Assessing and improving generalist-subspecialist communication in the shared care of children with chronic conditions

The Foundation's Generalist Physician Faculty Scholars Program was designed to support the career development of outstanding young faculty in academic departments/divisions of family practice, general internal medicine, and general pediatrics. This grant supports a study to assess and improve generalist-subspecialist communication in the shared care of children with chronic conditions. While communication between primary care providers and subspecialty consultants is essential to effective sharing of care, it is seen by many as a major problem. This is especially important for children with chronic health conditions who often require frequent visits to multiple subspecialists. Poor communication can lead to problems in care such as delayed treatment, duplication of unnecessary tests or procedures, implementation of the wrong plan, and decreased satisfaction. The purpose of this project is to provide detail on how physicians communicate in shared care and develop and pilot an intervention to improve care. The specific aims are: (1) to relate the quality of communication between general and subspecialty pediatric providers in the process of shared care to satisfaction of providers and families; (2) to determine the impact of childhood chronic illness on the quality of generalist-subspecialist communication; (3) to determine how system factors impact the quality of communication; and (4) to develop and pilot an educational and systems-based intervention for general and subspecialty practitioners to improve generalist-subspecialist communication in the office setting. This study will be in two phases. The first phase will examine the care provided to a sample of 200 children from central Massachusetts receiving subspecialty care at an academic medical center and a group-model HMO. Data will be gathered from medical records as well as questionnaires and interviews with families, subspecialists, and primary care providers participating in their care. In the second phase, they will work collaboratively with four primary care and subspecialty practices to develop and pilot an educational and systems-based intervention, using data from the first phase. The study will enroll 100 patients in this pilot intervention, with the goal of improving communication in shared care. By analyzing communication between primary care and subspecialty providers for a relatively small sample of children, the study will capture the detail that will allow them to create effective interventions at the level of the primary care and subspecialty practice.

Grant Details

Amount Awarded $300,000.00

Awarded on: 6/25/2001

Time frame: 7/1/2001 - 12/31/2005

Grant Number: 42206


University of Massachusetts Medical School Worcester

55 Lake Avenue North
Worcester, 01655-0002


Christopher J. Stille
Project Director