Mayo Clinic Proceedings Home

Value and Process of Curbside Consultations in Clinical Practice: A Grounded Theory Study

      Abstract

      Objectives

      To clarify the value and process of the curbside consultation and identify ways to optimize this activity.

      Participants and Methods

      We conducted 13 focus groups at an academic medical center and outlying community sites (September 2011 to January 2013), involving a purposive sample of 54 primary care and subspecialist internal medicine and family medicine physicians. Focus group discussions were transcribed and then analyzed using a constant comparative approach to identify benefits, liabilities, mechanisms, and potential improvements related to curbside consultations.

      Results

      We developed a model describing the role and process of the curbside consultation. Focus group participants perceived that curbside consultations add particular value in offering immediate, individualized answers with bidirectional information exchange, and this in turn expedites patient care and elevates patient confidence. Despite the uncompensated interruption and potential risks, experts provide curbside consultations because they appreciate the honor of being asked and the opportunity to help colleagues, expedite patient care, and teach. Key decisions for the initiator (each reflecting a potential barrier) include whom to contact, how to contact that expert, and how to determine availability. Experts decide to accept a request on the basis of personal expertise, physical location, and capacity to commit time and attention. Participants suggested systems-level improvements to facilitate expert selection, clarify expert availability, enhance access to clinical information, and acknowledge the expert’s effort.

      Conclusions

      Curbside consultations play an important role in enhancing communication and care coordination in clinical medicine, but the process can be further improved. Information technology solutions may play a key role.

      Abbreviations and Acronyms:

      EMR ( electronic medical record)
      To read this article in full you will need to make a payment

      References

        • McWilliams J.M.
        • Landon B.E.
        • Chernew M.E.
        Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract.
        JAMA. 2013; 310: 829-836
        • Landon B.E.
        • Roberts D.H.
        Reenvisioning specialty care and payment under global payment systems.
        JAMA. 2013; 310: 371-372
        • Nichols L.M.
        Accountable care organization pathways: diverse but ultimately parallel.
        Mayo Clin Proc. 2012; 87: 710-713
        • Rosenthal T.C.
        The medical home: growing evidence to support a new approach to primary care.
        J Am Board Fam Med. 2008; 21: 427-440
        • Jackson G.L.
        • Powers B.J.
        • Chatterjee R.
        • et al.
        The patient-centered medical home: a systematic review.
        Ann Intern Med. 2013; 158: 169-178
      1. Spatz C, Bricker P, Gabbay R. The patient-centered medical neighborhood: transformation of specialty care [published online August 21, 2013]. Am J Med Qual. http://dx.doi.org/10.1177/1062860613498812.

      2. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint Principles of the Patient-Centered Medical Home. http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home. Accessed February 15, 2013.

      3. Wachter B. A Call For a New Model For Generalist-Specialist Information Exchange (The Health Care Blog). http://thehealthcareblog.com/blog/2013/04/29/. Accessed August 31, 2013.

      4. Cook DA, Sorensen KJ, Wilkinson JM, Berger RA. Barriers and decisions when answering clinical questions at the point of care: a grounded theory study (published online August 26, 2013). JAMA Inter Med. http://dx.doi.org/10.1001/jamainternmed.2013.10103.

        • Myers J.P.
        Curbside consultation in infectious diseases: a prospective study.
        J Infect Dis. 1984; 150: 797-802
        • Burden M.
        • Sarcone E.
        • Keniston A.
        • et al.
        Prospective comparison of curbside versus formal consultations.
        J Hosp Med. 2013; 8: 31-35
        • Manian F.A.
        • McKinsey D.S.
        A prospective study of 2,092 “curbside” questions asked of two infectious disease consultants in private practice in the midwest.
        Clin Infect Dis. 1996; 22: 303-307
        • Keating N.L.
        • Zaslavsky A.M.
        • Ayanian J.Z.
        Physicians' experiences and beliefs regarding informal consultation.
        JAMA. 1998; 280: 900-904
        • Kuo D.
        • Gifford D.R.
        • Stein M.D.
        Curbside consultation practices and attitudes among primary care physicians and medical subspecialists.
        JAMA. 1998; 280: 905-909
        • Perley C.M.
        Physician use of the curbside consultation to address information needs: report on a collective case study.
        J Med Libr Assoc. 2006; 94: 137-144
        • Wadhwa A.
        • Ford-Jones E.L.
        • Lingard L.
        A qualitative study of interphysician telephone consultations: extending the opinion leader theory.
        J Contin Educ Health Prof. 2005; 25: 98-104
        • Wadhwa A.
        • Lingard L.
        A qualitative study examining tensions in interdoctor telephone consultations.
        Med Educ. 2006; 40: 759-767
        • Rappolt S.
        Family physicians' selection of informal peer consultants: implications for continuing education.
        J Contin Educ Health Prof. 2002; 22: 113-120
        • Wegner S.E.
        • Humble C.G.
        • Feaganes J.
        • Stiles A.D.
        Estimated savings from paid telephone consultations between subspecialists and primary care physicians.
        Pediatrics. 2008; 122: e1136-e1140
        • Bergus G.R.
        • Sinift S.D.
        • Randall C.S.
        • Rosenthal D.M.
        Use of an E-mail curbside consultation service by family physicians.
        J Fam Pract. 1998; 47: 357-360
        • Chen A.H.
        • Murphy E.J.
        • Yee Jr., H.F.
        eReferral–a new model for integrated care.
        N Engl J Med. 2013; 368: 2450-2453
        • Bergus G.R.
        • Randall C.S.
        • Sinift S.D.
        • Rosenthal D.M.
        Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues?.
        Arch Fam Med. 2000; 9: 541-547
        • Golub R.M.
        Curbside consultations and the viaduct effect.
        JAMA. 1998; 280: 929-930
        • American College of Physicians
        The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home With Specialty/Subspecialty Practices: Policy Paper.
        American College of Physicians, Philadelphia, PA2010
        • Glaser B.G.
        The constant comparative method of qualitative analysis.
        Soc Probl. 1965; 12: 436-445
        • Weinberg A.D.
        • Ullian L.
        • Richards W.D.
        • Cooper P.
        Informal advice- and information-seeking between physicians.
        J Med Educ. 1981; 56: 174-180
        • Manian F.A.
        • Janssen D.A.
        Curbside consultations: a closer look at a common practice.
        JAMA. 1996; 275: 145-147
        • Gennai S.
        • Francois P.
        • Sellier E.
        • Vittoz J.P.
        • Hincky-Vitrat V.
        • Pavese P.
        Prospective study of telephone calls to a hotline for infectious disease consultation: analysis of 7,863 solicited consultations over a 1-year period.
        Eur J Clin Microbiol Infect Dis. 2011; 30: 509-514
        • Rushakoff R.J.
        • Woeber K.A.
        Evaluation of a “formal” endocrinology curbside consultation service: advice by means of internet, fax, and telephone.
        Endocr Pract. 2003; 9: 124-127
        • Grace C.
        • Alston W.K.
        • Ramundo M.
        • Polish L.
        • Kirkpatrick B.
        • Huston C.
        The complexity, relative value, and financial worth of curbside consultations in an academic infectious diseases unit.
        Clin Infect Dis. 2010; 51: 651-655
        • Cotton V.R.
        Legal risks of “curbside” consults.
        Am J Cardiol. 2010; 106: 135-138
        • Olick R.S.
        • Bergus G.R.
        Malpractice liability for informal consultations.
        Fam Med. 2003; 35: 476-481
        • Porter M.E.
        • Pabo E.A.
        • Lee T.H.
        Redesigning primary care: a strategic vision to improve value by organizing around patients' needs.
        Health Aff (Millwood). 2013; 32: 516-525
        • Neuhausen K.
        • Grumbach K.
        • Bazemore A.
        • Phillips R.L.
        Integrating community health centers into organized delivery systems can improve access to subspecialty care.
        Health Aff (Millwood). 2012; 31: 1708-1716
        • Pham H.H.
        • O'Malley A.S.
        • Bach P.B.
        • Saiontz-Martinez C.
        • Schrag D.
        Primary care physicians' links to other physicians through Medicare patients: the scope of care coordination.
        Ann Intern Med. 2009; 150: 236-242
        • O'Malley A.S.
        • Reschovsky J.D.
        Referral and consultation communication between primary care and specialist physicians: finding common ground.
        Arch Intern Med. 2011; 171: 56-65

      Linked Article

      • Curbside Consultations: A Call for More Investigation Into a Common Practice
        Mayo Clinic ProceedingsVol. 89Issue 11
        • In Brief
          In their grounded theory study published in the May 2014 issue of Mayo Clinic Proceedings, Cook et al1 examined the important issue of curbside consultations. They determined via focus groups of selected physicians that curbside consultations are a valuable practice in clinical medicine and suggested that they merit institutional support. A common theme in the focus groups was that curbside consultations foster effective, bidirectional communication that does not occur when using a static resource such as a textbook, Web-based resource, or literature search to answer a clinical question.
        • Full-Text
        • PDF