DESCRIPTION (provided by applicant): Research Inpatient consultation by specialists is the primary mechanism by which specialist care is provided to hospitalized patients. More than 90% of Medicare patients have at least one consultation. Despite the prevalence of this practice, there has been very little research into the process of consultation and its outcomes. Further, in previous research performed by the applicant among 3.1 million admissions to 4,501 hospitals, the scope of variation in inpatient consultation use across U.S. hospitals was substantial - there was nearly a 3.6-fold difference in consultation use across quintiles of hospitals. Research to understand and quantify the value of consultation to patients and providers would allow for a more rational approach to the use of consultation nationally and has the potential to affect the inpatient care of millions of patients. In this career development proposal, the objective of this proposal is to advance knowledge of inpatient consultation in three ways: by defining the characteristics of beneficial consultations from multiple perspectives, including those of patients and families; by investigating novel non-clinical factors that drive consultation for reasons other than patient or family need; and by quantifying the relationship between inpatient consultations and patient outcomes and costs. In the first phase of her research, the applicant proposes to engage patients and providers through a mixed-methods approach to identify characteristics of beneficial consultations (Aim 1). She will then propose and pilot-test markers of consultation benefit that are available in electronic data. In the second phase of her research, she will use two large secondary data sources, Medicare claims and the granular clinical and administrative data available through the Beth Israel Deaconess Medical Center. She will investigate novel non-clinical drivers of variation in the use of inpatient consultation, distinct from the clinical eed of patients (Aim 2). Finally, she will incorporate these drivers into models that quantify the impact of consultation on patient outcomes and costs (Aim 3). The successful completion of this research will significantly advance our understanding of how this nearly ubiquitous intervention affects patient-centered outcomes. Additionally, this proposal will lead to future interventions to moderate consultation over-use. Candidate The applicant's long-term career goal is to become an independent patient-centered outcomes researcher focused on quantifying and improving health care delivery to acutely ill and hospitalized patients. She has extensive experience prior to this proposal with a range of research methods, including expertise using highly granular clinical and administrative data. In order to achieve her long-term goal, she has the following career objectives: to obtain additional didactic training in qualitative methods, econometrics and propensity scores, and h...