Effective Physician-to-Physician Communication: An Essential Ingredient for Care Coordination

Health care experts, policy makers, and patient advocacy groups have identified fragmentation of care as a major flaw in the current health care system—a flaw that has a negative effect on quality, patient outcomes, and health care costs. 1-4 A primary objective of the recently enacted Accountable Care Act (ACA) is improving care coordination.5 Two models encouraged by the ACA—patient-centered medical home and accountable care organizations (ACOs)—are espoused as approaches for achieving better coordination of care.5-7 Indeed, the proposed rules for accountable care organizations published by the Centers for Medicare and Medicaid include metrics that will be used to determine participants’ eligibility for receiving shared savings; a number of these metrics directly relate to care coordination.8 Effective communication among health care providers is essential to providing coordinated care.9 However, communication in health care has been shown to be less than optimal, with frequent gaps and errors. According to The Joint Commission, communication problems were the most commonly cited root cause of sentinel events in 2010.10 Communication between physicians—essential for the transfer of nuanced clinical information—is not immune from these frequent deficiencies. In a study of communication between referring pediatricians and consultants, specialists reported receiving communication regarding only half of initial referrals; general pediatricians reported receiving communication from consultants about initial referrals in only 84 percent of cases.11 A meta-analysis of information transfer at hospital discharge found that direct communication between hospital-based and primary care physicians was uncommon, occurring at only 3 percent to 20 percent of discharges.12 Effective communication between physicians is especially vital in certain clinical settings: between referring physicians and consultants; between emergency department or hospitalbased physicians and primary care providers; between house staff at end-of-shift; and between primary care providers caring for patients who transfer locations. Although all these settings provide important opportunities to improve communication and care coordination, we’ll focus on communication between referring and consulting physicians.