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2015 HSR&D/QUERI National Conference Abstract

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3126 — What is specialty care coordination? Voice of the "triad" - patient, PCP and specialist

Vimalananda VG, COIN-Bedford/Boston; Dvorin K, COIN-Bedford/Boston; Berlowitz D, COIN-Bedford/Boston; Fincke BG, COIN-Bedford/Boston; Meterko M, COIN-Bedford/Boston; Bokhour B, COIN-Bedford/Boston;

Objectives:
Specialty care coordination is critical to the success of patient-aligned care teams. However, each participant in the "specialty care triad" - patient, PCP, and specialist - has different priorities. We sought to understand elements of successful diabetes specialty care coordination from the perspective of each.

Methods:
Semi-structured telephone interviews in 2014 with 12 PCPs and 13 endocrinologists at 25 VAMCs and CBOCs nationwide. Two focus groups with diabetic Veterans (N = 9) at one urban and one rural VAMC. Grounded thematic analysis and constant comparative methods to identify themes.

Results:
Five domains were important for all triad members. Interpersonal communication and Relationships: Patients desired either that someone in the healthcare system understood and could manage their care, or that they were enabled to manage it themselves. Good communication with a specific provider was therefore necessary. For PCPs and endocrinologists, personal relationships and communication with other providers were essential to accomplishing work in a complex system. Roles and responsibilities: For patients, specialty care coordination was either their job, or that of their PCP. Providers wished for greater clarity and agreement about their own roles and responsibilities. Information transfer: Patients wanted to track and manage their health information online. Providers wanted organized, meaningful information transfer with each other. Access to services: Timeliness in access to services was important to all triad members. Patients wanted phone or secure messaging to replace clinic visits when possible. Endocrinologists saw triage of consults as critical to managing limited clinic availability. However, PCPs described these triage mechanisms as "blocking" access to specialty care.

Implications:
Patients, PCPs and specialists perceive success in specialty care coordination in overlapping but not identical ways.

Impacts:
These findings have implications for how we understand and intervene to improve specialty care coordination. For example, Interpersonal communication and Relationships are important domains of coordinated care for all triad members. For patients, it is important to ensure that a specific person is identified as the "hub" of coordination. For PCPs and endocrinologists, interventions that foster personal relationships between providers are needed, and may positively impact multiple aspects of specialty care coordination through improving communication.