by discussion with contributions by all parties, active listening, openness, a willingness to consider other ideas and ask for opinions, questioning (Baggs and Schmitt, 1997; Shortell et al., 1994), and the free flow of information among participants. This type of communication is less easily achieved through electronic, mail, and telephone communications. Nonetheless, when physical integration of services is not feasible, other efforts to promote effective collaboration (i.e., communication between providers by indirect means such as shared patient records or use of a case manager) may yield benefits.


Shared patient records Coordination of care provided by different providers can also be facilitated by shared patient records and documentation practices that promote interdisciplinary information exchange. Electronic health records (EHRs) are supported as an important mechanism for sharing such information and have been highlighted as one of the essential components of the developing National Health Information Infrastructure (NHII). EHRs allow (1) the longitudinal collection of electronic information pertaining to an individual’s health and health care; (2) immediate electronic access—by authorized users only—to person- and population-level information; (3) provision of knowledge and decision support to enhance the quality, safety, and efficiency of patient care; and (4) support for efficient processes of health care delivery (IOM, 2003b). Although still in a minority, hospitals and ambulatory practices are increasingly investing in EHRs; these investments typically are being made by larger facilities, creating what is referred to as the “adoption gap” between large and small organizations (Brailer and Terasawa, 2003). Although sharing of patient information maintained in paper-based records can still take place, the capture and storage of patient information electronically is endorsed as a more thorough and efficient mechanism for timely access to needed information by the many providers serving a patient.


Case (care) management Case (or care) management refers to varying combinations of actions performed by a designated individual18 (i.e., case manager) to arrange for, coordinate, and monitor health, psychological, and social services important to an individual’s recovery from illness and the effects of these services on the patient’s health. Although the services encompassed by case management often vary by the severity of the illness, the needs of the individual, and the specific model of case management

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We distinguish in this section between case management, provided by an additional resource person working with both the patient and the involved clinicians, and disease management programs. The latter often involve transfer of the overall medical and related health care management of a patient’s specific disease to a separate organization or program, frequently through a contract. Disease management programs can also offer case management services by an individual as a part of their approach to disease management.



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