Association of Care Coordination with Hospital Admissions and Patient Satisfaction among Adults with Asthma

Objective:Enhanced care coordination may reduce hospital admissions and improve patient satisfaction for patients with asthma. However, few studies have examined the effect of care coordination on these outcome measures. The primary objective of this study was to examine the relationship of care coordination with hospital admissions and patient satisfaction among persons with asthma.

Study Design: We examined survey and administrative data for 405 adults with persistent asthma enrolled in a large group model HMO. Persons with asthma were identified during calendar year 2005 using HEDIS inclusion criteria. In Fall 2006, the same patients were asked (mail/telephone survey) using four care coordination questions adapted from the 2005 Commonwealth Fund Survey of Sicker Adults: 1) ever were given conflicting advice from different providers other than their regular doctor, 2) had an appointment where tests results were not available, 3) had an appointment where tests were ordered that should have already been done, and 4) had an appointment where their provider asked questions that should have already been known. Each yes/no response (0=yes, 1=no) was summarized into a composite (0=lowest care coordination, 4=highest care coordination) measure. This measure was further dichotomized into high care coordination (3-4) vs low care coordination (<3). Patients were also asked about hospital admissions (all-cause) and overall satisfaction with patient care (1= lowest satisfaction, 10= highest satisfaction) in the 12 months prior to survey. These measures were dichotomized for analysis: any hospital admissions (>= 1 hospital admissions vs. none) and high patient satisfaction (score >= 9 vs. < 9) Multiple logistic regression was used to evaluate the independent effect of care coordination items with: all-cause hospital admissions (> 1 vs. none) and patient satisfaction (> 9 vs. < 9); adjusting for age, gender, race/ethnicity, educational attainment, health status and co-morbidities.

Results: After adjusting for demographic factors, presence of comorbidities and educational attainment, adults with high self-reported care coordination scores were less likely to have reported all-cause hospital admissions (OR=0.43, 95% CI=0.22-0.86) and more likely to report higher patient satisfaction (OR=3.48, 95% CI=1.94-6.25), compared to those with low care coordination scores.

Conclusions: We found that better care coordination was independently associated with reduced likelihood of all-cause hospitalization and increased patient satisfaction. These results highlight the need to better understand and improve care coordination for persons with asthma and other chronic conditions. Future research is necessary to clarify whether better care coordination is prospectively associated with improved asthma-specific outcomes.