Coordinated Care Needed Now

Joe Cantlupe, for HealthLeaders Media , September 16, 2010

"Primary care is the bedrock of a good healthcare system, but this report is saying just having more primary care will not necessarily fix our quality of care," says another co-author, Shannon Brownlee, MS.  Other report authors are David C. Goodman, MD, MS and  Chiang-Hua Chang, PhD. "It means that healthcare policy should focus on improving the actual services primary care clinicians provide, and make sure their efforts are coordinated with other providers, including specialists, nurses and hospitals."

While improving care delivered by primary care clinicians holds promise for a patient's wellbeing, the "value of primary care can be eroded by episodic delivery that is uncoordinated with specialists and hospitals," the study says. "Thus, simply increasing access to primary care, either by boosting the number of primary care physicians in an area or by ensuring that most patients have better insurance coverage, may not be enough to improve the quality of care or health outcomes; nor is it likely to eliminate racial disparities."

Brownlee, a writer and senior research fellow at the New America Foundation, says she was surprised by the findings. "I think part of what is happening is the chaos factor"—primary care physicians working in isolated practices, with a lack of coordination with specialists, such as for diabetes or other medical conditions, she says.

"Was the heart attack patient prescribed aspirin and a beta blocker on discharge?" she asks rhetorically. Sometimes, or too often, that doesn't happen because of the lack of coordination, Brownlee says. "It is really crucial to keep track of a patient. If the patient only knows what is happening, you've got a big problem."  Brownlee is a specialist in healthcare writing and has written "Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer."

In essence, the Dartmouth study shows that "organization of the system is a big part of the problem," Brownlee says, adding that "simply throwing more physicians at a problem is not going to fix it."

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5 comments on "Coordinated Care Needed Now"

John Morrow (9/18/2010 at 11:44 AM)
Buz is right...the last time I checked FFS data doesn't have an indicator for who got coordinated care and who didn't, so the conclusions are quite anecdotal, and biased toward the author's business interests in the health coaching industry. I think we are all seeking better care, but if we have no access to care, coordination is way downstream as the end solution. More PCPs will address access and allow for more appropriate coordination...assuming someone will reimburse for these services. Once again another self-serving bit of folly out of Dart_mouth.

Bob Stone (9/17/2010 at 11:07 AM)
There is certainly no question that better coordinated care must be part of any solution that is likely to be effective in improving heealth and well-being, as well as reeducing cost. I find it interesting, however, that [INVALID] at least according to this report [INVALID] most call for coordianted care seem to focus on coordination between elements of the delivery system. While there is certainly room for improvement in that area, I am surprised by the absence of reference to the need for the individual's and/or caregiver's active involvement in the coordination effort. In most cases, and in particular cases involving individual with chronic disease, it is the individual who is responsible for their own care [INVALID] sometimes as much as 98% of the time. Accordingly, unless the coordination infrastructure is focused primarily on the individual and is interacting with him or her on a regular and proactive basis, the opportunity to avoid the need for coordination among the elements of the "sick system" is lost, and cost will inevitably increase.

HD Carroll (9/17/2010 at 9:35 AM)
(1) Poverty, whether you spell it with hyphens or not, is a relative term, and measuring it is trying to define a moving target - the US Government is infamous for not adjusting the income definition. Having said that, I am certain housing, shelter, education, and hygiene (which in my terms includes basic preventative medicine) deficits have a lot to do with health outcomes - it is improvement overall in those items that caused the large majority of improvements in both morbidity and mortality since 1900. For certain demographic segments of the population such improvements are likely still available, with the education/cultural shift components being the primary ones. (2) the study period involved may simply turn out to be viewed historically as a time before true primary care shortages actually came about due to failure in medical education and the sudden influx of millions of new insured persons suddenly seeking the free wellness benefits promised by the reform laws. Do the study in 15 years and let's see if the situation has changed at all. (3) Of course we need more and better coordinated care - when have we not?




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