title: patient perceptions of integrated care and their relationship to utilization of emergency, inpatient and outpatient services.
abstract: BACKGROUND
  Patients with multiple chronic conditions have garnered particular attention from policymakers and health service researchers because these patients utilize more services and contribute disproportionally to rising health care expenses. The growing prevalence of patients with multiple chronic conditions has increased the importance of achieving better health care integration for this patient population. Patients may be well positioned to assess integration of their care, but the relationship between patients' perceptions of care integration and use of health services has not been studied. We sought to understand how patient-perceived integrated care relates to utilization of health services.
  
  
  METHODS
  We fielded the Patient Perceptions of Integrated Care survey among a random sample of 3000 (<65 years) patients with multiple chronic conditions belonging to the Massachusetts General Hospital Physician Organization; 1503 responses were collected (50% response rate). We assessed relationships between provider performance on 11 domains of patient-reported integrated care and rates of emergency department (ED) visits, hospital admissions, and outpatient visits.
  
  
  RESULTS
  Better performance on two of the surveyed dimensions of integrated care (information flow to other providers in your doctor's office and responsiveness independent of visits, p<0.05) was significantly associated with lower ED visit rates. Better performance on three dimensions of integrated care (information flow to your specialist, p<0.05, post-visit information flow to the patient, p<0.001, and continuous familiarity with patient over time, p<0.05) was associated with lower outpatient visit rates. No dimensions of integration were associated with hospital admission rates.
  
  
  CONCLUSIONS
  In a single health system, patient perceptions of integrated care were associated with ED and outpatient utilization but not inpatient utilization. With further development, patient reports of integration could be useful guides to improving health system efficiency.
authors.affiliation: Interfaculty Initiative in Health Policy, Harvard University, 14 Story Street, Cambridge, MA 02138, USA. Electronic address: afryer@post.harvard.edu.
authors.forename: Ashley-Kay
authors.initials: AK
authors.lastname: Fryer
authors.affiliation: RAND Corporation, Division of General Medicine, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
authors.affiliation: Director of Quality Improvement, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, USA.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Thompson
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Department of Medicine, Harvard Medical School, Mongan Institute for Health Policy, Massachusetts General Hospital, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000453:epidemiology / Q000639:trends; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts; D010361:Patients / Q000523:psychology*; D010465:Perception; D014481:United States / Q000453:epidemiology
keywords: Coordination; Integrated patient care; Integration; Patient-centeredness; Utilization