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).

REFERENCES

AHRQ (Agency for Healthcare Research and Quality). 2010. The CAHPS database: Preliminary comparative data for the CAHPS clinician & group survey (12-month version). Rockville, MD: AHRQ.

American Diabetes Association. 2011. Diagnosis and classification of diabetes mellitus. Diabetes Care 34(Suppl. 1):S62-S69.

Anderson, G. F. 2010. Chronic care: Making the case for ongoing care. Princeton, NJ: Robert Wood Johnson Foundation.

Anderson, G. F., and J. Horvath. 2004. The growing burden of chronic disease in America. Public Health Reports 119(3):263.

Antman, E. M., J. Lau, B. Kupelnick, F. Mosteller, and T. C. Chalmers. 1992. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. Journal of the American Medical Association 268(2):240-248.

Antman, E. M., D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, G. A. Lamas, C. J. Mullany, J. P. Ornato, D. L. Pearle, M. A. Sloan, S. C. Smith, J. S. Alpert, J. L. Anderson, D. P. Faxon, V. Fuster, R. J. Gibbons, G. Gregoratos, J. L. Halperin, L. F. Hiratzka, S. A. Hunt, A. K. Jacobs, American College of Cardiology, American Heart Association Task Force on Practice Guidelines, and Canadian Cardiovascular Society. 2004. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation 110(9):e82-e292.



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