Evaluating Behaviors that Build and Maintain Relationships between Patients and their Physicians

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Project Summary/Abstract This application requests an administrative supplement to extend the work of the University of Chicago Center for Healthy Aging Behaviors and Longitudinal InvestigationS (CHABLIS). CHABLIS supports research and infrastructure development that leverages longitudinal data from observational and interventional studies to study how demographic and economic factors affect healthy aging behaviors and outcomes in older adults. This application focuses on studying two behaviors that can affect continuity of care between patients at increased risk of hospitalization and their physicians. This focus is motivated by evidence that greater continuity of care can improve outcomes for patients at increased risk of hospitalization. This evidence includes studies of our Comprehensive Care Program (CCP) that find that providing patients at increased risk of hospitalization care from the same doctor in and out of the hospital can reduce hospitalization and improve health outcomes. These studies suggest that two key patient behaviors may reduce these potential benefits, especially for patients with unmet social needs. First, patients may not fully realize the opportunities for continuity of care because they do not engage in ambulatory carewiththeir CCPproviders. Second, patient actions (or inactions) with respect to insurance coverage can cause patients to lose coverage for care from their CCP care because limited provider networks in Medicare managed care may not cover care from their CCP. This study, involving quantitative and qualitative methods, would be the first to examine behaviors, including engagement in ambulatory care and maintaining traditional Medicare or in-network Medicare managed care coverage, that affect overall patient engagement in CCP care. It will also study whether the Comprehensive Care Community and Culture Program (C4P) designed to increase patient engagement in CCP care affects these behaviors that affect patient-provider continuity. Though focused in CCP, we expect the insights into drivers of relational continuity are also relevant to other interventions for high-risk patients. We propose 4 specific aims to study patient behaviors that may affect their engagement in CCP care: Aim 1: To assess the effects on engagement in CCP care of 1) reduced engagement in CCP ambulatory care in patients with access to CCP care, and 2) replacement of traditional Medicare or in-network Medicare managed care coverage that provides access to CCP care by Medicare managed care coverage that does not provide access to CCP care. We will assess this in the CCP arm of the CCP study and the CCP arm of the C4P study. Aim 2: To assess predictors, including dual eligible status, hospitalization history, and patterns of unmet social needs, of those forms of reduced engagement in CCP. We will assess this in the CCP arm of the CCP study and the CCP arm of the C4P study. Aim 3: To assess how the C4P program affects patient engagement in CCP care. Aim 4: To assess drivers of patient engagement in CCP/C4P through qualitative analysis of patient interviews.