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A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations.
J Gen Intern Med 2015; 30(4):417-24JG

Abstract

BACKGROUND

Care coordination between adult hospitalists and primary care providers (PCPs) is a critical component of successful transitions of care from hospital to home, yet one that is not well understood.

OBJECTIVE

The purpose of this study was to understand the challenges in coordination of care, as well as potential solutions, from the perspective of hospitalists and PCPs in North Carolina.

DESIGN AND PARTICIPANTS

We conducted an exploratory qualitative study with 58 clinicians in four hospitalist focus groups (n = 32), three PCP focus groups (n = 19), and one hybrid group with both hospitalists and PCPs (n = 7).

APPROACH

Interview guides included questions about care coordination, information exchange, follow-up care, accountability, and medication management. Focus group sessions were recorded, transcribed verbatim, and analyzed in ATLAS.ti. The constant comparative method was used to evaluate differences between hospitalists and PCPs.

KEY RESULTS

Hospitalists and PCPs were found to encounter similar care coordination challenges, including (1) lack of time, (2) difficulty reaching other clinicians, (3) lack of personal relationships with other clinicians, (4) lack of information feedback loops, (5) medication list discrepancies, and (6) lack of clarity regarding accountability for pending tests and home health. Hospitalists additionally noted difficulty obtaining timely follow-up appointments for after-hours or weekend discharges. PCPs additionally noted (1) not knowing when patients were hospitalized, (2) not having hospital records for post-hospitalization appointments, (3) difficulty locating important information in discharge summaries, and (4) feeling undervalued when hospitalists made medication changes without involving PCPs. Hospitalists and PCPs identified common themes of successful care coordination as (1) greater efforts to coordinate care for "high-risk" patients, (2) improved direct telephone access to each other, (3) improved information exchange through shared electronic medical records, (4) enhanced interpersonal relationships, and (5) clearly defined accountability.

CONCLUSIONS

Hospitalists and PCPs encounter similar challenges in care coordination, yet have important experiential differences related to sending and receiving roles for hospital discharges. Efforts to improve coordination of care between hospitalists and PCPs should aim to understand perspectives of clinicians in each setting.

Authors+Show Affiliations

Hospital Medicine Section, Division of General Internal Medicine, University of Colorado, Denver, Aurora, CO, USA, christine.jones@ucdenver.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

25316586

Citation

Jones, Christine D., et al. "A Failure to Communicate: a Qualitative Exploration of Care Coordination Between Hospitalists and Primary Care Providers Around Patient Hospitalizations." Journal of General Internal Medicine, vol. 30, no. 4, 2015, pp. 417-24.
Jones CD, Vu MB, O'Donnell CM, et al. A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations. J Gen Intern Med. 2015;30(4):417-24.
Jones, C. D., Vu, M. B., O'Donnell, C. M., Anderson, M. E., Patel, S., Wald, H. L., ... DeWalt, D. A. (2015). A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations. Journal of General Internal Medicine, 30(4), pp. 417-24. doi:10.1007/s11606-014-3056-x.
Jones CD, et al. A Failure to Communicate: a Qualitative Exploration of Care Coordination Between Hospitalists and Primary Care Providers Around Patient Hospitalizations. J Gen Intern Med. 2015;30(4):417-24. PubMed PMID: 25316586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations. AU - Jones,Christine D, AU - Vu,Maihan B, AU - O'Donnell,Christopher M, AU - Anderson,Mary E, AU - Patel,Snehal, AU - Wald,Heidi L, AU - Coleman,Eric A, AU - DeWalt,Darren A, Y1 - 2014/10/15/ PY - 2013/06/17/received PY - 2014/09/25/accepted PY - 2014/08/22/revised PY - 2014/10/16/entrez PY - 2014/10/16/pubmed PY - 2016/4/2/medline SP - 417 EP - 24 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 30 IS - 4 N2 - BACKGROUND: Care coordination between adult hospitalists and primary care providers (PCPs) is a critical component of successful transitions of care from hospital to home, yet one that is not well understood. OBJECTIVE: The purpose of this study was to understand the challenges in coordination of care, as well as potential solutions, from the perspective of hospitalists and PCPs in North Carolina. DESIGN AND PARTICIPANTS: We conducted an exploratory qualitative study with 58 clinicians in four hospitalist focus groups (n = 32), three PCP focus groups (n = 19), and one hybrid group with both hospitalists and PCPs (n = 7). APPROACH: Interview guides included questions about care coordination, information exchange, follow-up care, accountability, and medication management. Focus group sessions were recorded, transcribed verbatim, and analyzed in ATLAS.ti. The constant comparative method was used to evaluate differences between hospitalists and PCPs. KEY RESULTS: Hospitalists and PCPs were found to encounter similar care coordination challenges, including (1) lack of time, (2) difficulty reaching other clinicians, (3) lack of personal relationships with other clinicians, (4) lack of information feedback loops, (5) medication list discrepancies, and (6) lack of clarity regarding accountability for pending tests and home health. Hospitalists additionally noted difficulty obtaining timely follow-up appointments for after-hours or weekend discharges. PCPs additionally noted (1) not knowing when patients were hospitalized, (2) not having hospital records for post-hospitalization appointments, (3) difficulty locating important information in discharge summaries, and (4) feeling undervalued when hospitalists made medication changes without involving PCPs. Hospitalists and PCPs identified common themes of successful care coordination as (1) greater efforts to coordinate care for "high-risk" patients, (2) improved direct telephone access to each other, (3) improved information exchange through shared electronic medical records, (4) enhanced interpersonal relationships, and (5) clearly defined accountability. CONCLUSIONS: Hospitalists and PCPs encounter similar challenges in care coordination, yet have important experiential differences related to sending and receiving roles for hospital discharges. Efforts to improve coordination of care between hospitalists and PCPs should aim to understand perspectives of clinicians in each setting. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/25316586/A_failure_to_communicate:_a_qualitative_exploration_of_care_coordination_between_hospitalists_and_primary_care_providers_around_patient_hospitalizations_ L2 - https://dx.doi.org/10.1007/s11606-014-3056-x DB - PRIME DP - Unbound Medicine ER -