Intra- and interprofessional coordination in inpatient medicine
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Hospitals are increasingly providing services for more medically complicated patients who require the care of multiple providers. This results in complex interdependent work relationships that require coordination to optimize patient care. Consequently, coordination-- especially between nurses and physicians who constitute the main providers of care-- may play an increasingly important role in the provision of quality care to hospitalized patients. Three studies were done to examine the role of intra- and interprofessional coordination of nurses and physicians in inpatient medical care. All were cross-sectional, descriptive studies using multivariate linear regression methodology, with data aggregated and analyzed at the facility level. Both primary data obtained from surveys of nurse managers, attending physicians and chiefs of medicine, and secondary data obtained from surveys of staff nurses and administrative data sources were used. Study One: The impact of provider coordination on provider perceptions of patient care and job satisfaction in inpatient medicine examined the association between intra- and interprofessional coordination and provider perceptions of the quality of patient care, and provider job satisfaction and intent to leave. Study Two: Organizational predictors of provider perceptions of coordination in inpatient medicine examined the association between organizational factors and provider perceptions of inpatient coordination. Study Three: The impact of provider coordination on patient outcomes examined the association between perceptions of intra- and interprofessional coordination and patient satisfaction; in-hospital fall, pressure ulcer, readmission and mortality rates; hospital costs; and lengths of stay. These studies contribute to the literature by assessing the impact of perceived coordination on patient and provider outcomes, and by identifying the organizational factors associated with perceptions of coordination. Results indicated that greater intra- and/ or interprofessional coordination may be associated with: better provider perceptions of patient care, patient satisfaction, and physician job satisfaction; higher hospital costs; and lower provider intent to leave and mortality rates. An organization's explicit commitment to patient care, to resources that enable providers to do their jobs, and to strategies that enhance communication between providers may improve coordination. Some factors, such as appropriate staffing, may be pre-requisites before coordination can have an impact on some patient outcomes.
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