A Multilevel Analysis of Patient Engagement and Patient-Reported Outcomes in Primary Care Practices of Accountable Care Organizations

Autor: Stephen M. Shortell, Thomas P. Huber, Jeremy N. Rich, Tom Summerfelt, Bing Ying Poon, Hector P. Rodriguez, Patricia P. Ramsay, Susan L. Ivey
Rok vydání: 2017
Předmět:
Male
Outcome Assessment
Disease
Cardiovascular
0302 clinical medicine
Patient-Centered Care
Surveys and Questionnaires
Outcome Assessment
Health Care
80 and over
030212 general & internal medicine
Depression (differential diagnoses)
Aged
80 and over
Response rate (survey)
patient engagement
Depression
030503 health policy & services
Diabetes
Middle Aged
Heart Disease
Mental Health
patient-reported outcomes
Cardiovascular Diseases
Multilevel Analysis
Female
0305 other medical science
Adult
medicine.medical_specialty
Adolescent
Clinical Sciences
accountable care organizations
7.3 Management and decision making
Young Adult
03 medical and health sciences
Clinical Research
General & Internal Medicine
Behavioral and Social Science
Diabetes Mellitus
Internal Medicine
medicine
Humans
Patient Reported Outcome Measures
Social determinants of health
Aged
Patient Activation Measure
Accountable Care Organizations
business.industry
Prevention
Capsule Commentary
Odds ratio
medicine.disease
Comorbidity
Health Care
Good Health and Well Being
Cross-Sectional Studies
Logistic Models
Family medicine
Observational study
Management of diseases and conditions
Patient Participation
business
Zdroj: Journal of general internal medicine, vol 32, iss 6
ISSN: 1525-1497
0884-8734
Popis: BackgroundThe growing movement toward more accountable care delivery and the increasing number of people with chronic illnesses underscores the need for primary care practices to engage patients in their own care.ObjectiveFor adult primary care practices seeing patients with diabetes and/or cardiovascular disease, we examined the relationship between selected practice characteristics, patient engagement, and patient-reported outcomes of care.DesignCross-sectional multilevel observational study of 16 randomly selected practices in two large accountable care organizations (ACOs).ParticipantsPatients with diabetes and/or cardiovascular disease (CVD) who met study eligibility criteria (n = 4368) and received care in 2014 were randomly selected to complete a patient activation and PRO survey (51% response rate; n = 2176). Primary care team members of the 16 practices completed surveys that assessed practice culture, relational coordination, and teamwork (86% response rate; n = 411).Main measuresPatient-reported outcomes included depression (PHQ-4), physical functioning (PROMIS SF12a), and social functioning (PROMIS SF8a), the Patient Assessment of Chronic Illness Care instrument (PACIC-11), and the Patient Activation Measure instrument (PAM-13). Patient-level covariates included patient age, gender, education, insurance coverage, limited English language proficiency, blood pressure, HbA1c, LDL-cholesterol, and disease comorbidity burden. For each of the 16 practices, patient-centered culture and the degree of relational coordination among team members were measured using a clinician and staff survey. The implementation of shared decision-making activities in each practice was assessed using an operational leader survey.Key resultsHaving a patient-centered culture was positively associated with fewer depression symptoms (odds ratio [OR] = 1.51; confidence interval [CI] 1.04, 2.19) and better physical function scores (OR = 1.85; CI 1.25, 2.73). Patient activation was positively associated with fewer depression symptoms (OR = 2.26; CI 1.79, 2.86), better physical health (OR = 2.56; CI 2.00, 3.27), and better social health functioning (OR = 4.12; CI 3.21, 5.29). Patient activation (PAM-13) mediated the positive association between patients' experience of chronic illness care and each of the three patient-reported outcome measures-fewer depression symptoms, better physical health, and better social health. Relational coordination and shared decision-making activities reported by practices were not significantly associated with higher patient-reported outcome scores.ConclusionsDiabetic and CVD patients who received care from ACO-affiliated practices with more developed patient-centered cultures reported lower PHQ-4 depression symptom scores and better physical functioning. Diabetic and CVD patients who were more highly activated to participate in their care reported lower PHQ-4 scores and better physical and social outcomes of care.
Databáze: OpenAIRE
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