title: Quality and coordination of care for patients with multiple conditions: results from an international survey of patient experience.
abstract: Previous studies using clinical performance measures suggest that quality of care for patients with multiple chronic conditions is not worse than that for others. This article presents patient-reported experiences of health care among 8,973 of chronically ill adults from eight countries, using telephone survey data. We designed a ''morbidity score'' combining the number of conditions and reported health status. Respondents with high morbidity scores reported less favorable experience with coordination of care compared to those with low morbidity scores. They also reported lower ratings of overall quality of care. There were no differences in reported experience with the individual physicians. Comparing type of comorbidity, chronic lung, and mental health problems were associated with lower ratings than hypertension, heart disease, diabetes, arthritis, and cancer. The implications and limitations of this study are discussed in the context of health care reform. Pay-for-performance programs need to account for chronic conditions to avoid penalizing physicians who care for larger shares of such patients.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. j.burgers@iq.umcn.nl
authors.forename: Jako S
authors.initials: JS
authors.lastname: Burgers
authors.forename: Gerlienke E
authors.initials: GE
authors.lastname: Voerman
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Faber
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D007391:International Cooperation; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult