MON-138 Coordination of Care: National Survey of Endocrinologists’ Experience with PCPs

Introduction: Coordination of care between primary care physicians (PCPs) and specialists is crucial in providing safe, efficient specialty care for referred patients, but shortcomings in coordination are common. Objective: Examine endocrinologists’ experience of coordination with PCPs and examine the relationship of a shared EHR to coordination. Methods: We surveyed a national sample of US endocrinologist members of the Endocrine Society (ES) or American Association of Clinical Endocrinologists (AACE), using a previously-developed online survey for specialists about care coordination(1). ES and AACE included a link in a web-based newsletter and dedicated email. Four multi-item scales included 18 items measuring aspects of coordination with PCPs in the past 3 months: Communication (timeliness and helpfulness), Data Transfer (timeliness and usability), Relationships (mutually respectful), and Roles and Responsibilities (referral clarity, sufficiency, and appropriateness). Item responses and scale scores were on a 7-point frequency scale. A single-item measure of overall coordination with PCPs was measured on a 10-point scale (0 worst possible to 10 best possible). We asked “With about how many referring PCPs do you share an EHR?”. We examined frequencies of individual item responses (≤30%, about 50%, or ≥ 70% of the time) and extent of shared EHR with PCPs (None, Some, All), calculated mean scale scores (range 1-7) and used ANOVA to examine the relationship of a shared EHR to coordination scales and overall coordination. Results: Of 236 respondents: 35% age ≥ 60, 44% female, 80% ≥ 75% clinical effort. The highest frequency of good coordination (≥70% of the time) was reported for: aligned expectations of roles (84%), feeling valued by PCPs (80%) and clear division of responsibilities (70%). The lowest frequency of good coordination was for: kept informed by PCP about relevant issues (14%), and PCPs adequately evaluated prior to referring (18%). Mean (SD) for scale scores were: Communication 4.2 (1.0), Data Transfer 4.2 (1.1), Relationships 4.9 (0.8), Roles and Responsibilities 4.2 (0.9). The score for overall coordination with PCPs was 6.0 (1.9). Sharing an EHR with more PCPs was associated with higher Data Transfer scores (None, N=59, 3.9 (1.0), Some, N=126, 4.1 (0.9), All, N=26, 5.4 (0.8), P for trend <0.001). The effect size (Cohen’s d) for the difference between None and All EHR sharing was 1.6, well over the threshold for “large” effect size (d = 0.8). Conclusions: There are opportunities for improvement across all aspects of inter-clinician coordination for endocrinology referrals. Use of a shared EHR improves data transfer, but not other aspects of coordination. 1. Vimalananda VG, Fincke BG, Qian S, et al. Development and psychometric assessment of a novel survey to measure care coordination from the specialist’s perspective. Health Serv Res. 2019;54(3):689-699.