Christopher J. Stille, MD, MPH; Anthony Jerant, MD; Douglas Bell, MD, PhD; David Meltzer, MD, PhD; Joann G. Elmore, MD, MPH
Acknowledgments: The authors thank Kurt Stange, MD, PhD; Richard Wasserman, MD, MPH; and Kenneth Roberts, MD, for thoughtful advice and review of early drafts of the manuscript.
Grant Support: In part by the Robert Wood Johnson Foundation Generalist Faculty Scholars Program (grant 42206) and the National Center for Research Resources (grant G12 RR 03026-13).
Potential Financial Conflicts of Interest: None disclosed.
Corresponding Author: Christopher Stille, MD, MPH, Division of General Pediatrics, University of Massachusetts, Benedict A3-125, 55 Lake Avenue North, Worcester, MA 01655; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Stille: Division of General Pediatrics, University of Massachusetts, Benedict A3-125, 55 Lake Avenue North, Worcester, MA 01655.
Dr. Jerant: Family Medicine, University of California, Davis, School of Medicine, University of California Davis Medical Center, 4860 Y Street, Suite 2300, Sacramento, CA 95817.
Dr. Bell: Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, 911 Broxton Plaza, Room 314, Los Angeles. CA 90095-1736.
Dr. Meltzer: General Internal Medicine, Department of Economics, University of Chicago, 5841 South Maryland, MC 207, B220, Chicago, IL 60637.
Dr. Elmore: General Internal Medicine, Harborview Medical Center, Mailbox 359780, 325 Ninth Avenue, Room 10EH03, Seattle, WA 98104.
Coordinated care is a defining principle of primary care, but it is becoming increasingly difficult to provide as the health care delivery system in the United States becomes more complex. To guide recommendations for research and practice, the evidence about implementation of coordinated care and its benefits must be considered. On the basis of review of the published literature this article makes recommendations concerning needs for a better-developed evidence base to substantiate the value of care coordination, generalist practices to be the hub of care coordination for most patients, improved communication among clinicians, a team approach to achieve coordination, integration of patients and families as partners, and incorporation of medical informatics. Although coordination of care is central to generalist practice, it requires far more effort than physicians alone can deliver. To make policy recommendations, further work is needed to identify essential elements of care coordination and prove its effectiveness at improving health outcomes.
What evidence exists that care coordination improves health care?
What role should the generalist practice play in care coordination?
What improvements, if any, should be made in collaboration among generalist and subspecialty physicians?
How should teams be structured to provide optimally coordinated care?
What is the role of patients and families in care coordination?
How can medical informatics contribute to care coordination?
Table 1. Examples of Collaborative Care and Coordinated Care
Table 2. Potential Members of Generalist Coordination Teams
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Stille CJ, Jerant A, Bell D, Meltzer D, Elmore JG. Coordinating Care across Diseases, Settings, and Clinicians: A Key Role for the Generalist in Practice. Ann Intern Med. ;142:700–708. doi: 10.7326/0003-4819-142-8-200504190-00038
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Published: Ann Intern Med. 2005;142(8):700-708.
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