Examining the association between physician relational coordination and patient outcomes for seniors with multimorbidity

Care coordination is critical for senior patients with multimorbidity. The primary care physician (PCP) is in a unique position to coordinate care and the Chronic Care Model (CCM) purports to optimally support the PCP.

The CCM posits that the redesign of physician organizations will result in effective physician-patient interactions and subsequently improved patient outcomes. Physician-patient relational coordination (RC), that is not included in the CCM, may play a significant role.

This study evaluated quantitatively the impact of PCP relational coordination on quality measures using patient and organization data from a culturally-diverse, multispecialty medical group that had successfully implemented CCM.

The patient population consisted of managed-care Medicare beneficiaries with diabetes and at least one additional chronic condition served between 2004 and 2007 (n=5675). Longitudinal analyses were conducted using four years of medical claims and physician satisfaction data, incorporating a proxy variable (PCP communication/coordination score) for RC.

In all fitted Hierarchical Generalized Linear Models (HGLM) examining the log odds of the diabetes quality measures, PCP communication/coordination was a significant predictor. Additionally, the results of a patient survey directly measuring relational coordination found RC to be significantly correlated with the proxy variable of PCP coordination/ communication examined as a key predictor in the longitudinal analyses.

This study supports the current emphasis on the expansion of patient-centered medical homes within an infrastructure of the Chronic Care Model. It emphasizes the importance however of the relational component between PCP and patient that may be critical in achieving the desired results from CCM diffusion.