumental in the development of her proposal and in her ongoing research.
A new specialist becomes involved in care of hospitalized patients every two seconds. Usually, specialists improve the care of patients, but having multiple physicians involved may lead to unnecessary tests, longer stays in the hospital, and greater use of outpatient specialty services. Our proposal asks: (1) how do patients, families, nurses, and physicians think about what makes up a necessary and high quality interaction with a specialist; (2) why does specialist use in the hospital vary across the country; and (3) what are the outcomes and costs for patients who have inpatient specialist care.
| Law, Anica C; Stevens, Jennifer P; Hohmann, Samuel et al. (2018) Patient Outcomes After the Introduction of Statewide ICU Nurse Staffing Regulations. Crit Care Med 46:1563-1569 |
| Stevens, Jennifer P; Nyweide, David J; Maresh, Sha et al. (2017) Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists. JAMA Intern Med 177:1781-1787 |
