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Multisite Medicine Consults/Co-management Project. Emily Wang, Chris Moreland, Mike Shoffeitt , Bret Simon and Luci Leykum. Objectives. To identify the questions posed in Medicine consults/co-management (MCC) requests at academic medical centers

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multisite medicine consults co management project

Multisite Medicine Consults/Co-management Project

Emily Wang, Chris Moreland, Mike Shoffeitt, Bret Simon and LuciLeykum

objectives
Objectives
  • To identify the questions posed in Medicine consults/co-management (MCC) requests at academic medical centers
  • To refine the MCC curriculum to ensure coverage of adequate breadth of knowledge required to train Internal Medicine residents in MCC
background
Background
  • Consultation experience required by ACGME
    • Not necessarily as a MCC rotation
  • MCC part of core of IM practice
  • What questions are asked of IM consultants?
    • And what additional issues do we address?
data collection
Data Collection
  • Consult Data
    • 2 weeks every 3 months for one year= 8 weeks
    • Flexible time frame at each institution
    • Collecting consults daily 24/7
    • Staff physicians will preferentially enter data
data collection cont
Data Collection (cont)
  • Consult Data
    • # of consult requests, date/time
    • Service requesting consult
    • Reason for requested consult
    • Other issues addressed not specifically requested by consultant (e.g., bacteremia addressed during consult for diabetes)
    • Whether pt transferred to medicine
    • How often topic is addressed on inpatient medicine ward service
    • Whether consultant verbally discussed findings with requestor team
data collection cont1
Data Collection (cont)
  • Institutional Data
    • Type of hospital, # beds
    • Associated with a residency
    • MCCS rotation length, frequency
    • # residents, fellows
    • Formal curriculum or teaching plan
    • Coverage of MCCS and by whom
    • Associated pre-op clinics
    • Other resident responsibilities while on MCCS
    • Separate co-management services
    • Faculty staffing MCCS
    • POC for the initial consult
timeline
Timeline
  • 2010: idea discussed at research meeting
  • 2010-2012
    • Abstract and objectives defined
    • IRB submission and approval: exempt status due to QI
    • Initial data collection via Surveymonkey
      • https://www.surveymonkey.com/s/Hospital_Consults
    • Discussion and refinement of survey by perioperative experts within and outside of our institution
timeline cont
Timeline (cont)
  • 2012-2013
    • Recruitment of academic centers nationwide by convenience sample with regional selection
      • Mass General
      • University of Michigan
      • Johns Hopkins
      • University of Colorado at Denver
      • Denver Health
      • UCSF
      • UC Davis
      • Columbia
timeline and cont
Timeline (and cont…)
  • 2012-2013: participant conference call
    • Further survey refinement
    • Separate IRB submissions at each academic institution
    • Addressed academic product authorship
      • 1-2 PIs per institution, all staff assisting with consult data collection member of the “Medicine Consult Consortium”
  • 2013-2014
    • 1:1 participant calls for baseline program demographics, follow-up on IRB progress
  • 2014: Start consult data collection…soon hopefully
future plans
Future Plans
  • Manuscript with multi-site consult data collection, analysis
  • Possible descriptive paper about MCCS variation (and similarities) across programs
  • Data shared with all institutions and possible further products or ideas resulting from this project