Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA.
J Gen Intern Med. 2019 Nov;34(11):2482-2489. doi: 10.1007/s11606-019-05313-y. Epub 2019 Sep 3.
There is significant promise in analyzing physician patient-sharing networks to indirectly measure care coordination, yet it is unknown whether these measures reflect patients' perceptions of care coordination.
To evaluate the associations between network-based measures of care coordination and patient-reported experience measures.
We analyzed patient-sharing physician networks within group practices using data made available by the Centers for Medicare and Medicaid Services.
Medicare beneficiaries who provided responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey in 2016 (data aggregated by physician group practice made available through the Physician Compare 2016 Group Public Reporting).
The outcomes of interest were patient-reported experience measures reflecting aspects of care coordination (CAHPS). The predictor variables of interests were physician group practice density (the number of physician pairs who share patients adjusting for the total number of physician pairs) and clustering (the extent to which sets of three physicians share patients).
Four hundred seventy-six groups had patient-reported measures available. Patients' perception of "Clinicians working together for your care" was significantly positively associated with both physician group practice density (Est (95 % CI) = 5.07(0.83, 9.33), p = 0.02) and clustering (Est (95 % CI) = 3.73(1.01, 6.44), p = 0.007). Physician group practice clustering was also significantly positively associated with "Getting timely care, appointments, and information" (Est (95 % CI) = 4.63(0.21, 9.06), p = 0.04).
This work suggests that network-based measures of care coordination are associated with some patient-reported experience measures. Evaluating and intervening on patient-sharing networks may provide novel strategies for initiatives aimed at improving quality of care and the patient experience.
分析医患共享网络以间接衡量医疗协调度具有重要意义，但尚不清楚这些衡量指标是否反映了患者对医疗协调度的看法。
评估基于网络的医疗协调度衡量指标与患者报告的体验衡量指标之间的关联。
我们使用医疗保险和医疗补助服务中心提供的数据，分析了医疗机构内的医患共享网络。
在 2016 年对医疗保健提供者和系统消费者评估调查（CAHPS）做出回应的医疗保险受益人（通过 2016 年医生比较组公共报告获得的医生组实践汇总数据）。
感兴趣的结果是反映医疗协调度各方面的患者报告的体验衡量指标（CAHPS）。感兴趣的预测变量是医生组实践密度（调整医生对患者的总配对数后的共享患者的医生对数量）和聚类（三组医生共享患者的程度）。
有 476 个组提供了患者报告的衡量指标。患者对“医生共同为您的治疗提供服务”的看法与医生组实践密度（Est（95%CI）=5.07（0.83,9.33），p=0.02）和聚类（Est（95%CI）=3.73（1.01,6.44），p=0.007）显著正相关。医生组实践聚类也与“及时获得护理、预约和信息”显著正相关（Est（95%CI）=4.63（0.21,9.06），p=0.04）。
这项工作表明，基于网络的医疗协调度衡量指标与一些患者报告的体验衡量指标相关。评估和干预医患共享网络可能为旨在提高医疗质量和患者体验的举措提供新的策略。
