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Previous Volume 358:1064-1071 March 6, 2008 Number 10 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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In the United States, 125 million people are living with chronic illness, disability, or functional limitation.¹ The nature of modern medicine requires that these patients receive assistance from a number of different care providers. Between 2000 and 2002, the typical Medicare beneficiary saw a median of two primary care physicians and five specialists each year, in addition to accessing diagnostic, pharmacy, and other services. Patients with several chronic conditions may visit up to 16 physicians in a year.² Care among multiple providers must be coordinated to avoid wasteful duplication of diagnostic testing, perilous polypharmacy, and confusion about conflicting care plans.

. . . [Full Text of this Article]

Coordinating Care — How Are We Doing?

Barriers to Seamless Coordination

Overstressed Primary Care

Lack of Interoperable Computerized Records

Dysfunctional Financing

Lack of Integrated Systems of Care

Models for Improved Care Coordination

Coordination between Primary Care and Specialty Care

            Electronic Referral

            Referral Agreements

Care after Hospital Discharge

            Hospitalist-Initiated Projects

            Advanced-Practice Nursing

            Care Transitions Program

Assisting Primary Care Practices

            "Teamlet" Model

            Paying for Care Coordination

Organization of Health Services

Source Information

From the Department of Family and Community Medicine, University of California at San Francisco, San Francisco General Hospital, San Francisco.

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