O'Malley Ann S, Cunningham Peter J
Center for Studying Health System Change, 600 Maryland Ave., S.W. Suite 550, Washington, DC, 20024-2512, USA.
J Gen Intern Med. 2009 Feb;24(2):170-7. doi: 10.1007/s11606-008-0885-5. Epub 2008 Dec 19.
Coordination across a patient's health needs and providers is important to improving the quality of care.
(1) Describe the extent to which adults report that their care is coordinated between their primary care physician (PCP) and specialists and (2) determine whether visit continuity with one's PCP and the PCP as the referral source for specialist visits are associated with higher coordination ratings.
Cross-sectional study of the 2007 Health Tracking Household Survey.
A total of 3,436 adults with a PCP and one or more visits to a specialist in the past 12 months.
Coordination measures were patient perceptions of (1) how informed and up to date the PCP was about specialist care received, (2) whether the PCP talked with the patient about what happened at the recent specialist visit and (3) how well different doctors caring for a patient's chronic condition work together to manage that care.
Less than half of respondents (46%) reported that their PCP always seemed informed about specialist care received. Visit continuity with the PCP was associated with better coordination of specialist care. For example, 62% of patients who usually see the same PCP reported that their PCP discussed with them what happened at their recent specialist visit vs. 48% of those who do not usually see the same PCP (adjusted percentages, p < 0.0001). When a patient's recent specialist visit was based on PCP referral (vs. self-referral or some other source), 50% reported that the PCP was informed and up to date about specialist care received (vs. 35%, p < 0.0001), and 66% reported that their PCP discussed with them what happened at their recent specialist visit (vs. 47%, p < 0.0001).
Facilitating visit continuity between the patient and PCP, and encouraging the use of the PCP as the referral source would likely enhance care coordination.
协调患者的健康需求与医疗服务提供者之间的关系对于提高医疗质量至关重要。
（1）描述成年人报告其初级保健医生（PCP）与专科医生之间的医疗协调程度；（2）确定与PCP就诊的连续性以及PCP作为专科就诊的转诊来源是否与更高的协调评分相关。
对2007年健康跟踪家庭调查的横断面研究。
共有3436名成年人，他们有一名PCP，并且在过去12个月内至少就诊过一次专科医生。
协调指标包括患者对以下方面的看法：（1）PCP对患者接受的专科护理了解程度和信息更新情况；（2）PCP是否与患者谈论过近期专科就诊的情况；（3）不同医生在护理患者慢性病方面的协作管理情况。
不到一半的受访者（46%）表示他们的PCP似乎总是了解患者接受的专科护理情况。与PCP就诊的连续性与更好的专科护理协调相关。例如，62%通常看同一位PCP的患者表示，他们的PCP与他们讨论过近期专科就诊的情况，而不常看同一位PCP的患者中这一比例为48%（调整后的百分比，p<0.0001）。当患者近期的专科就诊是基于PCP的转诊（而非自行转诊或其他来源）时，50%的患者表示PCP了解并知晓患者接受的专科护理情况（自行转诊或其他来源组为35%，p<0.0001），66%的患者表示他们的PCP与他们讨论过近期专科就诊的情况（自行转诊或其他来源组为47%，p<0.0001）。
促进患者与PCP之间就诊的连续性，并鼓励将PCP作为转诊来源，可能会加强医疗协调。
