New 2011 Survey Of Patients With Complex Care Needs In Eleven Countries Finds That Care Is Often Poorly Coordinated

Abstract

Around the world, adults with serious illnesses or chronic conditions account for a disproportionate share of national health care spending. We surveyed patients with complex care needs in eleven countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) and found that in all of them, care is often poorly coordinated. However, adults seen at primary practices with attributes of a patient-centered medical home--where clinicians are accessible, know patients' medical history, and help coordinate care--gave higher ratings to the care they received and were less likely to experience coordination gaps or report medical errors. Throughout the survey, patients in Switzerland and the United Kingdom reported significantly more positive experiences than did patients in the other countries surveyed. Reported improvements in the United Kingdom tracked with recent reforms there in health care delivery. Patients in the United States reported difficulty paying medical bills and forgoing care because of costs. Our study indicates a need for improvement in all countries through redesigning primary care, developing care teams accountable across sites of care, and managing transitions and medications well. The United States in particular has opportunities to learn from diverse payment innovations and care redesign efforts under way in the other study countries.

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

“…4 Compared with other member countries of the Organisation for Economic Cooperation and Development, Canada performs poorly in accessibility, coordination and quality of care for patients with complex needs. 5 Several jurisdictions in Canada and internationally have introduced incentive payments for primary care providers targeting the treatment of patients with chronic illnesses. However, despite widespread interest and use, we still do not fully understand the impact of incentive payment programs, especially for patients with complex illness.…”

Expanding the breadth of Medicare: learning from Australia

“…Despite this, care coordination remains a critical issue for the health care system, causing problems with consistency of information provision and quality of care (Schoen et al, 2011). In 2016, Australians with chronic conditions were more likely to have experienced problems with care coordination than their counterparts in comparable countries (the United Kingdom, United States, New Zealand, Canada, France, Germany, the Netherlands, Norway, Sweden and Switzerland); specifically Australians with chronic conditions were less likely to have discussed their main goals and care priorities with a health professional, and less likely to have discussed treatment options and side effects (Osborn et al, 2016).…”

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

“…3 Although high use may be defined from either a frequency or cost perspective, the former is more convenient and easier to measure when identifying this population in a pragmatic context. Given that primary care is a first point of contact with the health and social care system, it may play a strong role in allowing the implementation of innovations to provide more coordinated care.…”

“…4 Different interventions have been developed and evaluated to improve care for frequent users of health care services, such as case management, individualized care plans, self-management support, and information sharing. 5 Case management is the intervention most supported by evidence on improving appropriate use of health care resources, decreasing undue Catherine Hudon, MD, PhD, CFPC 1,2 Maud-Christine Chouinard, RN, PhD 3,4,5 Marie RN, MSc(c) 3,4 Fatoumata Diadiou, MA(c) …”