This report examines the evidence for the extent to which poor coordination contributes to poor quality outcomes for patients and the approaches to clinical coordination which are shown to improve care and whether these can reduce costs.

The review concludes that greater coordination of care has the potential to reduce costs and should be a major consideration for how to improve quality and save money in the current funding situation. However, while better process coordination could release significant savings, these approaches also have high risks and costs.

Improving coordination is about relationships between people, which is why it is difficult. One of the most important messages from this review is that there are models of care which improve clinical coordination and have been shown to reduce cost but that attempts to replicate these need very careful consideration. By its nature, coordination is dependent upon the local context, so the opportunities and costs will vary in each different healthcare system and in different settings within the system.

The review summarises and grades the strength of the evidence, so that it is clear which approaches are the most robustly evaluated. Some of the evidence is not conclusive, as many changes that aim to improve coordination have not been well evaluated.

The final section of the report suggests how patients, health service providers, commissioners, regulators and professional organisations could all take some responsibility for improving clinical coordination and thus reducing duplication, waste and thus the overall costs of healthcare. 


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