CARE COORDINATION, QUALITY AND OUTCOMES: A STUDY IN OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS
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Date
2014-07-31
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Johns Hopkins University
Abstract
Background: Care coordination may be most effective in older adults with multiple chronic conditions because they see multiple primary care and specialist physicians, which may complicate efforts to coordinate care for their conditions. There is little evidence on how to best measure and improve care coordination in this population.
Objective: The objective of this thesis is to better understand care coordination in older adults with multiple chronic conditions. The first study examines how to measure care coordination. The second study examines the relationship of care coordination with quality of care processes and patient rating of care. The third study whether one dimension, continuity of care, is associated with subsequent emergency department utilization, and hospital utilization.
Study Design: This is an observational study. All analyses were conducted in a sample of 1,600 adults 65 years of age and older with multiple chronic conditions selected to participate in a patient survey. All subjects were enrolled in a Medicare Advantage Special Needs Plan living in Alabama, Georgia, Missouri, South Carolina, and Texas.
Results: The first study identifies three underlying domains of care coordination: continuity of care, informational continuity between clinicians, and information flow to the patient. The second study finds that patient reported experiences of informational continuity are strongly related to the patient related to the patient’s rating of care, but not related to other measures of technical care quality. The third study finds that higher levels continuity of care is associated with lower odds of a preventable hospitalization in patients with five or fewer conditions but continuity of care is not related to better outcomes in patients with six or more conditions.
Conclusion: Care coordination is a multidimensional construct. Evaluations of care coordination programs should consider using both claims-based and patient survey measures in order to comprehensively assess care coordination programs. Medicare and health plans should consider incentivize informational continuity between clinicians to improve patient rating of care.
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Keywords
Multimorbidity, Care Coordination, Elderly