Care coordination in U.S. may lag behind other countries, report finds

Primary care physicians in the U.S. were least likely to report receiving notifications when a patient is seen elsewhere for after-hours care, among other findings.

Compared to physicians in 10 other countries, U.S. physicians did not routinely receive timely notification or information needed to manage ongoing care from specialists, after-hours care centers, emergency departments, or hospitals, a study found.

The 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians queried primary care physicians in 11 high-income countries about their ability to coordinate patients' medical care with specialists, across settings of care, and with social service providers. The results of the survey were published Dec. 10 by Health Affairs.

The findings included the following:

  • Thirty-seven percent of U.S. physicians reported that they or a health care professional in their practice made home visits frequently or occasionally, compared to 70% or more in all of the other countries.
  • American and Canadian practices were much less likely than those in other countries to provide after-hours patient visits without the patient having to visit an ED, compared to 90% or more of physicians in Germany, the Netherlands, New Zealand, and Norway.
  • At least 70% of physicians in France, New Zealand, Norway, and the United Kingdom received information from specialists about changes made to their patients' medication or care plans, compared to 49% or fewer of physicians in Germany, the Netherlands, Sweden, and the U.S.
  • Thirty-six percent of physicians in the U.S. said they receive notifications when a patient has been seen for after-hours care, compared with 77% to 97% of physicians in the Netherlands, New Zealand, and the United Kingdom.
  • Fifty-two percent of U.S. physicians reported usually receiving a report from the hospital within 48 hours of a patient's discharge, compared to one-third or fewer in seven other countries. Physicians in Germany (63%) and New Zealand (57%) were the most likely to receive hospital discharge reports within 48 hours.

Countries with the best communication among clinicians at different sites of care demonstrate the feasibility of improving two-way communication between primary care clinicians and those at other sites of care, the authors wrote.

“Common ingredients of initiatives across countries include a strong commitment by government and other payers to primary care, the development of innovative care models, and active cooperation among professionals from the health care and social services sectors,” the survey concluded. “Advancing initiatives with these ingredients could improve coordination over time and improve the health of the public without unnecessary increases in cost.”