School of Public Health.
Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, University of California, Berkeley, CA.
Med Care. 2018 Jul;56(7):551-556. doi: 10.1097/MLR.0000000000000927.
Accountable care organizations (ACOs) have increased their use of patient activation and engagement strategies, but it is unknown whether they achieve better outcomes for patients with comorbid chronic physical and mental health conditions.
To assess the extent to which practices with patient-centered cultures, greater shared decision-making strategies, and better coordination among team members have better patient-reported outcomes (PROs) for patients with diabetes and/or cardiovascular and comorbid mental health diagnoses.
Sixteen practices randomly selected from top and bottom quartiles of a 39-item patient activation/engagement implementation survey of primary care team members (n=411) to assess patient-centered culture, shared decision-making, and relational coordination among team members. These data were linked to survey data on patient engagement and on emotional, physical, and social patient-reported health outcomes.
Adult patients (n=606) with diabetes, cardiovascular, and comorbid mental health conditions who had at least 1 visit at participating primary care practices of 2 ACOs.
Depression/anxiety, physical functioning, social functioning; patient-centered culture, patient activation/engagement implementation, relational coordination.
Patients receiving care from practices with high patient-centered cultures reported better physical functioning (0.025) and borderline better emotional functioning (0.059) compared with less patient-centered practices. More activated patients reported better PROs, with higher activation levels partially mediating the relationship of patient-centered culture and better PROs.
ACO patients with comorbid physical and mental health diagnoses report better physical functioning when practices have patient-centered cultures. More activated/engaged patients report better patient emotional, physical, and social health outcomes.
责任医疗组织（ACO）增加了对患者激活和参与策略的使用，但尚不清楚它们是否能为患有合并慢性身体和心理健康状况的患者带来更好的结果。
评估具有以患者为中心的文化、更多共享决策策略以及团队成员之间更好协调的实践是否能为患有糖尿病和/或心血管疾病以及合并心理健康诊断的患者带来更好的患者报告结果（PROs）。
从初级保健团队成员的 39 项患者激活/参与实施调查的前四分之一和后四分之一中随机选择了 16 个实践，以评估以患者为中心的文化、共享决策和团队成员之间的关系协调。这些数据与评估患者参与度以及情绪、身体和社会患者报告健康结果的调查数据相关联。
患有糖尿病、心血管疾病和合并心理健康状况的成年患者（n=606），他们在参与的 2 个 ACO 的初级保健实践中至少有 1 次就诊。
抑郁/焦虑、身体功能、社会功能；以患者为中心的文化、患者激活/参与实施、关系协调。
接受以患者为中心文化的实践护理的患者报告身体功能（0.025）更好，情绪功能（0.059）也有改善，与以患者为中心的实践相比。更活跃的患者报告了更好的 PROs，更高的激活水平部分中介了以患者为中心的文化和更好的 PROs 之间的关系。
患有合并身体和心理健康诊断的 ACO 患者在实践中具有以患者为中心的文化时，报告身体功能更好。更活跃/参与的患者报告情绪、身体和社会健康结果更好。
