Chronic Care: Patient Experiences and Clinical Performance
Abstract and Introduction
Objective To assess the relationship between clinical care metrics and patient experiences of care among patients with chronic disease.
Design Cross-sectional survey and clinical performance data.
Setting Eighty-nine medical groups across California caring for patients with chronic disease.
Participants Using patient surveys, we identified 51 129 patients with a chronic disease.
Main Outcome Measures Using patient surveys, we produced five composite measures of patient experiences of care and self-management support (scale 0–100). Using Health Plan Employer Data and Information Set data, we analyzed care for asthma, diabetes and cardiovascular disease, producing one composite summarizing clinical processes of care and one composite summarizing outcomes of care. We calculated adjusted Spearman's correlation coefficients to assess the relationship between patient experiences of care, clinical processes and clinical outcomes.
Results Clinical performance was higher for process measures compared with outcomes measures, ranging from 91% for appropriate asthma medication use to 59% for controlling low-density lipoprotein cholesterol in the presence of diabetes. Performance on patient experiences of care measures was the highest for the quality of clinical interactions (88.5) and the lowest for delivery of self-management support (68.8). Three of the 10 patient experience–clinical performance composite correlations were statistically significant. These three correlations involved composites summarizing integration of care and quality of clinical interactions, and ranged from a low of 0.30 to a high of 0.39.
Conclusions Chronic care delivery is variable across diseases and domains of care. Improving care integration processes and communication between health-care providers and their patients may lead to improved clinical outcomes.
The epidemic of chronic disease has important implications for improving the quality of care in the US health-care system. Nearly 50% of the US population, over 125 million Americans, is affected by a chronic condition, and 20% suffer from more than one chronic disease. Chronic diseases are responsible for 70% of deaths in the USA and over 75% of health-care costs, and it is projected that the burdens associated with chronic conditions will continue to grow.
Unfortunately, the majority of physicians and patients report that it is difficult to obtain high quality care for chronic illnesses. While some gains in clinical quality for chronic disease care have been achieved, there is still substantial room for improvement, and progress in patient experiences of care may be lagging behind. Improving delivery of chronic disease care will involve increasing the effectiveness of care delivery, as well as engaging patients in the management of their condition.
As physician groups become increasingly engaged in clinical programs to improve chronic disease care, comprehensive performance measurement represents an important component of an overall improvement strategy. While prior work has explored the interaction between patient experiences of care and clinical outcomes, there are little data to help physician groups understand these interactions in the setting of more complex chronic care management.
Using California statewide data, our study had three goals: (i) to report on clinical quality and patient experiences of care among patients with chronic conditions; (ii) to evaluate the association between measures of clinical processes and clinical outcomes for individual chronic conditions; and (iii) to evaluate the association between measures of clinical performance and measures of patient-centered care.