National Healthcare Quality and Disparities Report
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Topics
- Ambulatory Care and Surgery (1)
- Blood Pressure (1)
- Burnout (1)
- Cancer (1)
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- Care Coordination (1)
- Care Management (1)
- Children/Adolescents (2)
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- Clinician-Patient Communication (7)
- (-) Communication (24)
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- Electronic Health Records (EHRs) (2)
- Evidence-Based Practice (4)
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- Implementation (3)
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- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (1)
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- Patient-Centered Outcomes Research (2)
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- Patient Safety (1)
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- Prevention (3)
- (-) Primary Care (24)
- Primary Care: Models of Care (3)
- Provider (2)
- Provider: Physician (1)
- Quality Improvement (4)
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- Shared Decision Making (1)
- Stress (1)
- Teams (5)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedHood-Medland EA, White AEC, Kravitz RL
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
This study looked at primary care visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience with patients taking opioids for chronic pain. The study analyzed 83 video-recorded US primary care visits at a single academic medical center in California. A total of 49 family medicine and internal resident physicians and 83 patients were filmed. The authors developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discusses. They identified 2 visit opening styles with agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda opening styles (open-ended question, patient launch, physician launch). Only 11% of visits included agenda setting and was associated with fewer surprise patient topics than visits without agenda setting.
AHRQ-funded; HS022236.
Citation: Hood-Medland EA, White AEC, Kravitz RL .
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
BMC Fam Pract 2021 Jan 4;22(1):4. doi: 10.1186/s12875-020-01317-4..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Clinician-Patient Communication, Communication, Ambulatory Care and Surgery
Pestka DL, Paterson NL, Benedict KA
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
As part of a population health-focused primary care transformation, in 2019 a health system in Minnesota developed a primary care team to exclusively care for high-cost high-need patients. Through its development and implementation, the team has discovered several key lessons in delivering care to complex patients. In this paper, the authors discuss lessons learned from their research.
AHRQ-funded; HS026379.
Citation: Pestka DL, Paterson NL, Benedict KA .
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211023888. doi: 10.1177/21501327211023888..
Keywords: Primary Care, Primary Care: Models of Care, Healthcare Delivery, Teams, Communication, Implementation
Howland C, Despins L, Sindt J
Primary care clinic nurse activities with a telehealth monitoring system.
The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients using a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those assuming usual care. Significant differences were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up, providing evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.
AHRQ-funded; HS017035.
Citation: Howland C, Despins L, Sindt J .
Primary care clinic nurse activities with a telehealth monitoring system.
West J Nurs Res 2021 Jan;43(1):5-12. doi: 10.1177/0193945920923082..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Primary Care, Clinician-Patient Communication, Communication, Patient Self-Management, Nursing, Patient-Centered Healthcare, Diabetes
Lee YSH, King MD, Anderson D
The how matters: how primary care provider communication with team relates to patients' disease management.
This study examined how primary care provider (PCP)-team communication relates to patients’ disease management. A longitudinal study was conducted of how 3 aspects of PCP-care team communication including participation, time spent listening, an uninterrupted speaking length relate to disease management of patients with hypertension or diabetes. The study recruited 27 PCPs and 98 team members serving 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. Data was collected using sociometric sensors worn by PCPs and team members, surveys on patient-PCP communication, and electronic records which extracted PCP and patient characteristics. Results showed that PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. Greater PCP participation, listening, and length of uninterrupted time speaking were associated with significantly higher odds that their patients had controlled hypertension and diabetes.
AHRQ-funded; HS016978.
Citation: Lee YSH, King MD, Anderson D .
The how matters: how primary care provider communication with team relates to patients' disease management.
Med Care 2020 Jul;58(7):643-50. doi: 10.1097/mlr.0000000000001342..
Keywords: Primary Care, Communication, Teams, Provider, Quality of Care
McHugh M, Brown T, Walunas TL
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
The authors sought to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators as well as factors that may contribute to them. Through individual interviews, they found that turnover of staff was frequently reported in dyads with contrasting perspectives. They recommended that planners of quality improvement initiatives using practice facilitation consider taking steps to minimize contrasting perspectives by addressing turnover challenges and encouraging opportunities to share perspectives.
AHRQ-funded; HS023921.
Citation: McHugh M, Brown T, Walunas TL .
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
J Healthc Qual 2020 May/Jun;42(3):e32-e38. doi: 10.1097/jhq.0000000000000223..
Keywords: Primary Care, Quality Improvement, Quality of Care, Implementation, Communication, Provider
Kim LY, Giannitrapani KF, Huynh AK
What makes team communication effective: a qualitative analysis of interprofessional primary care team members' perspectives.
This paper describes the elements of effective communication as perceived by members of interprofessional patient-centered medical home primary care teams and identified elements of effective communication that have persisted over time. Nine elements of effective communication emerged: shared knowledge, situation/goal awareness, problem-solving, mutual respect, transparency, timeliness, frequency, consistency, and parsimony. Recommendations included comprehensive quality improvement efforts incorporating a variety of strategies to facilitate communication of pertinent patient information in a brief and concise manner.
AHRQ-funded; HS000046.
Citation: Kim LY, Giannitrapani KF, Huynh AK .
What makes team communication effective: a qualitative analysis of interprofessional primary care team members' perspectives.
J Interprof Care 2019 Nov-Dec;33(6):836-38. doi: 10.1080/13561820.2019.1577809..
Keywords: Teams, Communication, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare
Ronis SD, Kleinman LC, Stange KC
A learning loop model of collaborative decision-making in chronic illness.
In this article, the authors discuss their learning loop model, which posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians.
AHRQ-funded; HS024433.
Citation: Ronis SD, Kleinman LC, Stange KC .
A learning loop model of collaborative decision-making in chronic illness.
Acad Pediatr 2019 Jul;19(5):497-503. doi: 10.1016/j.acap.2019.04.006..
Keywords: Children/Adolescents, Chronic Conditions, Shared Decision Making, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Clinician-Patient Communication, Communication
Chou AF, Homco JB, Nagykaldi Z
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
The Healthy Hearts for Oklahoma (H2O) Study proposes to build a quality improvement (QI) infrastructure by (1) constructing a sustainable Oklahoma Primary Healthcare Improvement Collaborative (OPHIC) to support dissemination and implementation (D&I) of QI methods; and (2) providing QI support in primary care practices to better manage patients at risk for cardiovascular disease (CVD) events. H2O has 263 small primary care practices across Oklahoma that receive the bundled QI intervention to improve ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) performance. The infrastructure established as a result of this funding will help reach medically underserved Oklahomans, particularly among rural and tribal populations.
AHRQ-funded; HS023919.
Citation: Chou AF, Homco JB, Nagykaldi Z .
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
BMC Health Serv Res 2018 Jun 4;18(1):404. doi: 10.1186/s12913-018-3189-4.
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Keywords: Cardiovascular Conditions, Communication, Heart Disease and Health, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Prevention, Quality of Care, Quality Improvement
Holtrop JS, Ruland S, Diaz S
Using social network analysis to examine the effect of care management structure on chronic disease management communication within primary care.
The investigators examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. They sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Using surveys, they found that social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. They concluded that structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.
AHRQ-funded; HS022690.
Citation: Holtrop JS, Ruland S, Diaz S .
Using social network analysis to examine the effect of care management structure on chronic disease management communication within primary care.
J Gen Intern Med 2018 May;33(5):612-20. doi: 10.1007/s11606-017-4247-z.
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Keywords: Care Management, Chronic Conditions, Communication, Primary Care, Teams
Meyers D, Miller T, Genevro J
AHRQ Author: Meyers D, Miller T, Genevro J, Zhan C, De La Mare J, Fournier A, Bennett H, McNellis RJ
EvidenceNOW: Balancing primary care implementation and implementation research.
In 2015, AHRQ invested in the largest primary care research project in its history. EvidenceNOW is a $112 million effort to disseminate and implement patient-centered outcomes research evidence in more than 1,500 primary care practices and to study how quality-improvement support can build the capacity of primary care practices to understand and apply evidence. EvidenceNOW comprises 7 implementation research grants, each funded to provide external quality-improvement support to primary care practices to implement evidence-based cardiovascular care and to conduct rigorous internal evaluations of their work.
AHRQ-authored.
Citation: Meyers D, Miller T, Genevro J .
EvidenceNOW: Balancing primary care implementation and implementation research.
Ann Fam Med 2018 Apr;16(Suppl 1):S5-s11. doi: 10.1370/afm.2196.
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Keywords: Cardiovascular Conditions, Communication, Evidence-Based Practice, Heart Disease and Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Primary Care, Quality of Care, Quality Improvement, Implementation
Kurth AE, Krist AH, Borsky AE
AHRQ Author: Borsky AE, Fan T, Weinstein R
U.S. Preventive Services Task Force methods to communicate and disseminate clinical preventive services recommendations.
The U.S. Preventive Services Task Force (USPSTF) issues evidence-based screening and prevention recommendations, and key to this task is dissemination and implementation of these recommendations. This paper outlines the approaches used by the USPSTF to both solicit input (e.g., public comment periods), as well as to facilitate dissemination of its recommendations to help improve the health of all Americans (e.g., web-based and mobile application tools, journal publications, and annual reports to Congress).
AHRQ-authored.
Citation: Kurth AE, Krist AH, Borsky AE .
U.S. Preventive Services Task Force methods to communicate and disseminate clinical preventive services recommendations.
Am J Prev Med 2018 Jan;54(1s1):S81-s87. doi: 10.1016/j.amepre.2017.07.004.
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Keywords: Communication, Evidence-Based Practice, Guidelines, Prevention, Primary Care, U.S. Preventive Services Task Force (USPSTF)
Ganiats TG, Bierman AS
AHRQ Author: Ganiats TG, Bierman AS
AHRQ's tools for better practice: helping family physicians manage today's challenges.
AHRQ is engaged in the dissemination and widespread implementation of what works in primary care. The agency’s main point of contact with the primary care community is the National Center for Excellence in Primary Care Research (NCEPCR). The authors discuss the variety of tools and resources made available by the NCEPCR.
AHRQ-authored.
Citation: Ganiats TG, Bierman AS .
AHRQ's tools for better practice: helping family physicians manage today's challenges.
Am Fam Physician 2017 Nov 1;96(9):569-70.
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Keywords: Communication, Evidence-Based Practice, Provider: Physician, Primary Care, Tools & Toolkits
Turer CB, Barlow SE, Montano S
Discrepancies in communication versus documentation of weight-management benchmarks: analysis of recorded visits with Latino children and associated health-record documentation.
To examine gaps in communication versus documentation of weight-management clinical practices, communication was recorded during primary care visits with 6- to 12-year-old overweight/obese Latino children. The researchers found that benchmarks were neither communicated nor documented in up to 42 percent of visits, and communicated but not documented or documented but not communicated in up to 20 percent of visits.
AHRQ-funded; HS022418.
Citation: Turer CB, Barlow SE, Montano S .
Discrepancies in communication versus documentation of weight-management benchmarks: analysis of recorded visits with Latino children and associated health-record documentation.
Glob Pediatr Health 2017 Feb 6;4:2333794x16685190. doi: 10.1177/2333794x16685190.
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Keywords: Children/Adolescents, Communication, Obesity, Primary Care, Obesity: Weight Management
Shoemaker SJ, Parchman ML, Fuda KK
AHRQ Author: Ricciardi
A review of instruments to measure interprofessional team-based primary care.
The study’s aims were to develop a conceptual framework of high-functioning primary care teams to identify and review instruments that measure the constructs identified in the framework. The majority of instruments were surveys, and the remainder were observational checklists. They addressed multiple constructs, most commonly communication, heedful interrelating , respectful interactions, and shared explicit goals.
AHRQ-authored.
Citation: Shoemaker SJ, Parchman ML, Fuda KK .
A review of instruments to measure interprofessional team-based primary care.
J Interprof Care 2016 Jul;30(4):423-32. doi: 10.3109/13561820.2016.1154023..
Keywords: Communication, Healthcare Delivery, Primary Care, Teams
Meyer AN, Murphy DR, Singh H
Communicating findings of delayed diagnostic evaluation to primary care providers.
In this study, researchers examined the effectiveness of various communication strategies to inform primary care practitioners (PCPs) about the delayed follow-up of cancer-related abnormal or "red-flag" findings. They found that strategies (emails, phone calls, contacting clinic directors) to communicate to PCPs information on delayed follow-up of findings suspicious for cancer were useful, but not fail-safe.
AHRQ-funded; HS022901.
Citation: Meyer AN, Murphy DR, Singh H .
Communicating findings of delayed diagnostic evaluation to primary care providers.
J Am Board Fam Med 2016 Jul-Aug;29(4):469-73. doi: 10.3122/jabfm.2016.04.150363.
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Keywords: Cancer, Communication, Diagnostic Safety and Quality, Primary Care
Menon S, Murphy DR, SIngh H
Workarounds and test results follow-up in electronic health record-based primary care.
This study sought to understand why primary care practitioners use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management. It concluded that workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs.
AHRQ-funded; HS022901; HS022087.
Citation: Menon S, Murphy DR, SIngh H .
Workarounds and test results follow-up in electronic health record-based primary care.
Appl Clin Inform 2016 Jun 22;7(2):543-59. doi: 10.4338/aci-2015-10-ra-0135.
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Keywords: Communication, Electronic Health Records (EHRs), Primary Care, Workflow
Robinson JD, Tate A, Heritage J
Agenda-setting revisited: when and how do primary-care physicians solicit patients' additional concerns?
The authors assessed the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. They found that physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits. Further, those that were formatted so as to allow for 'concerns' were significantly more likely to generate some type of agenda item.
AHRQ-funded; HS010922; HS013343.
Citation: Robinson JD, Tate A, Heritage J .
Agenda-setting revisited: when and how do primary-care physicians solicit patients' additional concerns?
Patient Educ Couns 2016 May;99(5):718-23. doi: 10.1016/j.pec.2015.12.009.
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Keywords: Communication, Primary Care, Patient-Centered Healthcare, Patient Safety, Clinician-Patient Communication
Murphy DR, Meyer AN, Russo E
The burden of inbox notifications in commercial electronic health records.
The researchers quantified the notifications that physicians received via inboxes of commercial EHRs to estimate their burden. They found that across 3 sites, 46 primary care physicians received a mean of 76.9 total notifications per day; of which a mean of 15.5 notifications per day (20.2 percent) were related to test results.
AHRQ-funded; HS022087.
Citation: Murphy DR, Meyer AN, Russo E .
The burden of inbox notifications in commercial electronic health records.
JAMA Intern Med 2016 Apr;176(4):559-60. doi: 10.1001/jamainternmed.2016.0209..
Keywords: Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care
Garg SK, Lyles CR, Ackerman S
Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.
The researchers interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation. Sites interviewed applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. Patient privacy government regulations emerged as a crucial barrier. A technical challenge was the inablitiy to integrate texting platforms with electronic health records. The authors concluded that inadequate data management capabilities and unclear privacy and security regulations for mobile health technology slowed the initial implementation and limited the clinical use of texting in the safety net and scope of pilots.
AHRQ-funded; HS022047; HS022408.
Citation: Garg SK, Lyles CR, Ackerman S .
Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.
BMC Med Inform Decis Mak 2016 Feb 6;16:16. doi: 10.1186/s12911-016-0258-7.
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Keywords: Communication, Primary Care, Telehealth, Health Information Technology (HIT), Clinician-Patient Communication
Mirsky JB, Tieu L, Lyles C
A mixed-methods study of patient-provider e-mail content in a safety-net setting.
The researchers explored the content of patient-provider e-mails in a safety-net primary care clinic, by conducting a content analysis using inductive and deductive coding of e-mail exchanges. Their results showed that patients in safety-net clinics are capable of safely and effectively using electronic messaging for between-visit communication with providers.
AHRQ-funded; HS022408; HS023558.
Citation: Mirsky JB, Tieu L, Lyles C .
A mixed-methods study of patient-provider e-mail content in a safety-net setting.
J Health Commun 2016;21(1):85-91. doi: 10.1080/10810730.2015.1033118..
Keywords: Communication, Health Information Technology (HIT), Patient and Family Engagement, Primary Care, Web-Based
Mirsky JB, Tieu L, Lyles C
Readability assessment of patient-provider electronic messages in a primary care setting.
The purpose of this study was to generate hypotheses about the readability of patient and provider electronic messages. It found that patients used more words in their initial e-mails compared to providers, but the Flesch-Kincaid Grade Levels (FKGLs) were similar, and 68 percent of provider messages were written below an FKGL = 8.
AHRQ-funded; HS023558; HS022408.
Citation: Mirsky JB, Tieu L, Lyles C .
Readability assessment of patient-provider electronic messages in a primary care setting.
J Am Med Inform Assoc 2016 Jan;23(1):202-6. doi: 10.1093/jamia/ocv087.
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Keywords: Communication, Health Information Technology (HIT), Health Literacy, Primary Care, Clinician-Patient Communication
Schussler-Fiorenza Rose SM, Gangnon RE, Chewning B
Increasing discussion rates of incontinence in primary care: a randomized controlled trial.
The study’s aim was to evaluate whether the use of an electronic pelvic floor assessment questionnaire (ePAQ-PF) improves communication about incontinence in primary care. It found that use of the ePAQ-PF prior to clinic visits increases discussion of urinary and fecal incontinence, particularly clinician-initiated discussion.
AHRQ-funded; HS017028.
Citation: Schussler-Fiorenza Rose SM, Gangnon RE, Chewning B .
Increasing discussion rates of incontinence in primary care: a randomized controlled trial.
J Womens Health 2015 Nov;24(11):940-9. doi: 10.1089/jwh.2015.5230..
Keywords: Clinician-Patient Communication, Communication, Primary Care, Women
Linzer M, Poplau S, Grossman E
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
This study aimed to assess if improvements in work conditions reduce clinician stress and burnout. It found that burnout was more likely to improve with workflow interventions and with targeted QI projects than in controls. Also, interventions in communication or workflow led to greater improvements in clinician satisfaction.
AHRQ-funded; HS018160.
Citation: Linzer M, Poplau S, Grossman E .
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
J Gen Intern Med 2015 Aug;30(8):1105-11. doi: 10.1007/s11606-015-3235-4..
Keywords: Burnout, Stress, Primary Care, Workflow, Quality Improvement, Quality of Care, Communication
Jones CD, Vu MB, O'Donnell CM
A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations.
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. Hospitalists and PCPs were found to encounter similar care coordination challenges, including (1) lack of time, (2) difficulty reaching other clinicians, and (3) lack of personal relationships with other clinicians.
AHRQ-funded; HS020940.
Citation: Jones CD, Vu MB, O'Donnell CM .
A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations.
J Gen Intern Med 2015 Apr;30(4):417-24. doi: 10.1007/s11606-014-3056-x..
Keywords: Care Coordination, Communication, Hospital Discharge, Hospitalization, Primary Care