Unpacking Care Coordination Through a Multiteam System Lens: A Conceptual Framework and Systematic Review

Area of Science:

• Health Services Research
• Patient Care Coordination
• Chronic Disease Management

Background:

• The 2016 President's Cancer Panel Connected Health report highlighted the need to characterize care coordination for chronic conditions.
• Existing frameworks from team and care coordination literature were integrated to form a new multilevel model.

Purpose of the Study:

• To develop and apply a multilevel care coordination framework.
• To review evidence on care coordination processes for patients with cancer, diabetes, and cardiovascular disease.

Main Methods:

• A systematic literature search was conducted in PubMed/MedLINE, CINAHL Plus, Cochrane, and PsycINFO (December 2009-June 2016).
• Studies focusing on behavioral markers of coordination among US healthcare providers for adults with cancer, heart disease, or diabetes were included.
• 33 studies were selected from 4876 records after screening by two investigators.

Main Results:

• Information sharing and monitoring emerged as primary coordination processes in most studies.
• Commonly utilized mechanisms included designated roles (e.g., coordinators), shared objects (e.g., survivorship plans), protocols, and routines (e.g., meetings).
• Few studies examined integrating conditions or statistically analyzed coordination processes as mediators of patient outcomes.

Conclusions:

• Limited research explores the relationships between care coordination mechanisms, processes, integrating conditions, and patient outcomes.
• The proposed multilevel framework serves as an organizer for future research on effective care coordination behaviors and conditions.