Care coordination is more than a T-shirt slogan


A T-shirt advertised online reads, “Keep calm and let the patient care coordinator handle it.” The shirt must be popular, or maybe just a source of gallows humor, for those engaged in this noble pursuit.

But the underlying question of who is coordinating our medical care is a serious one. By one estimate, inadequate care coordination costs between $25 to $45 billion annually. For the individual patient with a chronic illness, inadequate coordination can increase the average cost of disease management by more than $4500 over three years. And estimates don’t account for the toll that suffering takes on the patient and the family.

For older patients, problems stemming from poor or nonexistent care coordination are especially grim. A Harris poll released just over a year ago showed that 70 percent of seniors rely on family or have no one to help them coordinate their health care needs. And in the critical months immediately following hospitalization, 63 percent reported that no one helped them coordinate their care. All of us should be alarmed by these findings.

Seniors aren’t the only ones in need of medical management, of course, but their needs are particularly pronounced as they have more illnesses, take more medication and may be less able to manage their own care. They also have more hospitalizations. Of the 35 million hospital admissions every year, seniors account for approximately 40 percent.

Being sick is bad enough. Patients and their families trying to cope with the medical bureaucracy often feel like tourists lost in a strange land where they don’t know the language, the culture or the customs. The burden can be crushing.

Over the years, my husband has been hospitalized multiple times for serious, sometimes life-threatening, illnesses. I have no medical training but lots of experience working in bureaucracies, running interference and getting results. So I have become his de facto advocate, playing a key role working with doctors and nurses, participating in medical decision-making and often coordinating his care.

My husband says he is lucky to have me involved and playing an active role. And I suppose that’s true. Nonetheless, solving the problems of care coordination would help all patients benefit from the best that medicine has to offer.

There are decent efforts underway, but they tend to be limited. For example, professional hospital advocates can be helpful, so long as patients or their families know they exist and can call upon their services. Some facilities assign nurse navigators to help guide and advise patients, especially those undergoing cancer treatment. Other care institutions provide routine follow-up phone calls following discharge and even take the extra step of having nurses visit high-risk patients in person.

These steps are all good, but far from universal. More advocates, nurse navigators, and follow-up visits could certainly help improve care coordination for many patients.

Here are additional steps that would also help:

  1. Require doctors to communicate directly with one another—in person or by phone — on a periodic basis when two or more are involved in patient care in the hospital or another facility.
  2. Notes in the electronic file are often cryptic, leave too much room for misunderstanding and are easily overlooked.
  3. Insist that hospitalists or attending physicians consult with primary care physicians when patients are admitted to and discharged from hospitals, nursing homes or rehabilitation facilities. And, add to that a requirement that, upon discharge, medical records must be shared immediately — within 24 to 48 hours — with the PCP.
  4. Strengthen discharge planning procedures when patients transfer from one medical facility to another or to home. Too often, important details about patient care and needs fall between the cracks during these transitions. Well-tested models are available and ready to be implemented.
  5. Improve education, training, and coaching for patients and families to increase their knowledge, understanding, and skill in adapting to home care and recuperation. Families should be treated as partners — not outliers — in the process.
  6. Compensate doctors for the time they spend coordinating and consulting with one another on a patient’s behalf. If we want our medical professionals to do a better job communicating, we must provide incentives.

Critics may argue that these steps will cost doctors, hospitals, and other facilities time and money. Others might claim that insurance companies and Medicare are already under pressure to comply with too many mandates. There is some truth to their concerns. But strengthening coordination of care can improve patient outcomes, reduce readmission rates, save money and — most importantly — save lives. These are results that should be well worth everyone’s investment. Put that on a T-shirt!

Bonnie Friedman is the author of Hospital Warrior: How to Get the Best Care for Your Loved One and can be reached at Hospital Warrior.

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