Park J, Lipner RS. — American Board of Internal Medicine
Presented: AcademyHealth Annual Research Meeting, June 2011
Research Objective: Recent U.S. health reforms encourage more accountable care organizations. While a renewed focus on care coordination by primary care physicians is gaining recognition, care coordination in the U.S. has often been characterized as poor, and empirical data on actual practices that can be used to understand effective coordination is lacking. The goals of this study were: (1) to assess the current status of care coordination by general internists both within and across practices, as well as internal capabilities necessary to improve care coordination; and (2) to examine the association between various internal capabilities and care coordination in order to identify how resources could be focused to improve care coordination.
Study Design: The analyses were conducted using the American Board of Internal Medicine (ABIM) databases linked to the area resource files. Using questions from the ABIM practice system surveys, we constructed variables of care coordination and key capabilities associated with improved care coordination, as identified in the literature. Then we created scores (ranging from 0 to 100) of all variables: care coordination (within and across practices) and four types of internal capabilities (care management and self-care education, system support and readiness, ability to measure and report on the quality of care, and quality culture of the practice). We compared mean scores by physician (gender, medical school type), practice (size, type) and market (geographic region, socioeconomic) characteristics. Using multivariate regressions, adjusting for different physician, practice and market characteristics, we also examined the association between each of four types of internal capabilities and care coordination.
Population Studied: 3,877 general internists who completed the ABIM practice system surveys during 2008-2010.
Principal Findings: General internists in smaller (fewer than 10) single-specialty practices (47% of total observations) than others had significantly lower scores on system support and readiness (24 vs. 41, p<.001), and ability to measure and report on the quality of care (37 vs. 62, p<.001). However, controlling for differences in practice characteristics, use of clinical guidelines and self-care education, and developing a strong primary care-based quality culture, had a greater effect on improving care coordination (both within and across practices) than enhanced system support and readiness, and ability to measure and report on the quality of care. For example, a one-point increase in developing quality culture of practice was significantly associated with 4.9 points increase in care coordination across practices (compared with the overall mean of 40) (p<.001), whereas a one-point increase in system support and readiness was associated with only 0.8 points increase in care coordination across practices (p<.001).
Conclusions: Greater investment in system and technical assistance (“meaningful use” of electronic health records) is necessary, but establishing governance and administrative leadership, providing evidence-based medicine and management, and developing culture change necessary for accountability are more important for successful implementation of new care delivery models.
Implications for Policy, Delivery or Practice: By understanding various resources needed to improve integration and coordination of care, the present findings can help both policymakers and physician practices develop the capabilities needed to successfully respond to the incentives.
For more information about this presentation, please contact Research@abim.org.