Care coordination and receipt of disease management support in adults with chronic conditions

Managing a complex chronic condition often requires patients to navigate through fragmented systems of care.  Care coordination is considered essential to high quality chronic care, yet little is known about care coordination on a population level. Our objective was investigate whether coordinate care is associated with chronic disease management support in a population-based sample of adults with chronic conditions. We examined data from adults with asthma (n = 7,874), heart disease (n = 9,237), or type 2 diabetes (n = 8,250) by pooling cross sectional data from years 2009 and 2011-2012 of the California Health Interview Survey, a population based survey.   Our main explanatory variable was coordinated care which we defined using three mutually exclusive groups: no usual source of care, usual source of care only, and coordinated care.  Coordinated care was defined as having someone in the healthcare setting who coordinate care with other doctors and services, such as tests or treatments.   We defined quality chronic disease management support in two ways: (1) working with a healthcare provider to develop a chronic disease management plan, and (2) receiving an influenza vaccination in the past 12 months.  We used multivariable logistic to model the odds of receipt of quality chronic disease management support, adjusting for sociodemographic characteristics, disease severity, and health insurance status.  Adjusted odds ratios (OR) and 95% CI (CI) are reported.  The percentage of adults who reported having coordinated care was 56.4% in adults with asthma, 65.4% in adults with heart disease, and 66.2% in adults with type 2 diabetes.  Compared to adults with a usual source of care only, adults with coordinated care were significantly more likely to work with their provider to create a chronic disease management plan in adults with asthma (OR 1.38; CI 1.08-1.76), heart disease (OR 1.29; CI 1.01-1.63); and type 2 diabetes (OR 1.83; CI 1.42-2.37).  In additions, adults with coordinated care were also more likely to receive a seasonal influenza vaccination in adults with heart disease (OR 1.42; CI 1.16-1.75), and type 2 diabetes (OR 1.29; CI 1.05-1.60) but not in adults with asthma (OR 1.05; CI 0.86-1.30) compared to adults with a usual source of care. Care coordination appears to be associated with quality chronic disease management support in adults with chronic conditions.  With the implementation of the Affordable Care Act and its emphasis on integration of care, future research needs to investigate barriers and facilitators to care coordination.