Geisinger Center for Health Research, 100 N. Academy Ave. M.C. 44-00 Danville, PA 17822, USA.
Health Serv Res. 2012 Oct;47(5):1960-79. doi: 10.1111/j.1475-6773.2012.01405.x. Epub 2012 Mar 30.
To identify factors associated with perception of care coordination problems among chronically ill patients.
Patient-level data were obtained from a random-digit dial telephone survey of adults with chronic conditions. The survey measured respondents' self-report of care coordination problems and level of patient activation, using the Patient Activation Measure (PAM-13). Logistic regression was used to assess association between respondents' self-report of care coordination problems and a set of patient characteristics.
Respondents in the highest activation stage had roughly 30-40 percent lower odds of reporting care coordination problems compared to those in the lowest stage (p < .01). Respondents with multiple chronic conditions were significantly more likely to report coordination problems than those with hypertension only. Respondents' race/ethnicity, employment, insurance status, income, and length of illness were not significantly associated with self-reported care coordination problems.
We conclude that patient activation and complexity of chronic illness are strongly associated with patients' self-report of care coordination problems. Developing targeted strategies to improve care coordination around these patient characteristics may be an effective way to address the issue.
确定与慢性病患者感知的护理协调问题相关的因素。
从对慢性病成人进行的随机数字拨号电话调查中获得患者层面的数据。该调查使用患者激活量表（PAM-13）衡量了受访者对护理协调问题的自我报告以及患者的激活水平。使用逻辑回归评估了受访者对护理协调问题的自我报告与一系列患者特征之间的关联。
处于最高激活阶段的受访者报告护理协调问题的可能性比处于最低阶段的受访者低约 30-40%（p<.01）。患有多种慢性病的受访者比仅患有高血压的受访者更有可能报告协调问题。受访者的种族/民族、就业、保险状况、收入和患病时间与自我报告的护理协调问题没有显著关联。
我们得出结论，患者的激活程度和慢性病的复杂性与患者对护理协调问题的自我报告密切相关。针对这些患者特征制定有针对性的改善护理协调的策略可能是解决该问题的有效方法。
