Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Patient Educ Couns. 2022 Jul;105(7):2429-2435. doi: 10.1016/j.pec.2022.03.015. Epub 2022 Mar 17.
The goal of this study was to examine variation in patient experiences and perceptions of care coordination across sociodemographic and health factors.
Data come from the 2016 Health and Retirement Study (N = 1, 216). Three domains of coordination were assessed: 1) Perceptions (e.g., patient impressions of provider-provider communication), 2) Tangible supports (e.g., meeting with a care coordinator, being accompanied to appointments), and 3) Technical supports (e.g., use of a "patient portal"). Logistic regression was used to quantify the frequency of each domain and examine variation by racial minority status, socioeconomic status, and health status.
Approximately 42% of older adults perceived poor care coordination, including 14.8% who reported receiving seemingly conflicting advice from different providers. Only one-third had ever met with a formal care coordinator, and 40% were occasionally accompanied to appointments. Although racial minorities were less likely to have access to technical supports, they were more likely to use them. Better perceived coordination was associated with higher care satisfaction (Odds Ratio: 1.43, 95% CI: 1.27-1.61).
Important gaps in care coordination remain for older adults.
Providers should consider assessing patient perceptions of care coordination to address these gaps in an equitable manner.
本研究旨在考察社会人口学和健康因素对患者对医疗协调体验和感知的差异。
数据来自 2016 年健康与退休研究（N=1216）。评估了三个协调领域：1）感知（例如，患者对医生间沟通的印象）；2）有形支持（例如，与协调员会面、陪同就诊）；3）技术支持（例如，使用“患者门户”）。使用逻辑回归来量化每个领域的频率，并根据种族少数群体状况、社会经济地位和健康状况来检查差异。
约 42%的老年人认为医疗协调不佳，包括 14.8%的人报告说从不同的提供者那里得到了似乎相互矛盾的建议。只有三分之一的人曾见过正式的协调员，40%的人偶尔会陪同就诊。尽管少数族裔获得技术支持的机会较少，但他们更有可能使用这些支持。更好的协调感知与更高的护理满意度相关（优势比：1.43，95%置信区间：1.27-1.61）。
老年人的医疗协调仍存在重要差距。
提供者应考虑评估患者对医疗协调的感知，以公平的方式解决这些差距。
