Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

References

  1. McDonald KM SE, Albin L, Pineda N, Lonhart J, Sundaram V, Smith-Spangler C, Brustrom J, and Malcolm E. Care Coordination Atlas Version 3 (Prepared by Stanford University under subcontract to Battelle on Contract no. 290040020). 2010.

  2. Agency for Healthcare Research and Quality. Improving primary care practice: Care coordination. Available at: Http://www.ahrq.gov/professionals/prevention-chronic-care/improve/index.html. Accessed May 5, 2014.

  3. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA. 2007;297:831–841

    Article  CAS  PubMed  Google Scholar 

  4. Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: A systematic review. BMJ Qual Saf. 2011;20:194–199

    Article  PubMed Central  PubMed  Google Scholar 

  5. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646–651

    Article  PubMed Central  PubMed  Google Scholar 

  6. Arora VM, Prochaska ML, Farnan JM, D’Arcy MJ 5tt, Schwanz KJ, Vinci LM, Davis AM, Meltzer DO, Johnson JK. Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: A mixed methods study. J Hosp Med. 2010;5:385–391

  7. Bell CM, Schnipper JL, Auerbach AD, Kaboli PJ, Wetterneck TB, Gonzales DV, Arora VM, Zhang JX, Meltzer DO. Association of communication between hospital-based physicians and primary care providers with patient outcomes. J Gen Intern Med. 2009;24:381–386

    Article  PubMed Central  PubMed  Google Scholar 

  8. Ruth JL, Geskey JM, Shaffer ML, Bramley HP, Paul IM. Evaluating communication between pediatric primary care physicians and hospitalists. Clin Pediatr (Phila). 2011;50:923–928

    Article  Google Scholar 

  9. Davis MM, Devoe M, Kansagara D, Nicolaidis C, Englander H. “Did i do as best as the system would let me?” Healthcare professional views on hospital to home care transitions. J Gen Intern Med. 2012;27:1649–1656

    Article  PubMed Central  PubMed  Google Scholar 

  10. Samal L, Dykes PC, Greenberg J, Hasan O, Venkatesh AK, Volk LA, Bates DW. The current capabilities of health information technology to support care transitions. AMIA Annu Symp Proc. 2013;2013:1231

    PubMed Central  PubMed  Google Scholar 

  11. O’Malley AS. Tapping the unmet potential of health information technology. N Engl J Med. 2011;364:1090–1091

    Article  PubMed  Google Scholar 

  12. Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: Controversies and recommendations. Ann Fam Med. 2008;6:331–339

    Article  PubMed Central  PubMed  Google Scholar 

  13. Göbel B, Zwart D, Hesselink G, Pijnenborg L, Barach P, Kalkman C, Johnson JK. Stakeholder perspectives on handovers between hospital staff and general practitioners: An evaluation through the microsystems lens. BMJ Qual Saf. 2012;21 Suppl 1:i106-113

    Article  PubMed Central  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christine D. Jones MD, MS.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jones, C.D., Vu, M.B., O’Donnell, C.M. 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 30, 417–424 (2015). https://doi.org/10.1007/s11606-014-3056-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-014-3056-x

KEY WORDS

  • care transitions
  • care coordination
  • accountability