Requirements for integrating care across providers, settings, and over time increase with patients’ needs. Health care providers’ ability to offer care that patients experience as integrated may vary among patients with different levels of need. We explore the variation in patients’ perceptions of integrated care among Medicare beneficiaries based on the beneficiary’s level of need using ordinary least square regression for each of four high-need groups: beneficiaries (a) with complex chronic conditions, (b) with frailties, (c) below 65 with disability, and (d) with any (of the first three) high needs. We control for beneficiary demographics and other factors affecting integrated care, and we conduct sensitivity analyses controlling for multiple individual chronic conditions. We find significant positive associations with level of need for provider support for self-directed care and medication and home health management. Controlling for multiple individual chronic conditions reduces effect sizes and number of significant relationships.
BenjaminiY.YekutieliD. (2001). The control of the false discovery rate in multiple testing under dependency. Annals of Statistics, 29(4), 1165–1188.
3.
BerryA. B. L.LimC.HartzlerA. L.HirschT.WagnerE. H.LudmanE.RalstonJ. D. (2017). How values shape collaboration between patients with multiple chronic conditions and spousal caregivers. In Proceedings of the 2017 CHI conference on human factors in computing systems (pp. 5257–5270). Association for Computing Machinery. https://doi.org/10.1145/3025453.3025923
4.
BerryL. L.RockB. L.Smith HouskampB.BrueggemanJ.TuckerL. (2013). Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clinic Proceedings, 88(2), 184–194. https://doi.org/10.1016/j.mayocp.2012.10.016
5.
BlumenthalD.AbramsM. K. (2016). Tailoring complex care management for high-need, high-cost patients. JAMA, 316(16), 1657–1658. https://doi.org/10.1001/jama.2016.12388
6.
BlumenthalD.ChernofB.FulmerT.LumpkinJ.SelbergJ. (2016). Caring for high-need, high-cost patients—An urgent priority. New England Journal of Medicine, 375(10), 909–911. https://doi.org/10.1056/NEJMp1608511
BrownR. S.PeikesD.PetersonG.SchoreJ.RazafindrakotoC. M. (2012). Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Affairs (Project Hope), 31(6), 1156–1166. https://doi.org/10.1377/hlthaff.2012.0393
ChenJ. G.ZouB.ShusterJ. (2017). Relationship between patient satisfaction and physician characteristics. Journal of Patient Experience, 4(4), 177–184. https://doi.org/10.1177/2374373517714453
12.
FentonJ. J.JerantA. F.BertakisK. D.FranksP. (2012). The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Archives of Internal Medicine, 172(5), 405–411. https://doi.org/10.1001/archinternmed.2011.1662
13.
FriedbergM. W.EdelenM. O.HirshmanS.KerrisseyM. J.BasileA. M.TietschertM. V.ElliotM. N.SingerS. J. (2019). Development and psychometric analysis of the revised patient perceptions of integrated care survey. Medical Care Research and Review, 78(1), 68–76. https://doi.org/10.1177/1077558719842951
FryerA.-K.FriedbergM. W.ThompsonR. W.SingerS. J. (2016). Achieving care integration from the patients’ perspective: Results from a care management program. Healthcare (Amsterdam, Netherlands), 4(1), 36–44. https://doi.org/10.1016/j.hjdsi.2015.12.006
16.
FryerA.-K.FriedbergM. W.ThompsonR. W.SingerS. J. (2017). Patient perceptions of integrated care and their relationship to utilization of emergency, inpatient and outpatient services. Healthcare (Amsterdam, Netherlands), 5(4), 183–193. https://doi.org/10.1016/j.hjdsi.2016.12.005
17.
GreeneJ.HibbardJ. H. (2012). Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of General Internal Medicine, 27(5), 520–526. https://doi.org/10.1007/s11606-011-1931-2
HochmanM.AschS. M. (2017). Disruptive models in primary care: Caring for high-needs, high-cost populations. Journal of General Internal Medicine, 32(4), 392–397. https://doi.org/10.1007/s11606-016-3945-2
20.
HopmanP.de BruinS. R.ForjazM. J.Rodriguez-BlazquezC.TonnaraG.LemmensL. C.OnderG.BaanC. A.RijkenM. (2016). Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review. Health Policy (Amsterdam, Netherlands), 120(7), 818–832. https://doi.org/10.1016/j.healthpol.2016.04.002
21.
Jean-BaptisteD.O’MalleyA.ShahT. (2017). Population segmentation and targeting of health care resources: Findings from a literature review (Working paper, 58). Mathematica Policy Research.
KerrisseyM. J.ClarkJ. R.FriedbergM. W.JiangW.FryerA. K.FreanM.ShortellS. M.RamsayP. P.CasalinoL. P.SingerS. J. (2017). Medical group structural integration may not ensure that care is integrated, from the patient’s perspective. Health Affairs, 36(5), 885–892. https://doi.org/10.1377/hlthaff.2016.0909
24.
KimD. H.SchneeweissS.GlynnR. J.LipsitzL. A.RockwoodK.AvornJ. (2018). Measuring frailty in Medicare data: Development and validation of a claims-based frailty index. The Journals of Gerontology. Series A, 73(7), 980–987. https://doi.org/10.1093/gerona/glx229
25.
KupferJ. M.BondE. U. (2012). Patient satisfaction and patient-centered care: Necessary but not equal. JAMA, 308(2), 139–140. https://doi.org/10.1001/jama.2012.7381
26.
LissD. T.ChubakJ.AndersonM. L.SaundersK. W.TuzzioL.ReidR. J. (2011). Patient-reported care coordination: Associations with primary care continuity and specialty care use. Annals of Family Medicine, 9(4), 323–329. https://doi.org/10.1370/afm.1278
27.
LongP.AbramsM.MilsteinA.AndersonG.AptonK. L.DahlbergM. L.WhicherD. (Eds.). (2017). Effective care for high-need patients. National Academy of Medicine. https://nam.edu/HighNeeds/
28.
LumleyT. (2018). Survey: Analysis of complex survey samples [R package version 3.35].
29.
MaengD. D.MartsolfG. R.ScanlonD. P.ChristiansonJ. B. (2012). Care coordination for the chronically ill: Understanding the patient’s perspective. Health Services Research, 47(5), 1960–1979. https://doi.org/10.1111/j.1475-6773.2012.01405.x
30.
Martínez-GonzálezN. A.BerchtoldP.UllmanK.BusatoA.EggerM. (2014). Integrated care programmes for adults with chronic conditions: A meta-review. International Journal for Quality in Health Care, 26(5), 561–570. https://doi.org/10.1093/intqhc/mzu071
OryM. G.AhnS.JiangL.SmithM. L.RitterP. L.WhitelawN.LorigK. (2013). Successes of a national study of the Chronic Disease Self-Management Program: Meeting the triple aim of health care reform. Medical Care, 51(11), 992–998. https://doi.org/10.1097/MLR.0b013e3182a95dd1
34.
ParkerJ. L.ReganJ. F.PetroskiJ. (2014). Beneficiary activation in the Medicare population. Medicare & Medicaid Research Review, 4(4), E1–E14. https://doi.org/10.5600/mmrr.004.04.b02
35.
RocksS.BerntsonD.Gil-SalmerónA.KaduM.EhrenbergN.SteinV.TsiachristasA. (2020). Cost and effects of integrated care: A systematic literature review and meta-analysis. The European Journal of Health Economics, 21(8), 1211–1221. https://doi.org/10.1007/s10198-020-01217-5
36.
ScheierM.CarverC.BridgesM. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67(6), 1063–1078.
37.
SegalJ. B.ChangH.-Y.DuY.WalstonJ. D.CarlsonM. C.VaradhanR. (2017). Development of a claims-based frailty indicator anchored to a well-established frailty phenotype. Medical Care, 55(7), 716–722. https://doi.org/10.1097/MLR.0000000000000729
38.
SimpsonK. N.SeamonB. A.HandB. N.RoldanC. O.TaberD. J.MoranW. P.SimpsonA. N. (2018). Effect of frailty on resource use and cost for Medicare patients. Journal of Comparative Effectiveness Research, 7(8), 817–825. https://doi.org/10.2217/cer-2018-0029
39.
SingerS. J.BurgersJ.FriedbergM.RosenthalM. B.LeapeL.SchneiderE. (2011). Defining and measuring integrated patient care: Promoting the next frontier in health care delivery. Medical Care Research and Review, 68(1), 112–127. https://doi.org/10.1177/1077558710371485
40.
SingerS. J.FriedbergM. W.KiangM. V.DunnT.KuhnD. M. (2013). Development and preliminary validation of the Patient Perceptions of Integrated Care survey. Medical Care Research and Review, 70(2), 143–164. https://doi.org/10.1177/1077558712465654
41.
TriccoA. C.AntonyJ.IversN. M.AshoorH. M.KhanP. A.BlondalE.GhassemiM.MacDonaldH.ChenM. H.EzerL. K.StrausS. E. (2014). Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: A systematic review and meta-analysis. Canadian Medical Association Journal, 186(15), E568–E578. https://doi.org/10.1503/cmaj.140289
42.
TurnerR. M.MaQ.LorigK.GreenbergJ.DeVriesA. R. (2018). Evaluation of a diabetes self-management program: Claims analysis on comorbid illnesses, health care utilization, and cost. Journal of Medical Internet Research, 20(6), Article e6207. https://doi.org/10.2196/jmir.9225
43.
TzelepisF.Sanson-FisherR. W.ZuccaA. C.FradgleyE. A. (2015). Measuring the quality of patient-centered care: Why patient-reported measures are critical to reliable assessment. Patient Preference and Adherence, 9, 831–835. https://doi.org/10.2147/PPA.S81975
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