Conclusion 2-3: Care delivery has become increasingly fragmented, leading to coordination and communication challenges for patients and clinicians.

Related findings:

  • Coordinating a patient’s care has become more demanding for clinicians. One study found that in a single year, a typical primary care physician coordinated with an average of 229 other physicians in 117 different practices just for his or her Medicare patient population (see Chapter 3).
  • Patients see a large number and variety of clinicians for their care. Between 2000 and 2002, fee-for-service Medicare patients saw an average of seven physicians, including five specialists, split among four different practices (see Chapter 3).
  • The involvement of multiple providers tends to blur accountability. One survey found that 75 percent of hospital patients were unable to identify the clinician in charge of their care (see Chapter 3).


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