• The Invisible Challenge of Care Coordination

    An interview with Gerri Lamb Mar 01, 2012

    "Care coordination is the weathervane—the canary in the mine, so to speak—of how well health care works for patients," says researcher Gerri Lamb, PhD, RN, FAAN.


    Gerri Lamb, PhD, RN, FAAN, has spent most of her 30-year career engrossed in an issue-care coordination-that only recently began to gain center stage under health reform. "I've worked with people with many chronic illnesses and lots of social problems, and I've watched the difficulties they have navigating our healthcare system," says Lamb. "I've always thought we could do better."

    Despite her years of hands-on experience, Lamb was thrown for a loop when her own mother became ill, and she was thrust into the caregiver role. "It was one of the most difficult experiences I have ever had," she says.

    One occasion stands out: A physician wanted to hospitalize Lamb's mother, but her mother was convinced that if she went into the hospital, she wouldn't come out. So Lamb did her best to keep her mother at home. "I'm in Arizona, she's in Florida, and I'm working long distance to orchestrate home care, oxygen … the works. There were all sorts of scheduling snafus and miscommunication. The doctor's office sent in the referral for home care, and then closed for the day. It ended up taking 36 hours to get home care. Meanwhile my mother-who is very high risk for a frightening and expensive hospitalization-is kept waiting."

    While disheartening, Lamb's experience with her mother led to an epiphany: "My greatest passion now is patient-centered care coordination, and shifting our measurement to look at what's important to patients and families. There's a huge gap between what we currently measure and what was important to me as a daughter trying to coordinate my mother's care."

    An Invisible Burden

    Lamb started out as a home care nurse in lower Manhattan helping patients and families coordinate needed services. She went on to lead seminal research into care coordination, including a 1990s Medicare demonstration project that tested a fully capitated model for community-based care coordination. Most recently, Lamb has been working with the National Quality Forum on performance measures around care coordination. She is also project codirector for INTERACT, a program that is helping reduce hospital admissions from skilled nursing facilities.

    Throughout her career, Lamb has kept circling back to the same theme: "Much of care coordination is difficult to articulate," she says. For instance, in a study funded by The Robert Wood Johnson Foundation, Lamb and her research team developed a tool to measure how hospital nurses coordinate care. "We found that nurses spend an extensive amount of time engaged in a wide range of coordination activities. But when we asked the nurses whether they thought anyone knows what they do to coordinate care, almost all of them said 'no.'"

    Patient-Centered Measures

    Care coordination is very hard work, says Lamb. "Connecting the different parts of the healthcare system and making those parts work together is really tough and takes a lot of skill."

    Following the dictum "you can only manage what you measure," Lamb believes that an important step in improving care coordination is to come up with more patient-centered metrics. Most of the current measures are condition-specific or provider- or facility-centered-and fail to consider how patients move across care settings.

    "We measure whether a patient has a discharge plan or has a physician appointment set up. But we don't examine whether there is an integrated plan of care across the various providers-which is one of the hallmarks of good care coordination. We don't have strong measures for that, and yet that was what I cared about with my mother."

    Lamb is committed to improving care coordination for patients and their families. Her research program at Arizona State University, which involves colleagues from many other disciplines, is aimed at making this happen.  

    Gerri Lamb, PhD, RN, FAAN, is associate professor, ASU College of Nursing and Health Innovation, Phoenix, Ariz.