With the advent of health care system reform, patient-centered medical homes and accountable care organizations have emerged as solutions to the fragmentation and duplication that characterize the US health care system.1 Given the increasing burden of chronic disease, the success of these models depends in part on improving the primary care–specialty care interface.
The interaction between PCPs and specialist consultants is not a trivial issue—it has a central role as a driver of health care quality2 and cost.3 Moreover, the importance of the PCP-specialist nexus is underscored by the sheer number of physicians potentially involved in any given patient's care. A recent study4 found that in caring for 100 Medicare patients, the average PCP needs to coordinate care with 99 other physicians working across 53 practices.
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