Rethinking the consultation paradigm: Validity evidence for a new framework, a multimethods study.

Area of Science:

• Healthcare Management
• Medical Communication
• Clinical Workflow Optimization

Background:

• In-hospital consultations are critical for patient care.
• A previously proposed framework with seven consultation types aimed to improve communication, workflow, and provider satisfaction.

Purpose of the Study:

• To evaluate the applicability of a seven-type consultation classification framework to real-world internal medicine consultations.
• To gather validity evidence for the framework using Kane's validity model.

Main Methods:

• A multimethods study involving focus groups and classification of 500 internal medicine consult requests from five specialties.
• Qualitative thematic analysis of focus groups and quantitative analysis of classification concordance rates.
• Comparison of concordance rates between specialists and hospitalists using chi-squared tests.

Main Results:

• Five major themes emerged from qualitative analysis, including consult question, interpersonal interactions, value, miscommunication, and framework application.
• Overall concordance rate for the classification framework was 88.8%.
• Perfect concordance was 46.6%, with significantly higher perfect concordance among hospitalists (67.2%) compared to specialists (57.8%).

Conclusions:

• The consultation classification framework demonstrated applicability across five internal medicine specialties.
• The framework has the potential to improve communication and education within hospital settings.