For patients, structural integration doesn’t always mean integrated care

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 - Michaela Kerrissey, PhD candidate
Michaela Kerrissey, PhD candidate, Harvard Business School

Structurally integrating a medical group may not mean patients see the care its delivering as integrated, according to a study published in the May 2017 issue of Health Affairs.

Led by Michaela Kerrissey, a PhD student at Harvard Business School, the study asked 3,067 patients with multiple chronic conditions to describe their care at 144 medical groups in six different domains of integrated care, such as provider, staff and specialist knowledge of their medical history and communicating test results. Respondents to the survey were asked whether providers “never,” “sometimes,” “usually” or “always” met their expectations in each category.

There were positive results. For example, 73 percent of respondents said providers “always” communicated test results. Nearly 68 percent said providers “always” had knowledge of the patient, and 61 percent of specialists “always” knew about the patient’s medical history.

Results were more mixed in other categories. Only 13.4 percent said there was “always” provider support for medication and home health management and less than a third found consistent support for self-directed care—two areas which Kerrissey and her coauthors “believe particularly reflect patient-centered care.”

“These findings lend some support to past research indicating that dimensions of care that are important to patients are often neglected by providers in their efforts to integrate care, including by providers in patient-centered medical homes and in physician groups that are integrated with hospitals,” they wrote.

The exact structure of the provider did affect results in limited ways. For example, multispecialty groups performed better on the perceived knowledge of staff of patients’ medical histories. Overall, however, patients served by smaller practices were more likely to perceive their care as integrated.

Larger practices may have more technological resources, but the study found no evidence it increased patients’ perception of their care as integrated. In fact, Kerrissey and her coauthors guessed the additional time spent on electronic health records and health IT tasks negatively impacted patients’ perception.

The findings indicate that practices shouldn’t assume structural integration and integrated care are one and the same, which the authors said would be an especially important lesson to accountable care organizations (ACOs).

“For ACOs, it is important to look beyond structural changes to identify mechanisms that enable the delivery of truly integrated care that improves patient health,” Kerrissey and her coauthors concluded.