Background:
Coordination is a critical aspect of care involving multiple interdependent providers. The characteristics of care coordination among providers in a comanagement model have never been examined.
Methods:
Between April and October 2008, hospitalists, midlevels, hepatologists, and Gl fellows on a novel comanagement service (described elsewhere) were surveyed at the completion of every rotation in order to assess management style experiences including the coordinating ability of their comanaging partners using a survey instrument that on a 5‐point scale assessed the 7 domains of relational coordination: (1) frequency, (2) timeliness, (3) accuracy, and (4) problem‐solving content of communications; (5) shared goals; (6) shared knowledge; and (7) mutual respect. The mean coordination score (cs) was calculated for each of the providers, who were then ranked and categorized into tertiles of coordinating ability. The associations between cs tertiles and patient outcomes were examined. The characteristic management styles of highest and lowest cs tertile providers were evaluated and compared.
Results:
Seventy‐nine percent of surveys (176 of 224) were completed by 31 providers (15 hospitalists, 5 midlevels, 6 hepatologists, and 6 Gl fellows) who worked 1 or more shifts on (he comanaged service during the study period. Two hundred and one admissions involving 119 unique patients were managed on the service. There were 13 patient transfers to the ICU and 3 unexpected inpatient deaths. Hospitalists in the lowest compared to the highest cs tertiles were more likely to be on shift when patients were transferred to the ICU (P < 0.01). Patient admissions ending in mortality were more likely to involve hospitalists (P = 0.08), hepatologists (P = 0.02), and Gl fellows (P = 0.01) in the lowest compared to the highest cs tertiles. More providers in the highest compared to the lowest cs tertiles claimed ownership of their patients (P < 0.01). Comanaged teams that included a provider in any role in the lowest cs tertile were associated with the hospitalist and midlevel on the service desiring greater influence over management decisions. The hepatologists in the highest compared to the lowest cs tertiles claimed responsibility over broader aspects of care and delegated overlapping responsibilities of care to other comanaging providers.
Conclusions:
Relational coordination is important to patient outcomes under comanagement models of care. High coordination is a characteristic of providers who claim patient ownership and personal responsibility over various facets of patients' overall care.
Author Disclosure:
K. I. Hinami, none; D. O. Meltzer, none; C. T. Whelan, none.