Coordinating Care: A Major (Unreimbursed) Task of Primary Care

For several decades, first-contact care, continuity of care, comprehensive care, and coordinated care have been core attributes of primary care (1). Of these features, perhaps the most problem-ridden is the task of coordinating the care of patients among multiple entities beyond the primary care practice, that is, specialists, ancillary services, pharmacies, hospitals, and home care agencies. Studies demonstrate that referrals from primary care physicians to specialists often lack sufficient (or any) flow of information in either direction (2, 3). In this era of hospitalists, primary care physicians are often uninformed about what took place during their patients' hospital stay (4).

Care coordination is particularly important for Medicare beneficiaries because they see many different physicians. In 2003, 33% of Medicare beneficiaries visited more than 6 physicians, and 26% of beneficiaries with a diagnosis of coronary heart disease, congestive heart failure, or diabetes visited 10 or more physicians (5).

Most definitions of “coordination of care” focus on information exchange among care providers to ensure that they all act toward a common goal (6). This focus is too narrow. Coordination also takes place between providers and patients and families. In this realm, performance is also far from stellar. In 1 study, physicians did not provide clear recommendations 47% of the time, which led patients to misunderstand the advice (7). Up to 33% of physicians do not consistently notify patients of abnormal diagnostic test results (8). Eighteen percent of patients report that they received conflicting advice from different physicians, probably because their physicians had failed to …