NEW YORK – Coordination of care among providers could be improved if financial incentives were properly aligned, recent research suggests.
“Although accountable for transfer to the next care setting, providers are neither accountable for nor supported to coordinate across the continuum,” a recent Commonwealth Fund-supported study concluded.
Addressing this system problem requires both introducing coordination mechanisms and also supporting their use through changes in providers’ incentives, resources and time, the authors said.
While a Kaiser Family Foundation and Agency for Healthcare Research and Quality report on patient safety and quality information found a decline in coordination problems since 2004, the Commonwealth Fund study revealed that significant, avoidable problems persist.
The study looked at 18 months’ worth of patient outcomes for unilateral knee replacement surgery at Boston-based Brigham and Women’s Hospital. The authors conducted a survey of 222 patients, who reported general satisfaction but revealed significant problems in coordination of care.
Even within this successful scenario, improvements in coordination made significant improvements in clinical outcomes, the report said.
“The patients reported a lot of problems in coordination of care,” said Dana Weinberg, assistant professor at Queen’s College, CUNY and lead author of the Commonwealth Fund report.
“The incentives aren’t set up to cover this kind of cross-organizational function,” Weinberg said. “It turns out that sometimes more than faxing the record is required.”
A Health Research and Educational Trust paper on population-based performance measures cited several recent studies of care coordination and provider finances. The paper cited problems in current performance measures “narrowly assessing only one or a few specific processes of care and failing to capture coordination of care or aligning financial incentives across healthcare settings.”
Weinberg said that while certain financial measures such as investments in patient information technology systems could help improve coordination, the results of the study point to a fundamental problem in the interactions among providers and between physicians and patients.
“On the one hand, if we had more IT, it would help, but we’ve also found that the relationships between the caregivers and care providers also had an impact,” said Weinberg. “That relational work needs to happen.”