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A relational perspective on care coordination

Ghaffari, Affan; Wells, Rebecca; Creel, Liza; Siañez, Mónica

doi: 10.1097/HMR.0000000000000208
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Background: Care coordination occurs largely through care coordinators’ interactions with patients and community partners to identify and address patients’ individual needs. More frequent and higher-quality communication with each may enhance care coordination effectiveness.

Purpose: The purpose of this study was to understand (a) how care coordinator perceptions of interactions with patients and community partners, respectively, compared to each other group’s perceptions of their interactions with care coordinators and (2) whether these dynamics between care coordinators and community partners changed over time.

Methodology: The research context was a comparative case study of provider-based care coordination projects funded through the Texas 1115(a) Medicaid waiver. The Relational Coordination instrument was administered through (a) two waves of in-person interviews with care coordinators (2014–2015 and 2015–2016) at a total of 10 sites across the state, (b) a single 2016 phone survey with 159 patients at nine of those sites, and (c) phone surveys with representatives of the community resources that care coordinators had identified as key partners in 2014–2015 and again in 2015–2016.

Results: Care coordinators reported more frequently needing both patients and community partners than either other group reported relative to care coordinators. Frequency of need and mutual influence with community partners increased in the first 2 years of the care coordination programs’ implementation. The perceived quality of interactions between care coordinators and both patients and community partners was positive, but with room for improvement.

Conclusion: Care coordination may entail limited interactions with patients and community partners, especially at program inception. As care coordination programs mature, interactions may become more frequent and influence with partners may expand.

Practice Implications: Decision makers should support care coordinators in improving the quality of their communication with both patients and community partners, as well as allow time for these relationships to develop.

Affan Ghaffari, PhD, is Alumnus, Department of Health Policy and Management, Texas A&M University Health Science Center, Bryan.

Rebecca Wells, PhD, is Professor, Department of Management, Policy, and Community Health, The University of Texas School of Public Health, Houston. E-mail: Rebecca.S.Wells@uth.tmc.edu.

Liza Creel, PhD, is Assistant Professor, Department of Health Management and Systems Sciences, University of Louisville School of Public Health & Information Sciences, Kentucky.

Mónica Siañez, DrPH, is Alumna, Department of Management, Policy, and Community Health, The University of Texas School of Public Health, Houston.

This study was funded by the Texas Health and Human Services Commission and the Centers for Medicare & Medicaid Services. The findings are those of the authors and do not necessarily represent the official position of the Health and Human Services Commission or Centers for Medicare & Medicaid Services. The study was approved for human subjects research by the University of Texas Health Science Center Institutional Review Board. A prior version of this study was presented at the 2015 Organizational Theory in Health Care conference at Virginia Commonwealth University in Richmond, VA.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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