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Med Care. 2018 Mar;56(3):247-259. doi: 10.1097/MLR.0000000000000874.

Unpacking Care Coordination Through a Multiteam System Lens: A Conceptual Framework and Systematic Review.

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Johns Hopkins University School of Medicine.
Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD.
Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center.
Baylor College of Medicine, Houston, TX.



The 2016 President's Cancer Panel Connected Health report calls for thoroughly characterizing the team structures and processes involved in coordinating care for people with chronic conditions. We developed a multilevel care coordination framework by integrating existing frameworks from the teams and care coordination literatures, and used it to review evidence examining care coordination processes for patients with cancer, diabetes, cardiovascular disease, and combinations of these conditions.


We searched Pubmed/MedLINE, CINAHL Plus, Cochrane, PsycINFO (December 2009-June 2016), and references from previous reviews. Studies describing behavioral markers of coordination between ≥2 US health care providers caring for adults with cancer, chronic heart disease, diabetes, or populations with a combination of these conditions were included. Two investigators screened 4876 records and 180 full-text articles yielding 33 studies. One investigator abstracted data, a second checked abstractions for accuracy.


Most studies identified information sharing or monitoring as key coordination processes. To execute these processes, most studies used a designated role (eg, coordinator), objects and representations (eg, survivorship plans), plans and rules (eg, protocols), or routines (eg, meetings). Few examined the integrating conditions. None statistically examined coordination processes or integrating conditions as mediators of relationships between specific coordination mechanisms and patient outcomes.


Restricted to United States, English-language studies; heterogeneity in methods and outcomes.


Limited research unpacks relationships between care coordination mechanisms, coordination processes, integrating conditions, and patient outcomes suggested by existing theory. The proposed framework offers an organizer for examining behaviors and conditions underlying effective care coordination.

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