To describe how physicians coordinate patient care for specialty referrals and to examine the effects of these activities on referring physicians' satisfaction with the specialty care their patients receive and referral completion.
Prospective study of a consecutive sample of referrals (N = 963) made from the offices of 122 pediatricians in 85 practices in a national practice-based research network. Data sources included a physician survey completed when the referral was made (response rate, 99%) and a physician survey and medical record review conducted 3 months later (response rate, 85%). Referral completion was defined as receipt of written communication of referral results from the specialist.
Pediatricians scheduled appointments with specialists for 39.3% and sent patient information to specialists for 50.8% of referrals. The adjusted odds of referral completion were increased 3-fold for those referrals for which the pediatrician scheduled the appointment and communicated with the specialist compared with those for which neither activity occurred. Referring physicians' satisfaction ratings were significantly increased by any type of specialist feedback and were highest for referrals involving specialist feedback by both telephone and letter. Elements of specialists' letters that significantly increased physician ratings of letter quality included presence of patient history, suggestions for future care, follow-up arrangements, and plans for comanaging care; only the inclusion of plans for comanaging patient care was significantly related to the referring physicians' overall satisfaction.
Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion. Improvements in the referral process may be achieved through better communication and collaboration between primary care physicians and specialists.
"In fact, it leads to facilitating appropriate care for patients. Results of various studies show that shortcomings in team coordination lead to serious concerns about achieving quality of care (Forrest et al., 2000; Gandhi, 2005). Audet, Davis, and Schoenbaum (2006) show that the problem of poor coordination within the healthcare team causes numerous health problems for patients, such as delayed discharge or failure to receive essential information in a timely fashion. "
[Show abstract][Hide abstract] ABSTRACT: To explore nurses' attitudes and experience toward the barriers to achieving patient-centered care in the critical care setting.
A qualitative exploratory design with thematic analysis approach was used to collect and analyze data, and identify barriers to patient-centered care. Data collection was based on in-depth semi-structured interviews.
Data analyses resulted in the identification of three themes: (a) lack of common understanding of teamwork, (b) individual barriers, and (c) organizational barriers.
This study goes beyond reporting problems with patient-centered care to try to understand why patients do not always receive high-quality care.
For achieving patient-centered care, not only nurses' individual efforts in following up-to-date evidence-based practice and having a holistic view are necessary, but also team coordination, organizational support, and elimination of nursing job problems.
International journal of nursing knowledge 02/2014; 25(1):2-8. DOI:10.1111/2047-3095.12012 · 0.40 Impact Factor
"Our study also indicates that the domains of integrated care and primary care are complementary. Most of the domains that patients described as important for integrated care, including continuity, coordination, access, and comprehensive services, are also core domains of primary care [13–17]. In essence, our study suggests that integrated care can be conceptualized as a health systems property and primary care as a key component of that system. "
[Show abstract][Hide abstract] ABSTRACT: Health care reform in the US has introduced terms such as 'the patient-centered medical home' and 'integrated care' that are often unclear and unfamiliar to patients. This study explored patient experiences with the functional domains of integrated care.
Patients first wrote their definitions of integrated care and then participated in focus group discussions about their experiences with the health care system. Transcripts were analyzed for thematic content.
Forty-four patients participated in one of seven focus groups in San Francisco, CA in English and Spanish. Many patients were not clear about the meaning of the term integrated care. However, patients described experiences largely reflected in an existing conceptual model of integrated care and the importance of coordination within and across teams and with community resources, continuity and sharing of information, and patient engagement. Patients with high medical needs described the ubiquitous challenges they faced in experiencing coordinated care.
Patients may not understand the term integrated care but are relatively clear on what the concept of integrated care entails and support its successful implementation. Patients and their families are at the center of integrated care, and health systems need to support and empower them to successfully navigate the medical neighborhood.
International journal of integrated care 03/2013; 13:e004. · 1.50 Impact Factor
"Successful referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting [1-3]. Several studies at the interface of primary and subspecialty care [4-9] suggest poor referral coordination and communication as an important contributor to delays in care,[10,11] mainly due to inappropriate timing and detail of information  and lost paperwork. "
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT:
Successful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs) (i.e., e-referrals), lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system.
We conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA) medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process.
Four themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported.
Despite facilitating information transfer between PCPs and subspecialists, e-referrals remain prone to coordination breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.
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