In a supplemental issue of the Journal of General Internal Medicine, Sherri Sheinfeld Gorin, M.D., Department of Family Medicine, co-authored a pair of papers relating to improving health care coordination for both primary care physicians and their patients, especially within Veterans Health Administration Medical Centers (VAMCs) .
The JGIM papers were authored by the invitees to a VA-led workshop on care coordination.
“Taken together, these companion papers seek to make theory more accessible and practical by systematically identifying and categorizing the current literature on theories of care coordination, then demonstrating how theory can be applied to specific cases,” Sheinfeld Gorin said.
Sheinfeld Gorin was part of teams creating both Incorporating Theory into Practice: Reconceptualizing Exemplary Care Coordination Initiatives from the US Veterans Health Delivery System and Health Care Coordination Theoretical Frameworks: a Systematic Scoping Review to Increase Their Understanding and Use in Practice.
In Incorporating Theory Into Practice, the authors developed insights from the theory-based literature to improve intervention design, implementation and evaluation.
Three theory-based conceptual domains – context of an intervention, locus in which an intervention is applied, and specific design features of the intervention - were applied to four use cases of care coordination among veterans to determine the best type of intervention to offer. The cases included: (1) Patient Aligned Care Team-Intensive Management, which focuses on coordination within the primary care setting; (2) Care Coordination and Integrated Case Management, that discusses coordination for complex patients without regard to setting. (3) Improving Transplant Medication Safety through Technology and Pharmacist, that describes medication management, one form of coordination; and (4) Hospital 2 Community, which focuses on transitions between care systems.
Health Care Coordination Theoretical Frameworks was a scoping review of care coordination theoretical frameworks published over the past eight years.
“Among 4,389 citations, we identified 37 widely-diverse frameworks, including 16 recent frameworks unidentified by previous reviews; five of these were most relevant to primary care,” Sheinfeld Gorin said. "We systematically identified existing care coordination theoretical frameworks, and categorized them using the sustainable integrated chronic care models for multi-morbidity: delivery, financing, and performance (SELFIE) framework. We discovered some new approaches to understanding care coordination and assessing its effectiveness in practice.
“Care coordination is crucial to avoid the potential risks of care fragmentation in increased morbidity—even mortality—for people with complex care needs. Primary care providers are often key to care coordination, particularly in cancer care. While there are many empirical and conceptual approaches to measuring and improving care coordination, the use of theory is limited by its complexity and the wide variability of available frameworks. These papers distill the strengths of theory to improving care coordination in primary care.”
Mcdonald KM, Singer SJ, Gorin SS, et al. Incorporating Theory into Practice: Reconceptualizing Exemplary Care Coordination Initiatives from the US Veterans Health Delivery System. Journal of General Internal Medicine. 2019;34(S1):24-29. doi:10.1007/s11606-019-04969-w.
Peterson K, Anderson J, Bourne D, et al. Health Care Coordination Theoretical Frameworks: a Systematic Scoping Review to Increase Their Understanding and Use in Practice. Journal of General Internal Medicine. 2019;34(S1):90-98. doi: 10.1007/s11606-019-04966-z.