Center for Studying Health System Change, 1100 First Street NE, 12th Floor, Washington, DC 20002-4221, USA.
Am J Manag Care. 2012 Nov 1;18(11):e398-404.
With growing pressure to improve the quality and coordination of care, physicians feel a need to streamline their relationships with other practitioners around shared care for patients. Some physicians have developed written agreements that articulate the respective responsibilities of 2 or more parties for coordination of patient care, ie, care coordination agreements (CCAs).
To describe how CCAs are formed and explore facilitators and barriers to adoption of effective CCAs, the extent to which CCAs may be replicable in different market contexts, and the implications for policies and programs that aim to improve the coordination of care.
Qualitative study of primary care physicians participating in CCAs and representatives of their specialist, hospital, or community-based partners.
Semi-structured interviews with participating providers and national thought leaders in care coordination were reviewed to develop key themes.
Agreements that address referral and access processes were considered useful by all practices that had implemented them. Practices that implemented agreements including guidance on shared management of specific clinical conditions (comanagement) also found them useful. CCAs were most successful in settings where both parties to the agreement already had stable communication pathways (such as an electronic health record [EHR], designated staff) and strong working relationships.
Policy changes (such as shifts in reimbursement to favor collaborative care or clarification of laws governing such collaborations) can help to support the development and implementation of CCAs, and can address factors that currently make some markets less supportive of coordination.
随着提高医疗质量和协调护理的压力不断增大，医生们感到需要简化他们与其他医生在共同管理患者方面的关系。一些医生已经制定了书面协议，阐明了两个或多个方在协调患者护理方面的各自责任，即护理协调协议 (CCA)。
描述 CCA 的形成方式，探讨采用有效 CCA 的促进因素和障碍、CCA 在不同市场环境下的可复制程度，以及对旨在改善护理协调的政策和计划的影响。
对参与 CCA 的初级保健医生和他们的专科医生、医院或基于社区的合作伙伴的代表进行定性研究。
对参与的提供者和护理协调方面的国家思想领袖进行半结构化访谈，以开发关键主题。
所有实施这些协议的实践都认为解决转诊和就诊流程的协议是有用的。实施包括特定临床情况共同管理指南的协议的实践也发现它们很有用。在协议双方已经有稳定的沟通途径（例如电子健康记录 [EHR]、指定的工作人员）和强大的工作关系的环境中，CCA 最为成功。
政策的改变（例如向有利于协作护理的报销方式转变或澄清有关此类合作的法律）可以帮助支持 CCA 的制定和实施，并可以解决目前使某些市场不太支持协调的因素。
