Coordinating Care Across Diseases, Settings and Clinicians

The complexity of the United States health care delivery system presents specific difficulties for the provision of coordinated care. In 2003, the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars program began a review of the state of coordinated care and implications for the future of generalist research, education and practice. Literature reviews of published material were conducted by a panel of five physicians and six key recommendations were made regarding gaps in current coordination of care research. More than 100 scholars, mentors and nationally acknowledged experts on generalist physician practice further discussed and refined these recommendations at the 2003 national program meeting.

Key Findings:

  • More evidence is needed to substantiate the value of care coordination in improving health outcomes and to identify the most useful components to be included in models of care coordination.
  • Additional recommendations for research include: creating generalist practices as the center of care coordination, improving communication among clinicians, utilizing a team approach to achieve coordination, integrating patients and families as partners and incorporating medical informatics.