Provider expectations and experiences of comanagement

Abstract

Background: Hospitalist comanagement of complex surgical and medical specialty patients is increasingly common, but it is unclear how provider expectations and experiences under the collaborative practice model differ from those of traditional consultations.

Methods: We analyzed survey data examining expectations and experiences on a medical hepatology comanagement service. Participating hospitalists, nonphysician providers (NPPs), hepatologists, and fellows completed a Baseline Survey that addressed preferences for decision-making under comanagement. Repeated Surveys, administered to each unique team of comanagers, addressed their experiences with decision-making on their rotations on the service between April and October 2008.

Results: All 43 providers completed the Baseline Survey. Among these, 32 providers who rotated on the service completed 79% (177/223) of Repeated Surveys. The majority of respondents indicated understanding their role. More providers of every professional role indicated their preference for hospitalists to participate in every management decision and for hepatologists not to participate in every management decision. Most indicated that they both preferred and experienced the direction of management issues by a single physician leader. Almost all indicated at baseline that comanagement tends to improve patient care (hospitalists 94%, hepatologists 83%, NPPs 100%, fellows 100%), although fewer NPPs (40%) and fellows (50%) felt comanagement actually improved care following their rotations.

Conclusions: Preferences and experiences about provider roles are not uniform under comanagement, and conflicting preferences exist around decision-making processes. Providers generally agreed that comanaging hospitalists should participate broadly in management decisions.