Study examines impact of poor care coordination on quality, cost of care in America

Many Americans seek medical treatment from a variety of care providers and often must play the role of informing each doctor what the others are recommending or prescribing. This fragmented experience of poorly coordinated care is due in part to a lack of consistent systems and processes in place to coordinate care across providers and facilities.

“Our study will provide a detailed look at the care that chronically ill patients receive and the opportunities for improvement through better care coordination”

A new national study to be funded by The Aetna Foundation and conducted by researchers at RAND Health, a division of RAND Corporation, will be among the first to examine the impact of poor care coordination on the quality and cost of care in America. The study also will examine whether significant disparities exist among different racial and ethnic groups in the frequency of avoidable treatments stemming from poor patient care coordination.

"Patients, especially with chronic illnesses, often see a range of specialists and experience a health care system in which their treatments are fragmented," said Anne C. Beal, M.D., M.P.H., president of the Aetna Foundation. "Although existing information and common sense would indicate that better coordinated care will be more efficient and more effective, we lack a good understanding of the true impact of poor care coordination - on both health care quality and costs. Providing a credible evidence base is an important first step in building solutions to ensure that all patients receive high quality care and avoid health setbacks."

The study will be among the first to provide credible data and an evidence base around the number of avoidable treatments occurring in health care and the quality and cost impacts of poorly coordinated patient care. RAND Health researchers will examine Medicare claims data to identify patterns of health care treatments that are more likely to result from poorly coordinated patient care and estimate their costs based on standardized Medicare payments.

The RAND Health researchers also will use Medicare claims data to identify treatment patterns for patients with one of three common chronic illnesses: diabetes, congestive heart failure and chronic obstructive pulmonary disease. The goal is to understand patients' treatments, co-morbidities and other risk factors and identify opportunities where significant improvements in care quality can be achieved through tighter care coordination.

"Our study will provide a detailed look at the care that chronically ill patients receive and the opportunities for improvement through better care coordination," said Peter Hussey, a policy researcher at RAND Health. "The study will produce tools that can be used to target care coordination interventions to areas with the greatest potential for improvement."

As part of its methodology, RAND Health will use its newly developed and tested techniques on claims-based data to measure fragmentation of care, such as the dispersion of patient visits among providers and specialists and the sequential order of visits of doctors' offices, inpatient care and emergency room visits. Researchers will test whether utilization rates of specific health care services are associated with the measures of care fragmentation.

Researchers will examine de-indentified Medicare claims data in eight cities over a two-year period, 2007 and 2008. The sample size of patients with diabetes, congestive heart failure or chronic obstructive pulmonary disease is estimated to be more than 500,000.