NEW YORK, NY--(Marketwired - April 03, 2014) - Teamwork and the key services of a patient-centered medical home -- important and controversial aspects of health reform efforts -- can improve older adults' health, according to "On Your Team," a survey of adults 65 and older released today by the John A. Hartford Foundation.
The survey found that this care is still relatively uncommon, as just 27 percent of older adults reported receiving these services. Nevertheless, a large majority (83%) of those who say they do receive well-coordinated care from a team of providers report that this "team care" has improved their health. Even among older adults not currently receiving this type of care, 61 percent say they believe team care would improve their health, and 73 percent would want this type of care, the survey found.
PerryUndem Research/Communication conducted the nationally representative survey on behalf of the John A. Hartford Foundation, which works to improve the health of older Americans. The survey included more than 1,000 older adults and has a margin of sampling error of 3.9 percentage points.
The critical need for team care
The growing number of older Americans have much to gain from team care and other enhanced services of a medical home because they face extremely high rates of chronic disease (the top driver of death, disability, and health care costs in this age group) but also tend to receive poorly coordinated care.
"The weakness of care coordination in our healthcare system represents a clear and present danger to many older patients, causing avoidable harm, errors, complications, overtreatment, and hospital readmissions," says Christopher Langston, PhD, program director of the John A. Hartford Foundation. "Team care is still a work in progress. Despite disappointing medical home demonstration results recently reported in the Journal of the American Medical Association, we believe that enhanced primary care can be a key part of the solution. The fact that older adults say that team care improved their health is very significant. We should build on this finding, improve the model, and make team care available to more patients who can benefit from it."
"As we try to reinvent primary care and develop more effective approaches to the patient-centered medical home, it is crucial that we listen closely to patients themselves. Their input helps us understand the services that really make a difference towards getting better outcomes," said David Dorr, MD, MS, Associate Professor and Vice Chair of Medical Informatics and Clinical Epidemiology at Oregon Health & Science University and co-creator of Care Management Plus, a medical home model for older patients.
What is team care?
"Team care" allows for greater coordination through a primary care provider, puts the patient at the center of the process, and creates a more seamless approach to a variety of services often referred to as a medical home. In these practices, physicians may work alongside nurses, nurse practitioners, social workers, pharmacists, dieticians, mental health professionals, and health educators or coaches. Services provided by this broader team may include extended office hours, after-hours telephone consultation, access to electronic medical records, reminders about immunizations and screenings, personalized care plans, medication management, and care coordination.
The team care and enhanced primary care services examined in this survey are key elements of the patient-centered medical home (PCMH) model, as defined by the National Committee for Quality Assurance (NCQA), the most widely used national standard. More primary care practices are beginning to offer team care, and almost 7,000 have already been recognized by NCQA as patient-centered medical homes.
Overall, team care influences older adults' satisfaction with their primary care. Three-quarters (75%) of those receiving team care said they were highly satisfied with their current care. In comparison, just half (52%) of those not receiving team care expressed similarly high levels of satisfaction. The "On Your Team" survey also looked individually at several of the key services associated with the medical home.
Specific findings: older adults reflect on aspects of team care
Expanded access to care: Emergencies caused by the flare-up of a chronic condition often send older adults to the hospital or emergency department, but many could be handled better and more cost-effectively by the primary care team that knows the person well. Team care practices can make this possible by offering expanded access to care, such as same-day appointments and off-hour telephone access.
Primary care may not be available when older adults need it most. Only about half (51%) of older adults surveyed say they can get a same-day appointment when they need it. Older adults surveyed overwhelmingly (85%) say they would like their practice to make it easier for them to get care; and interest is even higher (94%) among older adults who rate their health as fair or poor.
Nearly four out of five (78%) of those who do have such expanded access to primary care say it has made a difference in improving their health.
Electronic health records (EHRs): Fewer than four out of ten people surveyed (38%) say they can get their medical records or test results online or through email. But of those who do have such access to their EHRs, more than one in three (36%) say it has improved their health.
"Interestingly, patients want and benefit from a number of services made possible or easier by electronic health records -- reminders, extensive care coordination, tailored care management -- but only 36 percent note that the EHR helps improve their care," says Dr. Dorr. "The focus should be on what the EHR and related systems do and how they are used, not just the fact that one exists."
Coordinated care: Lack of care coordination is a near-universal complaint from patients and primary care providers alike.
A large majority of respondents (84%) say they would want their provider to call them to follow up after a hospital stay or emergency room visit, and 67 percent believe that such coordination would improve their health. But considerably fewer (46%) of all respondents think their current non-team care practice would do this for them.
In contrast, among respondents who do already receive team care, more than seven out of ten (71%) believe their practice would provide this type of follow-up and coordination.
Practice-initiated care: Patient-centered medical homes may reach out proactively to patients with reminders about needed preventive care and immunizations. While 42 percent of respondents say they do not receive this outreach, 57 percent say they would want it.
Most importantly, a large majority (70%) who do receive such reminders say it has made a difference in improving their health.
Medication management: Medication errors are a major risk factor, particularly for older patients, many of whom take a large number of medicines for multiple health conditions. Regularly reviewing all the prescription and non-prescription drugs a patient takes is an effective method of reducing medication errors, and three out of four respondents (75%) say their primary care provider did this with them in the last year.
Less than half of patients (48%) received a written list of their medications afterwards -- a missed opportunity, since more than half (53%) of those who did receive the written list say it improved their health.
Care plan: A care plan -- a written document that records a patient's personal health goals, treatment plan, details the providers of different types of care, and addresses non-medical needs -- is an important care coordination tool.
Only 14 percent of all older adults surveyed say they currently had a care plan, but 56 percent say they would want one. Of the few patients who say they do have a care plan, a resounding 74 percent believe that it has made a difference in improving their health.
Combining these findings, primary care practices may be encouraged to take on the challenging work of becoming a medical home, as the survey found the more team care and associated services older adults received, the more satisfied they were with their care. On a scale of 0 to 10 (from not at all satisfied to extremely satisfied), those receiving zero to two team care services rated their care satisfaction at 7.4. For those receiving three to five services, satisfaction rose to 8.6. And for those receiving six to ten of these services, satisfaction rose even higher, to 9.0.
About the "On Your Team" survey
PerryUndem Research/Communication conducted a national survey of n = 1,107 adults 65 and older January 30 through February 3, 2014. The margin of sampling error is +/- 3.9 percentage points.
About the John A. Hartford Foundation
The John A. Hartford Foundation is a private philanthropy working to improve the health of older Americans. After three decades of championing research and education in geriatric medicine, nursing, and social work, today the Foundation pursues opportunities to put geriatrics expertise to work in all health care settings. This includes advancing practice change and innovation, supporting team-based care through interdisciplinary education of all health care providers, supporting policies and regulations that promote better care, and developing and disseminating new evidence-based models that deliver better, more cost-effective health care. The Foundation was established by John A. Hartford. Mr. Hartford and his brother, George L. Hartford, both former chief executives of the Great Atlantic & Pacific Tea Company, left the bulk of their estates to the Foundation upon their deaths in the 1950's. Additional information about the Foundation and its programs is available at www.jhartfound.org.
PerryUndem Research/Communication, a nonpartisan research firm, conducts public policy research for nonprofit organizations, foundations, and government agencies. PerryUndem works on a number of health related policy issues, including health reform implementation, delivery system reform, health IT, costs, and quality. PerryUndem has briefed numerous state and federal policymakers on their work, including members of Congress, White House staff, Secretary Sebelius, and CMS leadership. For more information, visit http://perryundem.com.