Coordinated Care Needed Now

Neither higher amounts of primary care services nor routine visits with a primary care clinician is by itself a guarantee that a patient will experience better health outcomes.  What works? Coordination of care, the authors of a Dartmouth study say.

5 comments on "Coordinated Care Needed Now"
John Morrow (9/18/2010 at 11:44 AM)

Buz is right...the last time I checked FFS data doesn't have an indicator for who got coordinated care and who didn't, so the conclusions are quite anecdotal, and biased toward the author's business interests in the health coaching industry. I think we are all seeking better care, but if we have no access to care, coordination is way downstream as the end solution. More PCPs will address access and allow for more appropriate coordination...assuming someone will reimburse for these services. Once again another self-serving bit of folly out of Dart_mouth.
Bob Stone (9/17/2010 at 11:07 AM)

There is certainly no question that better coordinated care must be part of any solution that is likely to be effective in improving heealth and well-being, as well as reeducing cost. I find it interesting, however, that [INVALID] at least according to this report [INVALID] most call for coordianted care seem to focus on coordination between elements of the delivery system. While there is certainly room for improvement in that area, I am surprised by the absence of reference to the need for the individual's and/or caregiver's active involvement in the coordination effort. In most cases, and in particular cases involving individual with chronic disease, it is the individual who is responsible for their own care [INVALID] sometimes as much as 98% of the time. Accordingly, unless the coordination infrastructure is focused primarily on the individual and is interacting with him or her on a regular and proactive basis, the opportunity to avoid the need for coordination among the elements of the "sick system" is lost, and cost will inevitably increase.
HD Carroll (9/17/2010 at 9:35 AM)

(1) Poverty, whether you spell it with hyphens or not, is a relative term, and measuring it is trying to define a moving target - the US Government is infamous for not adjusting the income definition. Having said that, I am certain housing, shelter, education, and hygiene (which in my terms includes basic preventative medicine) deficits have a lot to do with health outcomes - it is improvement overall in those items that caused the large majority of improvements in both morbidity and mortality since 1900. For certain demographic segments of the population such improvements are likely still available, with the education/cultural shift components being the primary ones. (2) the study period involved may simply turn out to be viewed historically as a time before true primary care shortages actually came about due to failure in medical education and the sudden influx of millions of new insured persons suddenly seeking the free wellness benefits promised by the reform laws. Do the study in 15 years and let's see if the situation has changed at all. (3) Of course we need more and better coordinated care - when have we not?
Mark Drogowski, M.D. (9/16/2010 at 10:37 PM)

Coordinated care is needed, but our country will never come close to it until we straighten out the primary care physician shortage. We FPs, especially rural and inner urban, are too few and overrun to take care of the neediest patients needs. And physician extenders only go so far in helping with the complex patients that cost so much financially and in time. So, instead of worrying about quality of care or systems of care, both of which are needed but usually evident in residency trained FPs, increase the number (and decrease those specialties which lead to fragmented care). Good night.
Buz Cooper (9/16/2010 at 1:07 PM)

The reason that more visits didn't lead to better health is that poor people utilize the most care - primary care and every other kind of care - and they have the poorest outcomes. The problem is P-O-V-E-R-T-Y (though the Dartmouth spin machine denies it, possibly because their company can't make any money from it). And poverty is getting worse. Here's today's headline: [INVALID] The Census Bureau reported today that the poverty rate in the United States rose to 14.3% in 2009, the highest since 1994, up from 13.2% in 2009.


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