Julian Brunner1, Emmeline Chuang2, Donna L Washington3, Danielle E Rose4, Catherine Chanfreau-Coffinier4, Jill E Darling5, Ismelda A Canelo4, Elizabeth M Yano6. 1. HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Sepulveda, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California. Electronic address: julian.brunner@va.gov. 2. Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California. 3. HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Sepulveda, California; Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. 4. HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Sepulveda, California. 5. Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; USC Center for Economic and Social Research, University of Southern California, Los Angeles, California. 6. HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Sepulveda, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
Abstract
BACKGROUND: Primary care teams can facilitate access to care by helping patients to determine whether and when care is needed, and coordinating care across multiple clinicians and settings. Appointment availability metrics may or may not capture these contributions, but patients' own ratings of their access to care provide an important alternative view of access that may be more closely related to these key functions of care teams. PROCEDURES: We used a 2015 telephone survey of 1,395 women veterans to examine associations between key care team functions and patient-rated access to needed care. The care team functions were care coordination, in-person communication (between patient and care team), and phone communication (timely answers to health questions). We controlled for sociodemographics, health status, care settings, and other experience of care measures. KEY FINDINGS: Overall, 74% of participants reported always or usually being able to see a provider for routine care, and 68% for urgent care. In adjusted analyses, phone communication was associated with better ratings of access to routine care (odds ratio [OR], 4.31; 95% CI, 2.65-6.98) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Care coordination was also associated with better ratings of access to routine care (OR, 1.66; 95% CI, 1.01-2.74) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Associations with in-person communication were not significant. CONCLUSIONS: Access, communication, and care coordination are interrelated. Approaches to improving access may prove counterproductive if they compromise the team's ability to coordinate care, or diminish the team's role as a primary point of contact for patients. Published by Elsevier Inc.
BACKGROUND: Primary care teams can facilitate access to care by helping patients to determine whether and when care is needed, and coordinating care across multiple clinicians and settings. Appointment availability metrics may or may not capture these contributions, but patients' own ratings of their access to care provide an important alternative view of access that may be more closely related to these key functions of care teams. PROCEDURES: We used a 2015 telephone survey of 1,395 women veterans to examine associations between key care team functions and patient-rated access to needed care. The care team functions were care coordination, in-person communication (between patient and care team), and phone communication (timely answers to health questions). We controlled for sociodemographics, health status, care settings, and other experience of care measures. KEY FINDINGS: Overall, 74% of participants reported always or usually being able to see a provider for routine care, and 68% for urgent care. In adjusted analyses, phone communication was associated with better ratings of access to routine care (odds ratio [OR], 4.31; 95% CI, 2.65-6.98) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Care coordination was also associated with better ratings of access to routine care (OR, 1.66; 95% CI, 1.01-2.74) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Associations with in-person communication were not significant. CONCLUSIONS: Access, communication, and care coordination are interrelated. Approaches to improving access may prove counterproductive if they compromise the team's ability to coordinate care, or diminish the team's role as a primary point of contact for patients. Published by Elsevier Inc.
Authors: Sarah A Friedman; Susan M Frayne; Eric Berg; Alison B Hamilton; Donna L Washington; Fay Saechao; Natalya C Maisel; Julia Y Lin; Katherine J Hoggatt; Ciaran S Phibbs Journal: Med Care Date: 2015-04 Impact factor: 2.983
Authors: Rachel Kimerling; Joanne Pavao; Liberty Greene; Julie Karpenko; Allison Rodriguez; Meghan Saweikis; Donna L Washington Journal: Med Care Date: 2015-04 Impact factor: 2.983
Authors: Gala True; Anneliese E Butler; Bozena G Lamparska; Michele L Lempa; Judy A Shea; David A Asch; Rachel M Werner Journal: J Gen Intern Med Date: 2012-11-29 Impact factor: 5.128
Authors: Elizabeth M Yano; Jill E Darling; Alison B Hamilton; Ismelda Canelo; Emmeline Chuang; Lisa S Meredith; Lisa V Rubenstein Journal: Implement Sci Date: 2016-07-19 Impact factor: 7.327