To get to a fragmented care definition, U.S. News & World Report offers the following description, “The U.S. healthcare system is so fragmented that primary care doctors struggle to coordinate patient care as frequently as providers in other high-income countries.” The same article offers that, “For example, just under half of U.S. primary care doctors said they get information from specialists about changes to their patients’ medications or care plans, compared to 70% or more of doctors in Norway, France and New Zealand.”
Furthermore, according to the same source, not only are our healthcare providers having a problem communicating with each other about patients, but they also are not as available as in other countries. The same survey quoted in the article offered that “American primary care practices were also less likely to have options for patients to see a doctor or nurse after hours other than the emergency room, compared to 90% of practices in Germany, the Netherlands, New Zealand, and Norway. And just 37% of primary care doctors in the U.S. said they or another provider made home visits sometimes or often, compared to 70% or more of physicians in the other 10 countries, according to the study.”
This research tells us that to ensure continuity of care, we need to support efforts to deliver care beyond the limits of a primary care practice and the limited hours that have long characterized much of American healthcare. Likewise, primary care needs to occupy itself far more with timely information exchange to support more successful care coordination.
Here are a few typical characteristics of fragmented care that apply easily to the U.S. healthcare system:
Disconnected Medical Specialists – When a patient with multiple chronic conditions gets care from different specialists, it is not uncommon for each to focus on their own task, leaving the patient to follow multiple unconnected care pathways. What’s missing is for someone to oversee all the care and make sure it is coordinated.
Lack of overall accountability – In the scenario above, there’s not a single person with final responsibility over a person’s care. Without someone in this role, the patient can stay very confused about where care is headed.
Organization-specific healthcare – Care from providers at different organizations create a big communication and coordination risk. Disparate, unconnected systems don’t contriute to good outcomes for patients with multiple, chronic conditions.
Poor Communication within an individual provider office – According to a HealthStream blog post, Doctors and nurses in a single office can also have a problem with communication, with a significant negative effect on patient safety, quality of care, patient outcomes, and patient as well as staff satisfaction.
Fragmented care may well be hazardous to patients’ health. Multiple medications and regimens in the absence of care coordination may be a contributor to more frequent hospitalizations and perhaps readmissions. In addition, the cost of fragmented care can be significantly higher for patient and payer alike, connected duplication of diagnostic tests, prescriptions, and overlapping care.
The United States healthcare system has grown increasingly fragmented. Those afflicted by chronic conditions may attend unnecessary appointments, receive confusing and contradictory advice from their doctors, struggle to get to the doctor’s office, and despair at exorbitant out-of-pocket expenses. Every visit’s comprehensive history taking, counseling, medication reconciliation, and psychosocial intervention must also consider where individuals came from and where they are going and incorporate the full continuum of care, not just the single setting.
Considering that there are approximately 3.7 million nurses in the United States and registered nurses attend over 50% of outpatient visits, they are poised to play an essential role in ensuring quality and continuity of care delivery in the face of this fragmentation.
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