The association between care integration and care quality

Micah B Aaron; Michaela Kerrissey; Zhanna Novikov; Maike V Tietschert; Adam Scherling; Hassina Bahadurzada; Russell S Phillips; Anna D Sinaiko; Sara J Singer

doi:10.1111/1475-6773.14214

The association between care integration and care quality

Health Serv Res. 2023 Aug 21. doi: 10.1111/1475-6773.14214. Online ahead of print.

Authors

Micah B Aaron¹, Michaela Kerrissey², Zhanna Novikov^{3

4}, Maike V Tietschert⁵, Adam Scherling⁶, Hassina Bahadurzada⁷, Russell S Phillips⁸, Anna D Sinaiko², Sara J Singer⁴

Affiliations

¹ Department of Health Policy, Harvard Medical School, Boston, Massachusetts, USA.
² Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
³ Department of Management, Policy & Community Health, University of Texas School of Public Health, Houston, Texas, USA.
⁴ Stanford University School of Medicine, Stanford, California, USA.
⁵ Department of Socio-Medical Sciences, School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
⁶ RAND Corporation, Santa Monica, California, USA.
⁷ Harvard Business School, Boston, Massachusetts, USA.
⁸ Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 37605429
DOI: 10.1111/1475-6773.14214

Abstract

Objective: The study aims to analyze the relationship between care integration and care quality, and to examine if the relationship varies by patient risk.

Data sources and study setting: The key independent variables used validated measures derived from a provider survey of functional (i.e., administrative and clinical systems) and social (i.e., patient integration, professional cooperation, professional coordination) integration. Survey responses represented data from a stratified sample of 59 practice sites from 17 health systems. Dependent variables included three quality measures constructed from patient-level Medicare data: colorectal cancer screening among patients at risk, patient-level 30-day readmission, and a practice-level Healthcare Effectiveness Data and Information Set (HEDIS) composite measure of publicly reported, individual measures of ambulatory clinical quality performance.

Data collection/extraction method: We obtained quality- and beneficiary-level covariate data for the 41,966 Medicare beneficiaries served by the 59 practices in our survey sample.

Study design: We estimated hierarchical linear models to examine the association between care integration and care quality and the moderating effect of patients' clinical risk score. We graphically visualized the moderating effects at ±1 standard deviation of our z-standardized independent and moderating variables and performed simple slope tests.

Principal findings: Our analyses uncovered a strong positive relationship between social integration, specifically patient integration, and the quality of care a patient receives (e.g., a 1-point increase in a practice's patient integration was associated with 0.31-point higher HEDIS composite score, p < 0.01). Further, we documented positive and significant associations between aspects of social and functional integration on quality of care based on patient risk.

Conclusions: The findings suggest social integration matters for improving the quality of care and that the relationship of integration to quality is not uniform for all patients. Policymakers and practitioners considering structural integrations of health systems should direct attention beyond structure to consider the potential for social integration to impact outcomes and how that might be achieved.

Keywords: care integration; integrated care; patient risk; quality; social integration; structural integration.

Abstract

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