Evaluation of Physician Network-Based Measures of Care Coordination Using Medicare Patient-Reported Experience Measures

Abstract Background Care coordination between general practitioners (GPs) and cardiovascular specialists is expected to play a key role in establishing appropriate oral anticoagulant (OAC) treatment in atrial fibrillation (AF) patients. The aim of this study was to assess the impact of care coordination on oral anticoagulant therapy in the management of AF in Japan. Methods This study was a multi-center, single-arm, prospective cohort study with retrospective chart and claims data review for historical controls. The study included three study periods: a 12-month pre-campaign period; a 12-month campaign period for AF screening and care coordination; and a 3-month post-campaign period for follow-up of care coordination. During the campaign period, patients aged ≥65 years who attended participating GP clinics underwent opportunistic AF screening by GPs under the campaign. At the discretion of the GP, newly diagnosed AF patients after the screening were referred to a cardiovascular specialist for care coordination. To assess the impact of care coordination and evaluate the effects of the campaign, implementation of care coordination, antithrombotic therapies, and patient-reported outcomes were compared between patients with and without care coordination, and between patients during the pre-campaign and campaign periods. Results There were 86 newly diagnosed AF patients during the pre-campaign period and 90 during the campaign period. The percentage of patients with care coordination increased from 3.5% (3/86) in the pre-campaign period to 14.4% (n = 13/90) during the campaign period. The percentage of patients who received OAC therapies, according to the definition from the Japanese AF medication guideline, increased from 55.8% (48/86) to 71.1% (64/90) during the campaign period regardless of care coordination. Younger patients were referred to cardiovascular specialists for care coordination. Implementation of OAC therapy did not differ between patients with and without care coordination. Adherence to OAC therapy was low regardless of care coordination. Conclusions This GP-targeted campaign was effective at raising awareness regarding the implementation of care coordination and appropriate OAC therapy at local clinical practices in Japan. Improvement of adherence to OAC therapy in elderly patients is a critical issue, and measures such as education programs targeted to patients and healthcare professionals should be undertaken.

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Patient-reported quality of care and pain severity in cancer

Palliative & Supportive Care ◽

10.1017/s1478951514000777 ◽

2014 ◽

Vol 13 (4) ◽

pp. 875-884 ◽

Cited By ~ 7

Author(s):

Kathryn A. Martinez ◽

Claire F. Snyder ◽

Jennifer L. Malin ◽

Sydney M. Dy

Keyword(s):

Quality Of Care ◽

Cancer Patients ◽

Nursing Care ◽

Care Coordination ◽

Symptom Burden ◽

Care Quality ◽

Pain Severity ◽

Physician Communication ◽

Patient Reported

AbstractObjective:Despite treatment availability, many cancer patients experience severe pain. Although patient assessments of care are increasingly employed to evaluate quality of care, little is known about its association with cancer symptom burden. The objective of our study was to examine the association between patient-reported quality of care and pain severity in a nationally representative cohort of cancer patients.Method:Quality of care was measured in three domains: physician communication, care coordination/responsiveness, and nursing care. Quality scores were dichotomized as optimal versus nonoptimal. Pain was measured on a scale of 0 (least) to 100 (worst). We utilized multivariable linear regression to examine the association between patient-reported quality of care and pain severity.Results:The analytic sample included 2,746 individuals. Fifty and 54% of patients, respectively, rated physician communication and care coordination/responsiveness as nonoptimal; 28% rated nursing care as nonoptimal. In adjusted models, rating physician communication as nonoptimal (versus optimal) was associated with a 1.8-point higher pain severity (p = 0.018), and rating care coordination/responsiveness as nonoptimal was associated with a 2.2-point higher pain severity (p = 0.006).Significance of results:Patient-reported quality of care was significantly associated with pain severity, although the differences were small. Interventions targeting physician communication and care coordination/responsiveness may result in improved pain control for some patients.

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Patient characteristics associated with the level of patient-reported care coordination among male patients with colorectal cancer in the Veterans Affairs health care system

Cancer ◽

10.1002/cncr.29341 ◽

2015 ◽

Vol 121 (13) ◽

pp. 2207-2213 ◽

Cited By ~ 11

Author(s):

George L. Jackson ◽

Leah L. Zullig ◽

Sean M. Phelan ◽

Dawn Provenzale ◽

Joan M. Griffin ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Health Care System ◽

Care Coordination ◽

Patient Characteristics ◽

Veterans Affairs ◽

Patient Reported ◽

Male Patients ◽

Care System

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Patient-reported quality of life, unmet needs and care coordination outcomes: Moving toward targeted breast cancer survivorship care planning

Asia-Pacific Journal of Clinical Oncology ◽

10.1111/ajco.12254 ◽

2014 ◽

Vol 12 (2) ◽

pp. e323-e331 ◽

Cited By ~ 17

Author(s):

Meagan Elizabeth Brennan ◽

Phyllis Butow ◽

Andrew John Spillane ◽

Frances Boyle

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Care Coordination ◽

Unmet Needs ◽

Care Planning ◽

Survivorship Care ◽

Breast Cancer Survivorship ◽

Patient Reported ◽

Survivorship Care Planning

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The impact of depression in cancer patients on healthcare utilization.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.243 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 243-243

Author(s):

Star Ye ◽

Aidan Gilbert ◽

Chao-Hui Huang ◽

Gabrielle Betty Rocque

Keyword(s):

Cancer Patients ◽

Healthcare Utilization ◽

Group Performance ◽

Severe Depression ◽

Cancer Type ◽

Medicare Patient ◽

Patient Reported ◽

Ed Visits ◽

The Impact ◽

The Relationship

243 Background: The Oncology Care Model (OCM) has set several initiatives to improve payment and care delivery in the Medicare patient population, including screening for depression in cancer patients. We evaluated the prevalence of depression in OCM patients and the relationship between depression and healthcare utilization. Methods: This cross-sectional study used patient-reported outcome (PRO) surveys administered in the outpatient setting as part of OCM at the University of Alabama at Birmingham (UAB). Depression scores and Eastern Cooperative Oncology Group performance status were obtained from PRO surveys. Moderate to severe depression was defined as a score ≥10 on the Patient Health Questionnaire 2/9 (PHQ-2/9). Sex, marital status, phase of care, race, disease aggressiveness (stage, progression, cancer type), number of emergency department (ED) visits and inpatient admissions within a 3-month period from survey completion were abstracted from the electronic health record. The relationship between depression and hospital visits was assessed using rate ratios and 95% confidence limits from Poisson regression models adjusting for clinical and demographic characteristics. Results: Of 856 patients surveyed, 68% of patients were female, and 27% of patients were non-Caucasian. Notably, almost 14% of patients had moderate to severe depression (PHQ-2/9≥10). The cancer-specific prevalence of at least moderate depression was 2% in breast, 1% in gastrointestinal, 2% in genitourinary, 5% in gynecologic, and 2% in hematologic cancers. In adjusted models, the inpatient admission and ED visit rate in the 3 months following PRO survey completion did not differ by depression category (RR: 1.22; CI: 0.93-1.61). Conclusions: Over 13% of cancer patients report clinically significant depression during routine screening, which highlights the continued need for outpatient counseling and behavioral services. Although rates of inpatient admissions and ED visits were not impacted by the presence of depression, further analysis is needed to evaluate the impact of treating depression on healthcare utilization over time.

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Perceptions of care coordination among older adult cancer survivors: A SEER-CAHPS study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.178 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 178-178

Author(s):

Michelle Mollica ◽

Susan S Buckenmaier ◽

Michael T. Halpern ◽

Timothy S. McNeel ◽

Sallie J. Weaver ◽

...

Keyword(s):

Cancer Survivors ◽

Older Adult ◽

Care Coordination ◽

Reference Group ◽

Future Research ◽

Medicare Beneficiaries ◽

Personal Doctor ◽

Adult Cancer Survivors ◽

Patient Reported ◽

History Of

178 Background: Care coordination represents deliberate efforts to harmonize and organize patient care activities. This study examined sociodemographic and clinical predictors of patient-reported care coordination among Medicare beneficiaries older than 65 with a history of cancer. Methods: This study utilized the Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, including SEER cancer registry data, Medicare CAHPS patient experience surveys, and Medicare claims. We identified Medicare beneficiaries who completed a CAHPS survey within ten years after their most recent cancer diagnosis and reported visiting a personal doctor within six months before their survey (n = 14,646). Multivariable regression models examined associations between cancer survivor characteristics and care coordination, with higher scores indicating better coordination (scale of 0-100). Results: Residing in a rural area at time of diagnosis (1.2-points greater score than urban; p= 0.04) and reporting > 4 visits with a personal doctor within 6 months (3.0-points greater than 1-2 visits; p< 0.001) were significantly associated with higher care coordination scores. Older age ( p< 0.001) and seeing more specialists ( p= 0.006) were associated with significantly lower care coordination scores. Patients with melanoma (women: 5.2-point difference, p< 0.001; men: 2.8 points, p= 0.01) and breast cancer (women: 2.4 points; p< 0.001) also reported significantly lower care coordination scores than did men with prostate cancer (reference group). Conclusions: Adult cancer survivors who are older, have a history of breast, lung, or melanoma cancers, or see more specialists report worse care coordination. Future research should explore and address the multilevel influences that lead to worse care coordination for older adult cancer survivors.

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Patient-Reported Care Coordination: Associations With Primary Care Continuity and Specialty Care Use

The Annals of Family Medicine ◽

10.1370/afm.1278 ◽

2011 ◽

Vol 9 (4) ◽

pp. 323-329 ◽

Cited By ~ 36

Author(s):

D. T. Liss ◽

J. Chubak ◽

M. L. Anderson ◽

K. W. Saunders ◽

L. Tuzzio ◽

...

Keyword(s):

Primary Care ◽

Care Coordination ◽

Specialty Care ◽

Care Continuity ◽

Patient Reported

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Patient-Reported Satisfaction and Associated Changes in Health and Behavior Pre- and Post- Project INSPIRE: a Comprehensive Hepatitis C Care Coordination Program

10.21203/rs.2.21061/v1 ◽

2020 ◽

Author(s):

Regan Deming ◽

Anna Mageras ◽

Caroline Davidson ◽

Marie Bresnahan ◽

Sheila Reyonoso ◽

...

Keyword(s):

Hepatitis C ◽

Alcohol Use ◽

Care Coordination ◽

Self Efficacy ◽

Post Intervention ◽

The Past ◽

Individualized Care ◽

Patient Reported ◽

Ed Visits ◽

And Behavior

Abstract Background Individuals infected with hepatitis C (HCV) often present with co-morbidities and complex socio-behavioral risk factors. Project INSPIRE was a care coordination and telementoring demonstration project which aimed to treat and cure HCV-infected patients while providing them with services and education to improve overall health outcomes and self-sufficiency. We examined changes in HCV-related health and behavior associated with completion of Project INSPIRE (the “intervention”). Methods Patients were enrolled into Project INSPIRE at clinical sites where they received HCV clinical care paired with care coordination services. Baseline and post-intervention surveys were distributed to participants in-person at a clinical site and/or via mail at two time-points, one before and one after the intervention. Surveys were mailed back to the researchers by participants, and participant-identifying information was used to link survey responses to clinical data for each respondent. Logistic models using generalized estimating equations to account for partially overlapping observations examined the association between intervention participation and changes in self-reported overall health, emergency department (ED) visits and hospitalizations in the past 6 months, drug and alcohol use in the past 6 months, HCV knowledge, and general self-efficacy, adjusting for potential demographic and sociobehavioral confounding variables. Results The response rates for complete and partial surveys were 14.0% of 883 for baseline and 9.9% of 1,552 for post-intervention. In multivariable analyses (N=269, of which 50 were paired and 219 were unpaired), INSPIRE intervention participation was associated with a decreased odds of self-reported ED visits (OR: 0.34, 95% CI: 0.20–0.57), hospitalizations (OR: 0.30, 95% CI: 0.16–0.57), alcohol use (OR: 0.35, 95% CI: 0.18–0.69), and injection drug use (OR: 0.09, 95% CI: 0.02–0.34), and a 6.8% (CI: 1.6-12.2%) increase in reported self-efficacy (p=0.01). Conclusions Survey results suggest that INSPIRE successfully improved participant health behavior and self-efficacy, indicating the intervention’s value to patients, providers, and insurance companies beyond the immediate benefits of HCV treatment and cure. Participants also had a generally positive experience working with their care teams, indicating that further research should explore how an individualized care team can improve retention and patient referral rates compared with the HCV standard of care.

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The Effectiveness of the Nurse Care Coordinator Role on Patient-Reported and Health Service Outcomes: A Systematic Review

Evaluation & the Health Professions ◽

10.1177/0163278717734610 ◽

2017 ◽

Vol 42 (3) ◽

pp. 263-296 ◽

Cited By ~ 7

Author(s):

Aaron Conway ◽

Chris O’Donnell ◽

Patsy Yates

Keyword(s):

Systematic Review ◽

Health Service ◽

Care Coordination ◽

Evaluation System ◽

The United States ◽

Care Coordinator ◽

Nurse Care ◽

Patient Reported ◽

Service Outcomes ◽

The Impact

This systematic review examined the effectiveness of nurse care coordinator (CC) roles on patient-reported and health service outcomes. Multiple electronic databases (Medline, CINAHL, and EMBASE) were searched and the Cochrane Risk of Bias Assessment Tool was applied by two independent reviewers. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the quality of evidence. A total of 45 articles (reporting on 36 studies) were included. The majority of studies ( n = 28, 78%) were conducted in the United States and published after 2009 ( n = 24, 67%). Thirteen studies (36%) used a randomized controlled trial design. A total of 17 studies evaluated patient-reported outcomes and 29 studies reported health service outcomes. The individual components of nurse CC roles that were evaluated ranged considerably. The impact of nurse care coordination on patient-reported and health service outcomes was inconsistent. There was an indication from higher quality studies that nurse care coordination roles were more likely to result in improved patient and health service outcomes where they involved frequent, in-person interactions, had ongoing follow-up with monitoring of disease status, and involved transition care and the application of behavior change principles.

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