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Care integration within and outside health system boundaries
Author(s) -
Singer Sara J.,
Sinaiko Anna D.,
Tietschert Maike V.,
Kerrissey Michaela,
Phillips Russell S.,
Martin Veronique,
Joseph Grace,
Bahadurzada Hassina,
Agniel Denis
Publication year - 2020
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13578
Subject(s) - health care , nursing , quality (philosophy) , organizational unit , descriptive statistics , psychology , medicine , business , political science , computer science , law , philosophy , statistics , computer security , mathematics , epistemology
Objective Examine care integration—efforts to unify disparate parts of health care organizations to generate synergy across activities occurring within and between them—to understand whether and at which organizational level health systems impact care quality and staff experience. Data Sources Surveys administered to one practice manager (56/59) and up to 26 staff (828/1360) in 59 practice sites within 24 physician organizations within 17 health systems in four states (2017‐2019). Study Design We developed manager and staff surveys to collect data on organizational, social, and clinical process integration, at four organizational levels: practice site, physician organization, health system, and outside health systems. We analyzed data using descriptive statistics and regression. Principal Findings Managers and staff perceived opportunity for improvement across most types of care integration and organizational levels. Managers/staff perceived little variation in care integration across health systems. They perceived better care integration within practice sites than within physician organizations, health systems, and outside health systems—up to 38 percentage points (pp) lower ( P < .001) outside health systems compared to within practice sites. Of nine clinical process integration measures, one standard deviation (SD) (7.2‐pp) increase in use of evidence‐based care related to 6.4‐pp and 8.9‐pp increases in perceived quality of care by practice sites and health systems, respectively, and a 4.5‐pp increase in staff job satisfaction; one SD (9.7‐pp) increase in integration of social services and community resources related to a 7.0‐pp increase in perceived quality of care by health systems; one SD (6.9‐pp) increase in patient engagement related to a 6.4‐pp increase in job satisfaction and a 4.6‐pp decrease in burnout; and one SD (10.6‐pp) increase in integration of diabetic eye examinations related to a 5.5‐pp increase in job satisfaction (all P < .05). Conclusions Measures of clinical process integration related to higher staff ratings of quality and experience. Action is needed to improve care integration within and outside health systems.