The association between care co-ordination and emergency department use in older managed care enrollees
<b>Objective:</b> To investigate the association between care co-ordination and use of the Emergency Department (ED) in older managed care enrollees.<br><br> <b>Design:</b> Nested case-control with 103 cases (used the ED) and 194 controls (did not use the ED).<...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2002-10-01
|
| Series: | International Journal of Integrated Care |
| Subjects: | |
| Online Access: | http://www.ijic.org/articles/69 |
| _version_ | 1830382931149848576 |
|---|---|
| author | Eric A. Coleman Theresa B. Eilertsen David J. Magid Douglas A. Conner Arne Beck Andrew M. Kramer |
| author_facet | Eric A. Coleman Theresa B. Eilertsen David J. Magid Douglas A. Conner Arne Beck Andrew M. Kramer |
| author_sort | Eric A. Coleman |
| collection | DOAJ |
| description | <b>Objective:</b> To investigate the association between care co-ordination and use of the Emergency Department (ED) in older managed care enrollees.<br><br> <b>Design:</b> Nested case-control with 103 cases (used the ED) and 194 controls (did not use the ED).<br><br> <b>Patients and methods:</b> Older patients with multiple chronic illnesses enrolled in a care management programme of a large group-model health maintenance organisation with more than 50,000 members over the age of 64. Better care co-ordination was defined as timely follow-up after a change in treatment; fewer decision-makers involved with the care plan; and a higher patient-perceived rating of overall care co-ordination. Logistic regression was used to assess the relationship between ED use (the outcome variable) and measures of care co-ordination (the predictor variables).<br><br> <b>Results:</b> Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. Similarly, no differences were found in the number of different physicians or medication prescribers involved in the patients' care. Four-week follow-up after potentially high-risk events for subsequent ED use, including changes in chronic disease medications, missed encounters, and same day encounters, did not differ between subjects with inappropriate ED use and controls.<br><br> <b>Conclusion:</b> Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic. Future research should focus on the development of new measures and on approaches that better isolate the role of care co-ordination from other potential variables that influence utilisation. |
| first_indexed | 2024-12-20T10:18:01Z |
| format | Article |
| id | doaj.art-d0be02297a9143749384ca21944a8ba0 |
| institution | Directory Open Access Journal |
| issn | 1568-4156 |
| language | English |
| last_indexed | 2024-12-20T10:18:01Z |
| publishDate | 2002-10-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | International Journal of Integrated Care |
| spelling | doaj.art-d0be02297a9143749384ca21944a8ba02022-12-21T19:44:01ZengUbiquity PressInternational Journal of Integrated Care1568-41562002-10-012410.5334/ijic.6969The association between care co-ordination and emergency department use in older managed care enrolleesEric A. ColemanTheresa B. EilertsenDavid J. MagidDouglas A. ConnerArne BeckAndrew M. Kramer<b>Objective:</b> To investigate the association between care co-ordination and use of the Emergency Department (ED) in older managed care enrollees.<br><br> <b>Design:</b> Nested case-control with 103 cases (used the ED) and 194 controls (did not use the ED).<br><br> <b>Patients and methods:</b> Older patients with multiple chronic illnesses enrolled in a care management programme of a large group-model health maintenance organisation with more than 50,000 members over the age of 64. Better care co-ordination was defined as timely follow-up after a change in treatment; fewer decision-makers involved with the care plan; and a higher patient-perceived rating of overall care co-ordination. Logistic regression was used to assess the relationship between ED use (the outcome variable) and measures of care co-ordination (the predictor variables).<br><br> <b>Results:</b> Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. Similarly, no differences were found in the number of different physicians or medication prescribers involved in the patients' care. Four-week follow-up after potentially high-risk events for subsequent ED use, including changes in chronic disease medications, missed encounters, and same day encounters, did not differ between subjects with inappropriate ED use and controls.<br><br> <b>Conclusion:</b> Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic. Future research should focus on the development of new measures and on approaches that better isolate the role of care co-ordination from other potential variables that influence utilisation.http://www.ijic.org/articles/69care co-ordinationemergency departmenthealth services, managed care |
| spellingShingle | Eric A. Coleman Theresa B. Eilertsen David J. Magid Douglas A. Conner Arne Beck Andrew M. Kramer The association between care co-ordination and emergency department use in older managed care enrollees International Journal of Integrated Care care co-ordination emergency department health services, managed care |
| title | The association between care co-ordination and emergency department use in older managed care enrollees |
| title_full | The association between care co-ordination and emergency department use in older managed care enrollees |
| title_fullStr | The association between care co-ordination and emergency department use in older managed care enrollees |
| title_full_unstemmed | The association between care co-ordination and emergency department use in older managed care enrollees |
| title_short | The association between care co-ordination and emergency department use in older managed care enrollees |
| title_sort | association between care co ordination and emergency department use in older managed care enrollees |
| topic | care co-ordination emergency department health services, managed care |
| url | http://www.ijic.org/articles/69 |
| work_keys_str_mv | AT ericacoleman theassociationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT theresabeilertsen theassociationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT davidjmagid theassociationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT douglasaconner theassociationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT arnebeck theassociationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT andrewmkramer theassociationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT ericacoleman associationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT theresabeilertsen associationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT davidjmagid associationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT douglasaconner associationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT arnebeck associationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees AT andrewmkramer associationbetweencarecoordinationandemergencydepartmentuseinoldermanagedcareenrollees |