Coordinated Care Experiences Among Middle-Aged and Older Adults with Multiple Chronic Conditions: Characteristics, Correlates, and Consequences for Health and Healthcare Utilization

Weidi Qin; Viktoryia Kalesnikava; Linh Dang; Rodlescia S Sneed; Rossella Messina; Paola Rucci; Briana Mezuk

doi:10.1093/geront/gnae024

Coordinated Care Experiences Among Middle-Aged and Older Adults with Multiple Chronic Conditions: Characteristics, Correlates, and Consequences for Health and Healthcare Utilization

Gerontologist. 2024 Feb 28:gnae024. doi: 10.1093/geront/gnae024. Online ahead of print.

Authors

Weidi Qin¹, Viktoryia Kalesnikava², Linh Dang², Rodlescia S Sneed³, Rossella Messina⁴, Paola Rucci⁴, Briana Mezuk²

Affiliations

¹ Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA.
² Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, Michigan, USA.
³ Institute of Gerontology & Department of Psychology, Wayne State University, Detroit, Michigan, USA.
⁴ Unit of Public Health, Biostatistics and Health Services Research, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Emilia-Romagna, Italy.

PMID: 38416875
DOI: 10.1093/geront/gnae024

Abstract

Background and objectives: While coordinated care (CC) seeks to improve patient experiences and ultimately health outcomes, evidence from empirical research on the impacts of CC is mixed. This study examined the relationship between CC and healthcare outcomes over a four-year period among older adults with multiple chronic conditions.

Research design and methods: This observational cohort study is based on data come from the 2016-2020 Health and Retirement Study. Analysis is limited to respondents with 2+ chronic conditions who completed an experimental module on CC in 2016 (n = 906). Three domains of CC were assessed: perceptions, informal (family/friends) and formal (healthcare staff) tangible support, and technical support (using a "patient portal"). The longitudinal relationship between CC and health (e.g., pain, functioning, self-rated health) and healthcare (e.g., doctor visits, hospitalization, care satisfaction) outcomes was investigated using mixed-effects models.

Results: Better perceptions of CC were associated with lower odds of functional difficulties (Odds ratio (OR)=0.92; 95% CI=0.88-0.99) and greater satisfaction with care (B=0.04, 95% CI=0.02-0.05). Receipt of more informal tangible support was associated with 2.97 higher odds of ADL limitations (95% CI: 1.69-5.22) and 1.77 higher odds of hospitalization (95% CI=1.32-2.38). Use of technical support was associated with better self-rated health and greater satisfaction with care.

Discussion and implications: The longitudinal relationship between CC and health is multi-faceted. While positive perceptions and more technical support have beneficial effects on health outcomes, higher utilization of tangible support may reflect a higher demand among older adults with more complex healthcare needs.

Keywords: Affordable Care Act; doctor-patient communication; health services; multimorbidity; survey research.

Abstract

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