Secondary Logo

Journal Logo

Variation of hospital-based adoption of care coordination services by community-level social determinants of health

Chen, Jie; DuGoff, Eva Hisako; Novak, Priscilla; Wang, Min Qi

doi: 10.1097/HMR.0000000000000232
Features: PDF Only
Open
SDC
PAP

Background Hospital investments in care coordination services and innovative delivery models represent an important source for improving care efficiency and population health.

Objective The aim of this study was to explore variation of hospital-initiated care coordination services and participation in Accountable Care Organizations (ACOs) by community characteristics within an organizational theory framework.

Methods Our main data sets included the 2015 American Hospital Association Annual Survey, Survey of Care Systems and Payment, American Community Survey, and Area Health Resource File. Two main outcomes were (a) hospital-reported initiation of care coordination practices (such as chronic disease management, post-hospital discharge continuity of care, and predictive analytics) and (b) participation in ACO models. State fixed-effects models were used to test the association between the adoption of care coordination practices and hospital characteristics, community-level sociodemographic characteristics, and health policies.

Results Hospitals with large bed size, located in urban areas, and/or with high volume of operations were more likely to adopt care coordination practices and participate in the ACO models. Hospitals serving communities with high uninsurance rates and/or poverty rates were significantly less likely to provide care coordination practices. More stringent Community Benefit Laws (CBLs) were positively associated with the implementation of care coordination practices suggesting strong normative impacts of CBLs.

Conclusion Greater hospital-initiated care coordination practices and innovative ACO models were available in well-resourced areas. Policymakers may consider increasing resources for care coordination practices in rural, underserved, and high-poverty–high-uninsured areas to ensure that vulnerable populations can benefit from these services.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Jie Chen, PhD, is Associate Professor, Health Services Administration, School of Public Health, University of Maryland at College Park. E-mail: jichen@umd.edu.

Eva Hisako DuGoff, PhD, is Assistant Professor, Health Services Administration, School of Public Health, University of Maryland at College Park, and Visiting Assistant Professor, Department of Population Health Sciences, University of Wisconsin-Madison.

Priscilla Novak, MPH, is Graduate Student, Health Services Administration, School of Public Health, University of Maryland at College Park.

Min Qi Wang, PhD, is Professor, Behavioral and Community Health, School of Public Health, University of Maryland at College Park.

This work was supported by the National Institute on Minority Health and Health Disparities (Grant R01MD011523).

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

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s web site (www.hcmrjournal.com).

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved