David C Mohr1,2, Justin K Benzer3,4, Varsha G Vimalananda5,6, Sara J Singer7, Mark Meterko8,9, Nathalie McIntosh10, Kimberly L L Harvey11, Marjorie Nealon Seibert11, Martin P Charns11,8. 1. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA. David.Mohr2@va.gov. 2. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA. David.Mohr2@va.gov. 3. VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA Healthcare System, Waco, TX, USA. 4. Department of Psychiatry, Dell Medical School of the University of Texas at Austin, Austin, TX, USA. 5. Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA. 6. Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, MA, USA. 7. Stanford School of Medicine and Graduate School of Business, Stanford, USA. 8. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA. 9. Patient Experience Survey Team, VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID), ENRM Veterans Affairs Medical Center, Bedford, MA, USA. 10. Massachusetts Health Quality Partners, Watertown, MA, USA. 11. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
Abstract
BACKGROUND: Delivering care to patients with complex healthcare needs benefits from coordination among healthcare providers. Greater levels of care coordination have been associated with more favorable patient experiences, cost management, and lower utilization of services. Organizational approaches consider how systems, practices, and relationships influence coordination and associated outcomes. OBJECTIVE: Examine measures of organizational coordination and their association with patient experiences of care coordination involving specialists. DESIGN: Cross-sectional surveys of patients and primary care providers (PCPs). PARTICIPANTS: Final sample included 3183 patients matched to 233 PCPs from the Veterans Health Administration. All patients had a diagnosis of type 2 diabetes mellitus and one of four other conditions: hypertension; congestive heart failure; depression/anxiety; or severe mental illness/posttraumatic stress disorder. MAIN MEASURES: Patients completed a survey assessing perceptions of coordinated care. We examined ratings on three domains: specialist knowledge management; knowledge integration across settings and time; and knowledge fragmentation across settings and time. We created care coordination measures involving the PCP and three specialty provider types. PCPs provided ratings on relational coordination for specialists, feedback coordination, and team coordination. We aligned patient's specialty services used with corresponding PCP ratings of that specialty. KEY RESULTS: Patient ratings were significantly lower on specialist knowledge management and knowledge integration when either PCPs did not use feedback coordination (b = - .20; b = - .17, respectively) or rated feedback coordination lower (b = - .08 for both). Teamwork was significantly related to specialist knowledge management (b = .06), knowledge integration (b = .04); and knowledge fragmentation (b = - .04). Relational coordination was related to coordination between the primary care provider and (i) diabetes specialist (b = .09) and (ii) mental health provider (b = .12). CONCLUSIONS: Practices to improve provider coordination within and across primary care and specialty care services may improve patient experiences of care coordination. Improvements in these areas may improve care efficiency and effectiveness.
BACKGROUND: Delivering care to patients with complex healthcare needs benefits from coordination among healthcare providers. Greater levels of care coordination have been associated with more favorable patient experiences, cost management, and lower utilization of services. Organizational approaches consider how systems, practices, and relationships influence coordination and associated outcomes. OBJECTIVE: Examine measures of organizational coordination and their association with patient experiences of care coordination involving specialists. DESIGN: Cross-sectional surveys of patients and primary care providers (PCPs). PARTICIPANTS: Final sample included 3183 patients matched to 233 PCPs from the Veterans Health Administration. All patients had a diagnosis of type 2 diabetes mellitus and one of four other conditions: hypertension; congestive heart failure; depression/anxiety; or severe mental illness/posttraumatic stress disorder. MAIN MEASURES: Patients completed a survey assessing perceptions of coordinated care. We examined ratings on three domains: specialist knowledge management; knowledge integration across settings and time; and knowledge fragmentation across settings and time. We created care coordination measures involving the PCP and three specialty provider types. PCPs provided ratings on relational coordination for specialists, feedback coordination, and team coordination. We aligned patient's specialty services used with corresponding PCP ratings of that specialty. KEY RESULTS:Patient ratings were significantly lower on specialist knowledge management and knowledge integration when either PCPs did not use feedback coordination (b = - .20; b = - .17, respectively) or rated feedback coordination lower (b = - .08 for both). Teamwork was significantly related to specialist knowledge management (b = .06), knowledge integration (b = .04); and knowledge fragmentation (b = - .04). Relational coordination was related to coordination between the primary care provider and (i) diabetes specialist (b = .09) and (ii) mental health provider (b = .12). CONCLUSIONS: Practices to improve provider coordination within and across primary care and specialty care services may improve patient experiences of care coordination. Improvements in these areas may improve care efficiency and effectiveness.
Entities:
Keywords:
Veterans; care coordination; diabetes; patient care survey; primary care
Authors: Kevin J O'Leary; Diane B Wayne; Corinne Haviley; Maureen E Slade; Jungwha Lee; Mark V Williams Journal: J Gen Intern Med Date: 2010-04-13 Impact factor: 5.128
Authors: Mary Butler; Robert L Kane; Donna McAlpine; Roger Kathol; Steven S Fu; Hildi Hagedorn; Timothy Wilt Journal: J Ambul Care Manage Date: 2011 Apr-Jun
Authors: David T Liss; Jessica Chubak; Melissa L Anderson; Kathleen W Saunders; Leah Tuzzio; Robert J Reid Journal: Ann Fam Med Date: 2011 Jul-Aug Impact factor: 5.166
Authors: J H Gittell; K M Fairfield; B Bierbaum; W Head; R Jackson; M Kelly; R Laskin; S Lipson; J Siliski; T Thornhill; J Zuckerman Journal: Med Care Date: 2000-08 Impact factor: 2.983
Authors: James S Wrobel; Martin P Charns; Paula Diehr; Jeffrey M Robbins; Gayle E Reiber; Kristin M Bonacker; Linda B Haas; Leonard Pogach Journal: Diabetes Care Date: 2003-11 Impact factor: 19.112
Authors: Kristina M Cordasco; Denise M Hynes; Kristin M Mattocks; Lori A Bastian; Hayden B Bosworth; David Atkins Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Varsha G Vimalananda; Mark Meterko; Shirley Qian; Jolie B Wormwood; Amanda Solch Msw; Benjamin Graeme Fincke Journal: Health Serv Res Date: 2020-07-22 Impact factor: 3.402
Authors: Robert J Yawn; Ashley M Nassiri; Jacqueline E Harris; Nauman F Manzoor; Saniya Godil; David S Haynes; Marc L Bennett; Sheena M Weaver Journal: J Neurol Surg B Skull Base Date: 2021-02-04
Authors: Martin P Charns; Justin K Benzer; Nathalie M McIntosh; David C Mohr; Sara J Singer; Deborah Gurewich Journal: Med Care Date: 2022-05-01 Impact factor: 3.178
Authors: Ekaterina Anderson; Amanda K Solch; B Graeme Fincke; Mark Meterko; Jolie B Wormwood; Varsha G Vimalananda Journal: J Gen Intern Med Date: 2020-09-11 Impact factor: 5.128
Authors: May Hua; Laura D Fonseca; R Sean Morrison; Hannah Wunsch; Robert Fullilove; Douglas B White Journal: J Pain Symptom Manage Date: 2021-06-25 Impact factor: 3.612