142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

309548
Care coordination and receipt of disease management support in adults with chronic conditions

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Ifna Ejebe, AB , Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
Lauren E. Wisk, PhD , Department of Population Medicine, Harvard Medical School, Boston, MA
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.

Learning Areas:

Administration, management, leadership
Chronic disease management and prevention
Provision of health care to the public

Learning Objectives:
Describe the rates of care coordination in a population-based sample of adults with chronic conditions. Assess whether care coordination is associated with receiving chronic disease management support.

Keyword(s): Chronic Disease Management and Care, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Ifna Ejebe is currently an MD/PhD student at the Department of Population Health at the University of Wisconsin-Madison School of Medicine and Public Health. Her research interests include access to and impact of chronic disease self-management education and support for adults with chronic conditions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.