title: Patient-reported care coordination: associations with primary care continuity and specialty care use.
abstract: OBJECTIVE
  Care coordination is increasingly recognized as a necessary element of high-quality, patient-centered care. This study investigated (1) the association between care coordination and continuity of primary care, and (2) differences in this association by level of specialty care use.
  
  
  METHODS
  We conducted a cross-sectional study of Medicare enrollees with select chronic conditions in an integrated health care delivery system in Washington State. We collected survey information on patient experiences and automated health care utilization data for 1 year preceding survey completion. Coordination was defined by the coordination measure from the short form of the Ambulatory Care Experiences Survey (ACES). Continuity was measured by primary care visit concentration. Patients who had 10 or more specialty care visits were classified as high users. Linear regression was used to estimate the association between coordination and continuity, controlling for potential confounders and clustering within clinicians. We used a continuity-by-specialty interaction term to determine whether the continuity-coordination association was modified by high specialty care use.
  
  
  RESULTS
  Among low specialty care users, an increase of 1 standard deviation (SD) in continuity was associated with an increase of 2.71 in the ACES coordination scale (P <.001). In high specialty care users, we observed no association between continuity and reported coordination (P= .77).
  
  
  CONCLUSIONS
  High use of specialty care may strain the ability of primary care clinicians to coordinate care effectively. Future studies should investigate care coordination interventions that allow for appropriate specialty care referrals without diminishing the ability of primary care physicians to manage overall patient care.
authors: Department of Health Services, University of Washington, Seattle, Washington, USA. daveliss@uw.edu
authors: David T
authors: DT
authors: Liss
authors: Jessica
authors: J
authors: Chubak
authors: Melissa L
authors: ML
authors: Anderson
authors: Kathleen W
authors: KW
authors: Saunders
authors: Leah
authors: L
authors: Tuzzio
authors: Robert J
authors: RJ
authors: Reid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000704:Analysis of Variance; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D013038:Specialization / Q000706:statistics & numerical data*; D014861:Washington