Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, Michigan, USA.
Gerontologist. 2024 Jun 1;64(6). doi: 10.1093/geront/gnae024.
Although coordinated care (CC) seeks to improve patient experiences and ultimately health outcomes, evidence from empirical research on the impacts of CC is mixed. This study examined the relationship between CC and healthcare outcomes over a 4-year period among older adults with multiple chronic conditions.
This observational cohort study is based on data from the 2016-2020 Health and Retirement Study. Analysis is limited to respondents with 2+ chronic conditions who completed an experimental module on CC in 2016 (n = 906). Three domains of CC were assessed: perceptions, informal (family/friends) and formal (healthcare staff) tangible support, and technical support (using a "patient portal"). The longitudinal relationship between CC and health (e.g., pain, functioning, and self-rated health [SRH]) and healthcare (e.g., doctor visits, hospitalization, and care satisfaction) outcomes was investigated using mixed-effects models.
Better perceptions of CC were associated with lower odds of ADL limitations (Odds ratio [OR] = 0.91; 95% CI = 0.84-0.99) and greater satisfaction with care (B = 0.04, 95% CI = 0.02-0.06). Receipt of more informal tangible support was associated with 1.34 higher odds of ADL limitations (95% CI = 1.19-1.51) and 1.74 higher odds of hospitalization (95% CI = 1.07-1.21). Use of technical support was associated with better SRH and greater satisfaction with care.
The longitudinal relationship between CC and health is multifaceted. Although positive perceptions and more technical support have beneficial effects on health outcomes, higher utilization of tangible support may reflect a higher demand among older adults with more complex healthcare needs.
尽管协调护理（CC）旨在改善患者体验并最终改善健康结果，但来自实证研究的证据对 CC 的影响却不一致。本研究考察了在 4 年期间，患有多种慢性病的老年人的 CC 与医疗保健结果之间的关系。
本观察性队列研究基于 2016-2020 年健康与退休研究的数据。分析仅限于在 2016 年完成 CC 实验模块且有 2 种以上慢性病的受访者（n=906）。评估了 CC 的三个领域：感知、非正式（家庭/朋友）和正式（医护人员）有形支持以及技术支持（使用“患者门户”）。使用混合效应模型研究了 CC 与健康（例如，疼痛、功能和自我评估健康[SRH]）和医疗保健（例如，就诊、住院和护理满意度）结果之间的纵向关系。
对 CC 的更好感知与较低的日常生活活动能力受限的可能性相关（优势比[OR] = 0.91；95%可信区间[CI] = 0.84-0.99），并且对护理的满意度更高（B = 0.04，95%CI = 0.02-0.06）。获得更多非正式的有形支持与日常生活活动能力受限的可能性增加 1.34 倍相关（95%CI = 1.19-1.51），与住院的可能性增加 1.74 倍相关（95%CI = 1.07-1.21）。使用技术支持与更好的 SRH 和更高的护理满意度相关。
CC 与健康之间的纵向关系是多方面的。尽管积极的认知和更多的技术支持对健康结果有有益的影响，但更多的有形支持的利用可能反映了具有更复杂医疗保健需求的老年人的更高需求。
