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Coordinating Care - A Perilous Journey through the Health Care System
by Thomas Bodenheimer, M.D. published in the New England Journa of Medicine, March 6, 2008.
Patient hand-off related studies:
| Coordination between primary care physicians and specialists | A study of referrals by 122 pediatricians found that no information was sent to the specialist in 49% of referrals. The referring physician received feedback from the specialist 55% of the time. |
| In a study of the adult referral process at an academic medical center, 28% of primary care physicians and 43% of specialists were dissatisfied with the quality of information they received from each other; 25% of the time, specialist consultation reports had not reached the primary care physician 4 weeks after the specialty visit. | |
| Coordination between primary care physicians and emergency departments | In almost 33% of emergency department visits studied, information that included medical history and laboratory results was absent. |
| In 2004, 30% of adults seen in the emergency department reported that their regular physician was not informed about the care they received there. | |
| Coordination between physicians and sources of diagnostic data | Among patients who had visited at least one physician in the previous 2 years, 17% reported that test results or medical records were not available at the time of a scheduled appointment |
| Adults with chronic illness who had seen a physician in the previous 2 years reported that either test results or medical records were not available at the time of a scheduled visit or the physician unnecessarily ordered a duplicate test 22% of the time for patients seeing one physician and 43% of the time for patients seeing four or more physicians. | |
| Coordination between hospial-based physicians and primary care physicians | A 2005 survey of U.S. adults with chronic illness or with a recent acute illness showed that one third of hospital-based physicians and primary care physicians those who had been hospitalized in the previous 2 years reported that no follow-up arrangements had been made after hospital discharge. |
| One study found that fewer than half of primary care physicians were provided information about the discharge plans and medications of their recently hospitalized patients. | |
| A literature review of information transfer between hospital-based and primary care physicians found that only 3% of primary care physicians were involved in discussions with hospital physicians about patients’ discharge plans; 17 to 20% were always notified that the patient had been discharged; and fewer than 20% had received a discharge summary at 1 week after discharge. In addition, 25% of discharge summaries never reached the primary care physician, 38% of discharge summaries did not include reports of laboratory results, and 21% did not list discharge medications. In 66% of cases, primary care physi-cians contacted or treated patients after hospital discharge before receiving a discharge summary. |