Evaluation of Physician Network-Based Measures of Care Coordination Using Medicare Patient-Reported Experience Measures
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BACKGROUND: There is significant promise in analyzing physician patient-sharing networks to indirectly measure care coordination, yet it is unknown whether these measures reflect patients’ perceptions of care coordination. OBJECTIVE: To evaluate the associations between network-based measures of care coordination and patient-reported experience measures. DESIGN: We analyzed patient-sharing physician networks within group practices using data made available by the Centers for Medicare and Medicaid Services. SUBJECTS: Medicare beneficiaries who provided responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey in 2016 (data aggregated by physician group practice made available through the Physician Compare 2016 Group Public Reporting). MAIN MEASURES: The outcomes of interest were patient-reported experience measures reflecting aspects of care coordination (CAHPS). The predictor variables of interests were physician group practice density (the number of physician pairs who share patients adjusting for the total number of physician pairs) and clustering (the extent to which sets of three physicians share patients). KEY RESULTS: Four hundred seventy-six groups had patient-reported measures available. Patients’ perception of “Clinicians working together for your care” was significantly positively associated with both physician group practice density (Est (95 % CI) = 5.07(0.83, 9.33), p = 0.02) and clustering (Est (95 % CI) = 3.73(1.01, 6.44), p = 0.007). Physician group practice clustering was also significantly positively associated with “Getting timely care, appointments, and information” (Est (95 % CI) = 4.63(0.21, 9.06), p = 0.04). CONCLUSIONS: This work suggests that network-based measures of care coordination are associated with some patient-reported experience measures. Evaluating and intervening on patient-sharing networks may provide novel strategies for initiatives aimed at improving quality of care and the patient experience. KEY WORDS: physician networks; network analysis; care coordination; Physician Compare; CAHPS. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05313-y) contains supplementary material, which is available to authorized users. Received November 7, 2018 Revised May 2, 2019 Accepted August 6, 2019
J Gen Intern Med DOI: 10.1007/s11606-019-05313-y © Society of General Internal Medicine 2019
INTRODUCTION
Optimizing care coordination is a cornerstone to efforts aimed at improving patient care.1 Despite strong consensus that improving care coordination is a high priority, robust measures of care coordination are lacking, making assessment of the efficacy of improvement strategies a challenge.2 Agreement on measure(s) has been a key issue for researchers and policymakers due to the various definitions and diverse stakeholders involved. Physician patient-sharing networks hold significant promise in offering a quantitative, scalable approach for indirectly measuring care coordination by defining relationships bet
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