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Journal of General Internal Medicine

, Volume 30, Issue 4, pp 417–424 | Cite as

A Failure to Communicate: A Qualitative Exploration of Care Coordination Between Hospitalists and Primary Care Providers Around Patient Hospitalizations

  • Christine D. Jones
  • Maihan B. Vu
  • Christopher M. O’Donnell
  • Mary E. Anderson
  • Snehal Patel
  • Heidi L. Wald
  • Eric A. Coleman
  • Darren A. DeWalt
Original Research

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.

KEY WORDS

care transitions care coordination accountability 

Notes

Acknowledgments

The authors would like to acknowledge the valuable contributions of all of the study participants. We would also like to thank Troy A. Jones for his contributions to this project.

This work was supported by AHRQ grant U18 HS020940. Dr. Christine D. Jones was supported by a NIH/HRSA training grant as an NRSA Primary Care Research Fellow (T32HP14001).

Conflict of Interest

The authors each declare that they have no conflict of interest.

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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Christine D. Jones
    • 1
  • Maihan B. Vu
    • 2
  • Christopher M. O’Donnell
    • 3
    • 7
  • Mary E. Anderson
    • 1
  • Snehal Patel
    • 3
  • Heidi L. Wald
    • 1
    • 4
  • Eric A. Coleman
    • 4
  • Darren A. DeWalt
    • 5
    • 6
  1. 1.Hospital Medicine Section, Division of General Internal MedicineUniversity of Colorado, DenverAuroraUSA
  2. 2.Center for Health Promotion and Disease Prevention, Qualitative Research Unit and Department of Health Behavior, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Duke Regional Hospital MedicineDuke University Health SystemDurhamUSA
  4. 4.Division of Health Care Policy and ResearchUniversity of Colorado, DenverAuroraUSA
  5. 5.The Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillUSA
  6. 6.Division of General Internal Medicine and Clinical EpidemiologyUniversity of North Carolina at Chapel HillChapel HillUSA
  7. 7.Division of Hospital MedicineEmory University School of MedicineAtlantaGeorgia

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