Relational coordination in Veterans Affairs home-based primary care

Abstract

Department of Veterans Affairs (VA) home-based primary care (HBPC) is an intensive primary care program in which interdisciplinary teams care for patients with complex, chronic medical and social needs in their homes. HBPC teams consist of multiple disciplines, perform complex, interdependent tasks, coordinate care with other providers to meet patient needs. Relational coordination (RC) is a mutually reinforcing process of communicating and relating that provides the information-processing capacity to coordinate complex, interdependent tasks. In this mixed-methods study, we examined RC within home-based primary care teams (HBPC), and between clinic-based primary care providers and HBPC team members. RC was assessed by a cross-sectional survey of 33 HBPC team members and semi-structured interviews with 14 HBPC and 10 clinic-based PCPs were conducted to explicate findings. Survey results showed strong RC within HBPC teams but gaps in timely communication and shared knowledge among HBPC teams and clinic-based PCPs. These gaps may underlie confusion and frustration over the role of HBPC and what types of patients should get HBPC care. Interview data suggest that functional specialization and lack of face-to-face interactions may have hindered the development of strong RC. Interventions that promote boundary spanning may improve RC between HBPC teams and clinic based primary care.