Dataset Information

A Multi-site Case Study of Care Coordination Between Primary Care and Specialty Care.

ABSTRACT:

Background

Care coordination is critical for patients with multiple chronic conditions, but fragmentation of care persists. Providers' perspectives of facilitators and barriers to coordination are needed to improve care.

Objectives

We sought to understand providers' perspectives on care coordination for patients having multiple chronic diseases served by multiple providers.

Research design

Based upon our earlier survey of patients with multiple chronic conditions, we selected 8 medical centers having high and low coordination. We interviewed providers to identify facilitators and barriers to coordination and compare them between patient-rated high sites and low sites and between primary care (PC)-mental health (MH) and PC-medical/surgical specialty care.

Subjects

Physicians, nurses and other clinicians in PC, cardiology, and MH (N=102) in 8 Veterans Affairs medical centers.

Results

We identified warm handoffs, professional relationships, and physical proximity as facilitators, and service agreements, reporting relationships and staffing as barriers. PC-MH coordination was reported as better than PC-medical/surgical specialty coordination. Facilitators were more prevalent and barriers less prevalent in sites rated high by patients than sites rated low, and between PC-MH than between PC-specialty care.

Discussion

We noted that professional relationships were highly related to coordination and both affected other facilitators and barriers and were affected by them. We suggested actions to improve relationships directly, and to address other facilitators and barriers that affect relationships and coordination. Among these is the use of the Primary Care Mental Health Integration model.

SUBMITTER: Charns MP

PROVIDER: S-EPMC8989667 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

A Multi-site Case Study of Care Coordination Between Primary Care and Specialty Care.

Charns Martin P MP Benzer Justin K JK McIntosh Nathalie M NM Mohr David C DC Singer Sara J SJ Gurewich Deborah D

Medical care 20220501 5

<h4>Background</h4>Care coordination is critical for patients with multiple chronic conditions, but fragmentation of care persists. Providers' perspectives of facilitators and barriers to coordination are needed to improve care.<h4>Objectives</h4>We sought to understand providers' perspectives on care coordination for patients having multiple chronic diseases served by multiple providers.<h4>Research design</h4>Based upon our earlier survey of patients with multiple chronic conditions, we select ...[more]

PMID: 35239562

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Project description:PurposeSpecialty care coordination relies on information flowing bidirectionally between all three participants in the "specialty care triad" - patients, primary care providers (PCPs), and specialists. Measures of coordination should strive to account for the perspectives of each. As we previously developed two surveys to measure coordination of specialty care as experienced by PCPs and specialists, this study aimed to develop and evaluate the psychometric properties of a related survey of specialty care coordination as experienced by the patient, thereby completing the suite of surveys among the triad.MethodsWe developed a draft survey based on literature review, patient interviews, adaptation of existing measures, and development of new items. Survey responses were collected via mail and online in two waves, August 2019-November 2019 and September 2020-May 2021, among patients (N=939) receiving medical specialty care and primary care in the Veterans Affairs health system. Exploratory and confirmatory factor analysis were used to assess scale structure. Multiple linear regression was used to examine the relationship of the final coordination scales to patients' overall experience of specialty care coordination.ResultsA 38-item measure representing 10 factors that assess the patient's experience of coordination in specialty care among the patient, PCP, and specialist was finalized. Scales demonstrated good internal consistency reliability and, together, explained 59% of the variance in overall coordination. Analyses revealed an unexpected construct describing organization of care between patient and specialist that accounted for patient goals and preferences; this 10-item scale was named Patient-Centered Care Coordination.ConclusionsThe final survey, Coordination of Specialty Care - Patient, or CSC-Patient for short, is a reliable instrument that can be used alone or with its companions (CSC-PCP, CSC-Specialist) to provide a detailed assessment of specialty care coordination and identify targets for coordination improvement.

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Dataset Information

A Multi-site Case Study of Care Coordination Between Primary Care and Specialty Care.

Background

Objectives

Research design

Subjects

Results

Discussion

Publications

A Multi-site Case Study of Care Coordination Between Primary Care and Specialty Care.

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