If accountable care organizations and healthcare reform practices have a chance of improving quality and lowering cost, primary care providers and specialists must share essential information about their patients in a timely way. But that essential communication happens rarely, according to research published in this week's Archives of Internal Medicine.
Worse, specialists and primary care physicians don't even know how much essential communication they're not sharing, because their perceptions of how much timely information is exchanged varies greatly.
Ann O'Malley, MD, and James Reschovsky, of the Center for Studying Health System Change in Washington, D.C. say they believe their study is the "first nationally representative study of physicians to describe interspecialty communication regarding consultations and referrals."
The researchers surveyed 4,720 physicians in both camps who provide at least 20 hours per week of direct patient care. They analyzed responses sent to the Center's 2008 Health Tracking Physician Survey, the fifth in a series since 1996.
For example, questions asked of primary care providers were "When referring a patient to a specialist, how often do you send the specialist notification of the patient's history and the reason for consultation?" and "How often do you receive useful information about your referred patients from specialists?"
Specialists, on the other hand, were asked " When you see a patient referred to you by a PCP, how often do you receive notification of the patient's medical history and reason for consultation?" and "For patients who were referred t you by a PCP, how often do you send the PCP notification of the results of your consultation and advice to the patient?"
Responses could be "always," "most of the time," "sometimes," "seldom or never" and "not applicable."
The way the two groups answered those questions varied "significantly," O'Malley and Reschovsky wrote.
For example, although 69.3% of primary care providers said they "always" or "most of the time" send specialists notification of a patient's history and reason for consultation and referral, only 34.8% of specialists said they always or most of the time receive that notification.
Likewise, specialists said that 80.6% of the time they always or most of the time send PCPs results of their consult and what advice they gave patients, only 62.2% of PCPs reported they received that information.
Perhaps even more important, both groups of doctors said that the failure to consistently receive this information from the PCP or the specialist threatened their ability to provide high quality care.
The authors say that health information technology systems, ACOs, and medical homes "have the potential to strengthen financial incentives, structures and care processes to support communication."
In a related commentary, Alice Hm Chen, MD and Hal F. Yee, MD of the Department of Medicine at the University of California San Francisco, noted that the issue's importance "is underscored by the sheer number of physicians potentially involved in any given patient's care."
They pointed to a study that found that "in caring for 100 Medicare patients, the average PCP needs to coordinate care with 99 other physicians working across 53 practices."
The report may be viewed here.