title: A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations.
abstract: BACKGROUND
  Care coordination between adult hospitalists and primary care providers (PCPs) is a critical component of successful transitions of care from hospital to home, yet one that is not well understood.
  
  
  OBJECTIVE
  The purpose of this study was to understand the challenges in coordination of care, as well as potential solutions, from the perspective of hospitalists and PCPs in North Carolina.
  
  
  METHODS
  We conducted an exploratory qualitative study with 58 clinicians in four hospitalist focus groups (n = 32), three PCP focus groups (n = 19), and one hybrid group with both hospitalists and PCPs (n = 7).
  
  
  METHODS
  Interview guides included questions about care coordination, information exchange, follow-up care, accountability, and medication management. Focus group sessions were recorded, transcribed verbatim, and analyzed in ATLAS.ti. The constant comparative method was used to evaluate differences between hospitalists and PCPs.
  
  
  RESULTS
  Hospitalists and PCPs were found to encounter similar care coordination challenges, including (1) lack of time, (2) difficulty reaching other clinicians, (3) lack of personal relationships with other clinicians, (4) lack of information feedback loops, (5) medication list discrepancies, and (6) lack of clarity regarding accountability for pending tests and home health. Hospitalists additionally noted difficulty obtaining timely follow-up appointments for after-hours or weekend discharges. PCPs additionally noted (1) not knowing when patients were hospitalized, (2) not having hospital records for post-hospitalization appointments, (3) difficulty locating important information in discharge summaries, and (4) feeling undervalued when hospitalists made medication changes without involving PCPs. Hospitalists and PCPs identified common themes of successful care coordination as (1) greater efforts to coordinate care for "high-risk" patients, (2) improved direct telephone access to each other, (3) improved information exchange through shared electronic medical records, (4) enhanced interpersonal relationships, and (5) clearly defined accountability.
  
  
  CONCLUSIONS
  Hospitalists and PCPs encounter similar challenges in care coordination, yet have important experiential differences related to sending and receiving roles for hospital discharges. Efforts to improve coordination of care between hospitalists and PCPs should aim to understand perspectives of clinicians in each setting.
authors.affiliation: Hospital Medicine Section, Division of General Internal Medicine, University of Colorado, Denver, Aurora, CO, USA, christine.jones@ucdenver.edu.
authors.forename: Christine D
authors.initials: CD
authors.lastname: Jones
authors.forename: Maihan B
authors.initials: MB
authors.lastname: Vu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Donnell
authors.forename: Mary E
authors.initials: ME
authors.lastname: Anderson
authors.forename: Snehal
authors.initials: S
authors.lastname: Patel
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.forename: Eric A
authors.initials: EA
authors.lastname: Coleman
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D017144:Focus Groups / Q000379:methods; D020445:Hospitalists / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D010351:Patient Discharge / Q000592:standards*; D058007:Physicians, Primary Care / Q000592:standards*; D036301:Qualitative Research