Background:
Although comanagement models of care are proliferating, the management structures of comanaging providers have not been characterized.
Methods:
Between April and October 2008, all eligible providers on a novel medical comanagement service (described elsewhere) were asked to complete a preliminary survey soliciting respondents' expectations about their role on an ideally comanaged service. Subsequently, each participating provider was surveyed repeatedly at the completion of every service rotation to evaluate the degree to which their experiences on the service met their expectations. The surveys addressed single‐leader and consensus‐based management styles, degree of involvement by comanaging physicians, sense of ownership of patients, and adequacy of patient care under comanagement.
Results:
All eligible providers, involving 18 hospitalists, 5 midlevels, 6 hepatologists, and 12 Gl fellows, completed the initial survey. Mean years of experience in their roles were 2.3 ± 2.6 for hospitalists, 7.0 ± 5.7 for midlevels, 8.7 ± 8.4 for hepatologists, and 1.2 ± 1.3 for fellows. Seventy‐nine percent (176 of 224) of the repeat surveys were completed by 31 providers (15 hospitalists, 5 midlevels, 6 hepatologists, 6 Gl fellows) who worked 1 or more shifts during the study period. Forty‐one percent indicated that consensus should be sought in every clinical decision, with no difference in response by role (P = 0.11). However, more hepatologists and fellows than hospitalists and midlevels reported experiencing consensus‐based management while on service (P < 0.01). Eighty‐five percent, regardless of role (P = 0.43), indicated that there should be 1 physician responsible for directing the overall management of patients' hospital course. But 67% reported actually experiencing leadership by 1 physician while on service, with no difference in response by role (P = 0.11). More hospitalists and midlevels than hepatologists and fellows preferred to be informed about every clinical decision for patients on the service (P < 0.01). Conversely, more hepatologists and fellows than hospitalists and midlevels preferred that their comanagers participate in every clinical decision (P = 0.02). Forty‐six percent of hospitatists and 49% of midlevels reported wanting greater influence in directing management decisions compared with 15% of hepatologists and 17% of fellows (P < 0.01). Eighty‐one percent of all providers believed that patients on the service received better care than they would have without comanagement.
Conclusions:
Physician and midlevel hospitalists prefer to be actively involved in patient care under comanagement, whereas hepatologists and fellows welcome such participation. Although expectations of management structures are generally met on a medical comanagement service, the difference in perception of consensus seeking between the teams suggest an asymmetrical relationship that requires further analysis.
Author Disclosure:
K. Hinami, none; C. T. Whelan, none; D. O. Meltzer, none.