Survey of Patient-Centered Coordination of Care for Diabetes with Cardiovascular and Mental Health Comorbidities in the Department of Veterans Affairs
Survey of Patient-Centered Coordination of Care for Diabetes with Cardiovascular and Mental Health Comorbidities in the Department of Veterans Affairs
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DOI：
10.1007/s11606-019-04979-8
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发表时间：
2019-05-01
影响因子：
5.7
通讯作者：
Charns, Martin P.
中科院分区：
文献类型：
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作者：
Benzer, Justin K.;Singer, Sara J.;Charns, Martin P.
背景：由于需要共同的治疗计划和患者的积极参与等因素，多个合并症被认为与协调不良有关。目的：确定退伍军人事务部心血管和精神健康并存与以患者为中心的协调护理的关系。设计：这项观察性研究使用2×2析因设计来确定在2型糖尿病患者中，心血管和精神健康并存如何与患者对协调护理的感知有关。世卫组织在退伍军人事务部(VA)完成了一项以患者为中心的协调护理在线调查。主要测量：患者对综合护理的感知(PPIC)调查的八个维度，这是一项衡量患者对协调和以患者为中心的护理的最新衡量标准。KEY结果：心理健康状况与患者显著降低的协调护理体验相关。疾病严重程度的假设不被支持，只有一个维度在假设的方向上存在关联。结论：结果表明，VA可能足以满足与心血管疾病相关的协调需求，但应更多地关注精神健康问题的协调。虽然针对更严重的疾病(例如，心力衰竭和严重的精神疾病)的专门计划很重要，但对于更常见、不太严重的疾病(例如，高血压、抑郁、焦虑)也需要协调。加强对常见、不太严重的疾病的协调尤为重要，因为退伍军人管理局开发了可能对协调护理的程度产生负面影响的替代模式(例如，社区护理)。
BACKGROUND: Multiple comorbidities thought to be associated with poor coordination due to the need for shared treatment plans and active involvement of patients, among other factors. Cardiovascular and mental health comorbidities present potential coordination challenges relative to diabetes.OBJECTIVE: To determine how cardiovascular and mental health comorbidities relate to patient-centered coordinated care in the Department of Veterans Affairs.DESIGN: This observational study used a 2 x 2 factorial design to determine how cardiovascular and mental health comorbidities are associated with patient perceptions of coordinated care among patients with type 2 diabetes mellitus as a focal condition.PARTICIPANTS: Five thousand eight hundred six patients attributed to 262 primary care providers, from a national sample of 29 medical centers, who had completed an online survey of patient-centered coordinated care in the Department of Veterans Affairs (VA).MAIN MEASURES: Eight dimensions from the Patient Perceptions of Integrated Care (PPIC) survey, a state-of-the-art measure of patients' perspective on coordinated and patient-centered care.KEY RESULTS: Mental health conditions were associated with significantly lower patient experiences of coordinated care. Hypotheses for disease severity were not supported, with associations in the hypothesized direction for only one dimension.CONCLUSIONS: Results suggest that VA may be adequately addressing coordination needs related to cardiovascular conditions, but more attention could be placed on coordination for mental health conditions. While specialized programs for more severe conditions (e.g., heart failure and serious mental illness) are important, coordination is also needed for more common, less severe conditions (e.g., hypertension, depression, anxiety). Strengthening coordination for common, less severe conditions is particularly important as VA develops alternative models (e.g., community care) that may negatively impact the degree to which care is coordinated.