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Patient, Primary Care Provider, and Specialist Perspectives on Specialty Care Coordination in an Integrated Health Care System

Vimalananda, Varsha, G., MD, MPH; Dvorin, Kelly, PsyD; Fincke, B., Graeme, MD; Tardiff, Nicole, MS; Bokhour, Barbara, G., PhD

Journal of Ambulatory Care Management: January/March 2018 - Volume 41 - Issue 1 - p 15–24
doi: 10.1097/JAC.0000000000000219
Original Articles

Successful coordination of specialty care requires understanding the perspectives of patients, primary care providers, and specialists—that is, the specialty care “triad.” This study used qualitative methods to compare these perspectives in an integrated health care system, using diabetes specialty care as an exemplar. Primary care providers and endocrinologists relied on interclinician relationships to coordinate care. Clinicians rarely included patients or other staff in their conceptualization of specialty care coordination. Patients often assumed responsibility for specialty care coordination but struggled to succeed. We identified several opportunities to improve coordination across the triad. In an integrated medical system, the shared organizational structure can facilitate these efforts.

Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts (Drs Vimalananda, Dvorin, Fincke, and Bokhour and Ms Tardiff); Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (Dr Vimalananda); and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts (Drs Fincke and Bokhour).

Correspondence: Varsha G. Vimalananda, MD, MPH, Center for Healthcare Organization and Implementation Research (152), Edith Nourse Rogers VA Medical Center, 200 Springs Rd, Bedford MA 01730 (

This work was funded by a Career Development Award (V.V.) from the Veterans Integrated Service Network 1 (VISN 1), Department of Veterans Affairs.

The contents of this manuscript do not represent the views of the US Department of Veterans Affairs or the United States Government.

The authors have no conflict of interest.

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