Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care

Quality of Care for Decompensated Heart Failure: Comparable Performance between Academic Hospitalists and Non-hospitalists

“…27 In contrast to previous studies suggesting no effect of hospitalist systems on rates of specialty consultation, 26,28 we noted some evidence, though not conclusive, that MCH hospitalists consulted cardiologists more often and more frequently ordered invasive tests. Increases in referrals for congestive heart failure may be because hospitalists were less comfortable caring for heart failure patients or because they were more attentive to reasons why cardiologist care would be needed (e.g., evaluation for revascularization), or recognition that cardiologists may improve quality of care and potentially outcomes as well, 22,23 particularly in patients with active cardiac ischemia. This latter mechanism is suggested by a trend towards more frequent invasive tests in hospitalists' patients.…”

“…Next, we assessed whether formal inpatient cardiac consultation was obtained, based on literature suggesting improved outcomes with cardiology specialist consultation. 22,23 Finally, as more stringent measures of quality, we determined the percentage of eligible patients who received all three care processes (LVEF assessment, ACE-I use, and beta-blocker use) and those who received all five measures (the first three plus care coordination measures).…”

The Paradox of Primary Care

“…For most people, and probably for almost everyone over time, a combination of continuing primary care and selective specialty care is needed. [72][73][74]112,113 Provision of the majority of care through ongoing person-focused, contextualized primary care relationships can allow care to be integrated and prioritized across acute and chronic illness, preventive, psychosocial, and family care. 103,114 That health care is not organized this way in the United States 115,116 may be an important factor in the high cost and low performance of the US health care system compared with other systems based on primary care.…”

Differences in Specialist Consultations for Cardiovascular Disease by Race, Ethnicity, Gender, Insurance Status, and Site of Primary Care

“…The literature supports that comanagement enhances clinical performance for patients with improved blood pressure and low-density lipoprotein cholesterol control among patients with CAD and improved left ventricular function assessment, increased angiotensin-converting enzyme inhibitor use, and reduced hospitalization and 90-day mortality rates for CHF. [17][18][19] However, the finding of a differential effect of consultation on performance by gender is particularly important because CAD is the leading cause of death for both men and women, yet the rate of decline in CAD mortality for women is less than that for men. 2 Prior studies have suggested that markets with higher use of services and procedures do not always provide higher quality.…”