Appendix A. Baseline Survey.  Sample shown of a survey administered to hepatologists.

Name: [filled in]
Date: [filled in]

1.	How many completed years of experience do you have as an attending physician? (__)
2.	Do you plan to change jobs within the next 3 years?  (Yes/No/Don’t know)
		
Please answer the following questions based on your beliefs about the ideal co-management relationship between a hospitalist and a hepatologist in the care of patients with chronic liver disease.
	
3.	There are clinical areas which hospitalists, in general, do not feel comfortable managing on their own without the input from hepatologists. (Agree…Disagree, 4 point Likert)
4.	There are clinical areas which hepatologists, in general, do not feel comfortable managing on their own	without the input from hospitalists. (Agree…Disagree, 4 point Likert)
5.	There should be one physician responsible for directing the overall management of the patients’ hospital course. (Agree…Disagree, 4 point Likert)
6.	Consensus between the hospitalist and the hepatologist should be sought in every clinical decision. (Agree…Disagree, 4 point Likert)
7.	I prefer to be informed about every clinical decision for my hospitalized patients. (Agree…Disagree, 4 	point Likert)
8.	I prefer to participate in every clinical decision for my hospitalized patients. (Agree…Disagree, 4 point	Likert)
9.	I prefer that my co-manager participate in every clinical decision for my hospitalized patients. (Agree…Disagree, 4 point Likert)
10.	I prefer to have the final say in every clinical decision for my hospitalized patients. (Agree…Disagree, 4 point Likert)
11.	I have a clear understanding of my role on the co-management service. (Agree…Disagree, 4 point Likert)
12. I have as much a sense of ownership of my patients on the co-managed service as on a non-co-managed service. (Agree…Disagree, 4 point Likert)
13. Co-management tends to improve patient care. (Agree…Disagree, 4 point Likert)
14. Which of the following illustrative relationships best parallels the ideal relationship between a pair of co-managing hospitalist and hepatologist?  Please indicate HOS for hospitalist and HEP for hepatologist on the blank next to each role. (anesthesiologist and surgeon/resident physician and attending physician/primary care physician and consulting physician/internist and proceduralist/endocrinologist and cardiologist/Other)

For the following 3 clinical plans of care, assume that you are on service with a co-managing team.  Please indicate all the providers who you think should be responsible for each of the steps involved in carrying out the plan to completion.  Check all that apply.  

15.	Obtaining a transjugular liver biopsy in a patient with coagulopathy and insulin dependent diabetes mellitus:
a.	Deciding to obtain a transjugular liver biopsy based on clinical indications (Physician Hospitalist/ Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
b.	Scheduling the transjugular liver biopsy with the interventional radiology service (Physician Hospitalist Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
c.	Explaining the procedure to the patient (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/ GI Fellow/Other)
d.	Communicating with the interventional radiologist to coordinate the procedure (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
e.	Ensuring that pre-procedural NPO and insulin reduction orders are obtained (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
f.	Ensuring that the patient’s coagulopathy is corrected with transfusion of blood products prior to the procedure (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
g.	Monitoring the patient for post-procedural complications (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
16.	Addressing goals of care with a homeless patient with advanced hepatocellular carcinoma not amenable to further therapy.
a.	Titrating analgesics to patient comfort (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/ GI Fellow/Other)
b.	Initiating end of life discussions with the patient (Physician Hospitalist/Midlevel Hospitalist/ Hepatologist/GI Fellow/Other)
c.	Locating and contacting family of the patient (Physician Hospitalist/Midlevel Hospitalist/ Hepatologist/GI Fellow/Other)
d.	Calling a palliative care consult (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
e.	Participating in a family meeting with a representative from hospice care (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
f.	Serving as the contact medical provider to the outpatient hospice staff (Physician Hospitalist/ Midlevel Hospitalist/Hepatologist/GI Fellow/Other)	
17.	Discharging an elderly patient home on a new diuretic regimen:
a.	Explaining the new drug regimen to the patient (Physician Hospitalist/Midlevel Hospitalist/ Hepatologist/GI Fellow/Other)
b.	Scheduling appropriate clinic follow-up for the patient (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
c.	Performing medication reconciliation (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/ GI Fellow/Other)
d. 	Communicating the discharge plan with the social worker and case manager (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
e.	Discharging the patient (Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)
f.	Answering patient questions about the new diuretic regimen over the telephone 	(Physician Hospitalist/Midlevel Hospitalist/Hepatologist/GI Fellow/Other)

Appendix B. Repeated Survey. Sample shown of a survey administered to hospitalists.
							Co-Managers
Your Name: [filled in]				Hepatologist: [filled in]
Mid-Levels: [filled in]				GI Fellow: [filled in]
Service period: [filled in]

Please answer the following questions based on your experiences during the whole or part of the above service period on the co-management service.

1.	Between the attending hospitalist and the hepatologist, there was one physician who directed	the 	overall management of every patients’ hospital course. (Agree…Disagree, 4 point Likert)
2.	I would have liked greater influence in directing the overall management of patients. (Agree…Disagree, 4 point Likert)
3.	I was responsible for work in clinical areas I was not comfortable managing. (Agree…Disagree, 4 point Likert)
4.	Consensus between the hospitalist and the hepatologist teams was sought in every clinical decision. (Agree…Disagree, 4 point Likert)
5.	I had a clear understanding of my role on the co-management service. (Agree…Disagree, 4 point 	Likert)
6.   	I had as much a sense of ownership of my patients on the co-managed service as on a non-co-managed service. (Agree…Disagree, 4 point Likert)
7.  	Patients on my service received better care than they would have without co-management. (Agree…Disagree, 4 point Likert)

Please answer the following based on your experience with the other providers on the co-management service during this rotation.

8. 	How often did you communicate with the provider in each of the following groups while on the co-management service? (For Midlevel, Hepatologist, GI fellow: Never/Rarely/Occasionally/Regularly /Frequently)
9. 	The provider in the following groups communicated with me in a timely way. (For Midlevel, Hepatologist, GI fellow: Disagree/Somewhat Disagree/Neither/Somewhat Agree/Agree)
10.	 The provider in the following groups communicated accurate information. (For Midlevel, Hepatologist, GI fellow: Disagree/Somewhat Disagree/Neither/Somewhat Agree/Agree)
11. 	When there is a problem, the provider in the following groups worked with me to solve the problem, instead of trying to determine whose fault it was. (For Midlevel, Hepatologist, GI fellow: Disagree/Somewhat Disagree/Neither/Somewhat Agree/Agree)
12. 	The provider in the following groups worked toward the same goals as I had. (For Midlevel, Hepatologist, GI fellow: Disagree/Somewhat Disagree/Neither/Somewhat Agree/Agree)
13. 	The provider in the following groups knew what my job is(For Midlevel, Hepatologist, GI fellow: Disagree/Somewhat Disagree/Neither/Somewhat Agree/Agree)
14. The provider in the following groups respected me. (For Midlevel, Hepatologist, GI fellow: Disagree/Somewhat Disagree/Neither/Somewhat Agree/Agree)