title: Coordination of care for individuals with advanced progressive conditions: a multi-site ethnographic and serial interview study.
abstract: BACKGROUND
  Coordination of care for individuals with advanced progressive conditions is frequently poor.
  
  
  OBJECTIVE
  To identify how care is coordinated in generalist settings for individuals with advanced progressive conditions in the last year of life.
  
  
  METHODS
  A mixed methods study of three UK generalist clinical settings producing three parallel case studies: an acute admissions unit in a regional hospital, a large general practice, and a respiratory outpatient service.
  
  
  METHODS
  Ethnographic observations in each setting, followed by serial interviews of patients with advanced progressive conditions and their family carers in the community. A spectrum of clinicians and healthcare workers were also interviewed.
  
  
  RESULTS
  Ethnographic observations were conducted for 22 weeks. A total of 56 patients, 25 family carers and 17 clinicians yielded 198 interviews. Very few participants had been identified for a palliative approach. Rapid throughput of hospital patients and time pressures in primary care hindered identification of palliative care needs. Lack of care coordination was evident during emergency admissions and discharges. Patient, families, and professionals identified multiple problems relating to lack of information, communication, and collaboration at care transitions. Family carers or specialist nurses, where present, usually acted as the main care coordinators.
  
  
  CONCLUSIONS
  Care is poorly coordinated in generalist settings for patients in the last year of life, although those with cancer have better coordinated care than other patients. A model to improve coordination of care for all individuals approaching the end of life must ensure that patients are identified in a timely way, so that they can be assessed and their care planned accordingly.
authors: Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh.
authors: Bruce
authors: B
authors: Mason
authors: Eleni
authors: E
authors: Epiphaniou
authors: Veronica
authors: V
authors: Nanton
authors: Anne
authors: A
authors: Donaldson
authors: Cathy
authors: C
authors: Shipman
authors: Barbara A
authors: BA
authors: Daveson
authors: Richard
authors: R
authors: Harding
authors: Irene
authors: I
authors: Higginson
authors: Dan
authors: D
authors: Munday
authors: Stephen
authors: S
authors: Barclay
authors: Kirsty
authors: K
authors: Boyd
authors: Jeremy
authors: J
authors: Dale
authors: Marilyn
authors: M
authors: Kendall
authors: Allison
authors: A
authors: Worth
authors: Scott A
authors: SA
authors: Murray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D058006:General Practice / Q000458:organization & administration / Q000592:standards; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012944:Social Support
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