Recently, the American College of Physicians (ACP) released a paper outlining steps that can be taken to improve care coordination. Maya A. Babu, MD, MBA, FAANS, represented the AANS and the CNS in the ACP workgroup that developed the paper. Titled “Beyond the Referral: Principals of Effective, Ongoing Primary and Specialty Care Collaboration,” the document outlines four guiding principles that should underpin primary care and specialty care collaborations:
- Patient and Family Partnering: Clinical care teams should work collaboratively with patients, families and caregivers to empower them to be active partners in all aspects of their care. Their needs, preferences and limitations should be actively predicted, solicited and considered in all care encounters and decisions.
- Defined Clinical Roles and Responsibilities: The roles, responsibilities and mutual expectations of primary care and specialty care team members should be clear and acceptable to all parties, including the patient and family.
- Timely, Productive Communication: All parties should engage in timely, informative and focused communication with one another that highlights critical issues and/or items needing action.
- Effective Data Sharing: Patient data should be shared in a timely, thorough, actionable and well-organized manner.
