Effects of provider characteristics on care coordination under comanagement

Care coordination is critical in settings characterized by high levels of uncertainty, time constraints, and interdependent work processes. The effects of provider characteristics on coordination in comanaged teams has never been examined.

To characterize individual providers based on their contribution to team coordination.

Hospitalists, nonphysician providers, hepatologists, and fellows on a comanaged liver service of an academic hospital.

Between April 2008 and October 2008, participants were surveyed at baseline and repeatedly at the completion of physician rotations to assess their preferred and actual comanagement structures. In addition, they repeatedly rated their comanagers' contributions to overall coordination using an instrument that assessed relational coordination (RC). Providers were categorized into tertiles of RC. Their management preferences and the frequency of a "composite bad outcome" (intensive care unit [ICU] transfer or inpatient death) in each tertile were evaluated.

All (100%) Baseline Surveys and 177/224 (79%) Repeated Surveys were completed by 32 providers. RC was shown to be a stable attribute of providers and not of adverse patient outcomes. Higher coordinators were characterized by their "ownership of patients" (higher 86% vs. lowest 20%, P < 0.01). High compared to low coordinator hepatologists demonstrated leadership through a broader delegation of tasks as well as self-assignment of responsibilities. A trend toward more frequent "composite bad outcomes" was seen for low tertile physicians: hospitalists (low 8.6% vs. high 1.1%, P < 0.01), hepatologists (low 5.2% vs. high 2.0%, P = 0.22), fellows (low 5.8% vs. high 1.8%, P = 0.08).

Individual provider's teamwork-related disposition affects perceived coordination on comanaged team and may influence patient outcomes.