Coordinating specialty care across health systems: primary care provider survey

Specialty care coordination is particularly challenging across health systems. The Veterans Health Administration (VHA) has implemented several measures to support coordination between VHA and VHA-paid community care. The objective of this study is to examine how within-system specialty care coordination compares with cross-system coordination with an array of organizational supports in place.

Cross-sectional online survey of VHA primary care providers (PCPs) who placed referrals for specialty care.

We administered the Coordination of Specialty Care-Primary Care Provider survey, which comprises 1 item about overall coordination (0 [worst] to 10 [best]) and 6 multi-item scales measuring coordination subdomains: relationships and collaboration, communication, data transfer, role clarity, role agreement, and making referrals.

Responses were from 351 PCPs about within-system and 226 PCPs about cross-system specialty care coordination. Overall coordination was higher for within-system than cross-system care (mean [SD] score, 7.01 [2.33] vs 6.22 [2.64]; P = .002). All scale scores were higher for within-system care. Cross-system respondents commonly lacked experience directly interacting with specialists. In both settings, the strongest association with overall coordination was with relationships and collaboration (within-system: standardized beta coefficient [β] = 0.45; P < .0001; cross-system: β = 0.69; P < .0001). Relationships and collaboration was a greater contributor to overall coordination for cross-system than within-system care.

Specialty care coordination is worse in cross-system care than in within-system care, even with significant organizational investment in structures and processes to coordinate across systems. Strategies to support direct clinician-clinician interactions could be particularly impactful for cross-system care.