Comparing patients care coordination in Germany and the United States: A systematic review

Abstract

Background: Care coordination (CC) is the holistic approach of interacting care providers across interfaces of care to deliver the appropriate healthcare service. Poorly coordinated care can lead to adverse patient outcomes and increased health expenditure. There is an increasing need for CC in countries like Germany (DE) and the United States (US) who face the challenges of aging population and hence a rise in chronic illnesses which require a continuum of care. Objectives: The aim of this study is to compare the degree of vertical CC of patient care in DE and the US including the structure of the healthcare system, implemented policies, the available mechanisms for coordinating care as well as the challenges faced by each country. Research Methodology: For fulfilling this study, a systematic review is conducted for the peer-reviewed articles published in the years from 2013 to 2018 and written in English language in these three databases: PubMed, Cochrane and Google Scholar. The review is conducted in line with PRISMA guidelines. Results: A total of 24 studies were included for the final analysis of this review: nine for DE and 15 for the US. Almost half of the studies were observational. Findings suggest that despite the several efforts implemented, the degree of CC in both countries is still poor. Designation of case managers is either absent or inconsistent. Fax and paper formats are still being used for recording patient data despite the adoption of EHR in some settings which creates a lack of interoperability and consequent CC gaps. Challenges like physician resistance for using EHR, technical barriers as well as absence of financial incentives for applying CC need to be addressed. Conclusion: No evidence of CC is seen in both countries. Further strategies are required to tackle the barriers of sharing patient information across different levels of care.