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19 April 2005 | Volume 142 Issue 8 | Pages 700-708
Coordinated care is a defining principle of primary care, but it is becoming increasingly difficult to provide as the health care delivery system in the United States becomes more complex. To guide recommendations for research and practice, the evidence about implementation of coordinated care and its benefits must be considered. On the basis of review of the published literature this article makes recommendations concerning needs for a better-developed evidence base to substantiate the value of care coordination, generalist practices to be the hub of care coordination for most patients, improved communication among clinicians, a team approach to achieve coordination, integration of patients and families as partners, and incorporation of medical informatics. Although coordination of care is central to generalist practice, it requires far more effort than physicians alone can deliver. To make policy recommendations, further work is needed to identify essential elements of care coordination and prove its effectiveness at improving health outcomes.
Author and Article Information
From University of Massachusetts Medical School, Worcester, Massachusetts; University of California, Davis, Sacramento, and University of California, Los Angeles, Los Angeles, California; University of Chicago, Chicago, Illinois; and University of Washington, Seattle, Washington.
Acknowledgments: The authors thank Kurt Stange, MD, PhD; Richard Wasserman, MD, MPH; and Kenneth Roberts, MD, for thoughtful advice and review of early drafts of the manuscript.
Grant Support: In part by the Robert Wood Johnson Foundation Generalist Faculty Scholars Program (grant 42206) and the National Center for Research Resources (grant G12 RR 03026-13).
Potential Financial Conflicts of Interest: None disclosed.
Corresponding Author: Christopher Stille, MD, MPH, Division of General Pediatrics, University of Massachusetts, Benedict A3-125, 55 Lake Avenue North, Worcester, MA 01655; e-mail, stillec{at}ummhc.org.
Current Author Addresses: Dr. Stille: Division of General Pediatrics, University of Massachusetts, Benedict A3-125, 55 Lake Avenue North, Worcester, MA 01655.
Dr. Jerant: Family Medicine, University of California, Davis, School of Medicine, University of California Davis Medical Center, 4860 Y Street, Suite 2300, Sacramento, CA 95817.
Dr. Bell: Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, 911 Broxton Plaza, Room 314, Los Angeles. CA 90095-1736.
Dr. Meltzer: General Internal Medicine, Department of Economics, University of Chicago, 5841 South Maryland, MC 207, B220, Chicago, IL 60637.
Dr. Elmore: General Internal Medicine, Harborview Medical Center, Mailbox 359780, 325 Ninth Avenue, Room 10EH03, Seattle, WA 98104. SUPPLEMENT: THE FUTURE OF GENERALISM IN MEDICINE
Eric B. Larson, MD, MPH; Kenneth B. Roberts, MD; Kevin Grumbach, MD, and Christine Laine, MD, MPH, Editors
Coordinating Care across Diseases, Settings, and Clinicians: A Key Role for the Generalist in Practice
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