Experience Of Care Coordination Research Articles

Transforming Primary Care in the New Orleans Safety-net

The patient-centered medical home (PCMH) is a key service delivery innovation in health reform. However, there are growing questions about whether the changes in clinics promoted by the PCMH model lead to improvements in the patient experience. To test the hypothesis that PCMH improvements in safety-net primary care clinics are associated with a more positive patient experience. Multilevel cross-sectional analysis of patients nested within the primary care clinics that serve them. Primary care clinic leaders and patients throughout the City of New Orleans health care safety-net. Dependent variables included patient ratings of accessibility, coordination, and confidence in the quality/safety of care. The key independent variable was a score measuring PCMH structural and process improvements at the clinic level. Approximately two thirds of patients in New Orleans gave positive ratings to their clinics on access and quality/safety, but only one third did for care coordination. In all but the largest clinics, patient experiences of care coordination were positively associated with the clinic's use of PCMH structural and process changes. Results for patient ratings of access and quality/safety were mixed. Among primary care clinics in the New Orleans safety-net, use of more PCMH improvements at the clinic level led to more positive patient rating of care coordination, but not of accessibility or confidence in quality/safety. Ongoing efforts to pilot, demonstrate, implement, and evaluate the PCMH should consider how the impact of medical practice transformation could vary across different aspects of the patient experience.

Transforming Psychology into a True Healthcare Discipline

It has been my privilege to be the editor of the Journal of Clinical Psychology in Medical Settings (JCPMS) during a time when our health care system is in transformation. Recently, psychology’s survival has depended on its ability to interface its unique contributions with those of other health care disciplines and embed itself within medical settings. Subsequently, my goal has been to insure that JCPMS publishes articles that are representative of the cutting edge research health and clinical psychologists offer, provides descriptions of our education and training activities within academic health centers that are innovative, and offers reviews of clinical service delivery models that are community based and inter-professional resulting in high quality, cost effective, equitable health care. As an editor, I am particularly proud of the strategically chosen topics for Special Issues that I oversaw during my tenure. I believe that each of these Special Issues included vital information to our readership about maintaining psychology’s prominence in a health care world that is rapidly changing. The first of these Special Issue was the March 2008 issue, based on several talks presented at the Association of Psychologists in Academic Health Center (APAHC) National Conference, titled Psychologists in Academic Health Centers: Traditions and Innovations in Education, Science and Practice. The second Special Issue was the March 2009 issue on Integrated Care (with special editor Rodger Kessler) and the third was the June 2011 issue Strengthening Our Soldiers (SOS) and Their Families: Contemporary Psychological Advances Applied to Wartime Problems (with special editor Barbara Melamed). I am also proud of the Special Sections that I have occasionally embedded in the issues published during my six year as editor of JCPMS. It is highly rewarding to see that psychology has become increasingly aware of its call to action during my editorship of JCPMS as the implementation of the Patient Protection and Affordable Care Act (ACA) [P.L. 111–148] comes into full fruition. Our training programs have and will need to continue to focus more on prevention and health promotion, management of acute and chronic conditions, family experiences of care, care coordination, and access to care. The next generation of psychologists must be skilled at caring for a higher volume of patients as more individuals are insured in 2014 with implementation of the ACA. Additionally, training in new health care delivery models that employ team based service delivery is crucial as is coursework and clinical placements that prepare psychologists to better comprehend the linkages between health and behavior to meet societal needs (e.g. a more diverse and aging population that will receive most of its behavioral services in primary care settings). All psychologists must understand the mission and scope of Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs) as applicable to how we prepare psychology to provide direct clinical services, teach other disciplines about integrated mental health care, design research protocols, develop and evaluate behavioral services within medical settings, and serve as administrators and leaders in the health care field of tomorrow. Thus, I felt it only fitting that the last issue of the journal under my editorship focus on my passion, integrated primary care. Long before the enactment of the ACA, I oversaw a training model at the Eastern Virginia Medical School focused on training clinical psychology interns and B. Cubic (&) Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA 23507, USA e-mail: cubicba@evms.edu

Measuring cancer care coordination: development and validation of a questionnaire for patients.

BackgroundImproving the coordination of cancer care is a priority area for service improvement. However, quality improvement initiatives are hindered by the lack of accurate and reliable measures of this aspect of cancer care. This study was conducted to develop a questionnaire to measures patients' experience of cancer care coordination and to assess the psychometric properties of this instrument.MethodsQuestionnaire items were developed on the basis of literature review and qualitative research involving focus groups and interviews with cancer patients, carers and clinicians. The draft instrument was completed 686 patients who had been recently treated for a newly diagnosed cancer, including patients from metropolitan, regional and rural areas of New South Wales, Australia. To assess test-retest reliability, 119 patients completed the questionnaire twice. Unreliable items those with limited variability or high levels of missing data were eliminated. Exploratory factor analysis was conducted to define the underlying factor structure of the remaining items and subscales were constructed. Correlations between these and global measures of the experience of care coordination and the quality of care were assessed.ResultsOf 40 items included in the draft questionnaire, 20 were eliminated due to poor test-retest reliability (n = 4), limited response distributions (n = 8), failure to load onto a factor (n = 7) or detrimental effect on the internal consistency of the scale (n = 1). The remaining 20 items loaded onto two factors named 'Communication' and 'Navigation', which explained 91% of the common variance. Internal consistency was with high for the instrument (Cronbach's alpha 0.88) and each subscale (Cronbach's alpha 0.87 and 0.73 respectively). There was no apparent 'floor' or 'ceiling' effect for the total score or the Communication subscale, but evidence of a ceiling effect for the Navigation subscale with 21% of respondents achieving the highest possible score. There were moderate positive associations between the total score and global measures of care coordination (r = 0.57) and quality of care (r = 0.53).ConclusionsThe instrument developed in this study demonstrated consistency and robust psychometric properties. It may provide a useful tool to measure patients' experience of cancer care coordination in future surveys and intervention studies.

O-133 Meeting the challenge of patient-centred care: The experience of care coordination in South Western Sydney, NSW, Australia

O-133 Meeting the challenge of patient-centred care: The experience of care coordination in South Western Sydney, NSW, Australia

Experiences with care co-ordination among people with cerebral palsy, multiple sclerosis, or spinal cord injury

Purpose: To describe the experiences with care co-ordination of people with cerebral palsy, multiple sclerosis, or spinal cord injury; to determine barriers to effective care co-ordination; and to compare experiences across disability and health plan types. Method: Qualitative, semi-structured telephone interviews with 30 people with cerebral palsy, multiple sclerosis, or spinal cord injury. Interviews focused on the care co-ordination experience of individuals in managed care and traditional indemnity health insurance plans in the USA and were analysed using NVivo. Results: Half of the respondents reported that they had a health professional who co-ordinated their care. Participants identified barriers that prevented effective care co-ordination, including a lack of disability specific knowledge, providers' limited time and effort related to care, and insufficient communication among providers. There were few differences between managed care and fee-for-service respondents with regard to these barriers. Conclusions: Study findings reveal few differences in the care co-ordination experiences amongst people with cerebral palsy, multiple sclerosis, or spinal cord injury in both plan types. All providers need to become more literate about the health care needs of people with physical disabilities, and health plans need to reward communication among providers and the time and effort invested in care co-ordination.