Association Between Patients’ Self-Reported Gaps in Care Coordination and Preventable Adverse Outcomes: a Cross-Sectional Survey

Background Whether patients’ reports of gaps in care coordination reflect clinically significant problems is unclear. Objective To determine any association between patient-reported gaps in care coordination and patient-reported preventable adverse outcomes. Design and Participants We administered a cross-sectional survey on experiences with healthcare to participants in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were ≥ 65 years old. Of the 15,817 participants in REGARDS at the time of our survey (August 2017–November 2018), 11,138 completed the survey. We restricted the sample to participants who reported ≥ 2 ambulatory visits and ≥ 2 ambulatory providers in the past year ( N = 7568). Main Measures We considered 7 gaps in ambulatory care coordination, elicited with previously validated questions. We considered 4 outcomes: (1) a test that was repeated because the doctor did not have the result of the first test, (2) a drug-drug interaction that occurred due to multiple prescribers, (3) an emergency department visit that could have been prevented by better communication among providers, and (4) a hospital admission that could have been prevented by better communication among providers. We used logistic regression to determine the association between ≥ 1 gap in care coordination and ≥ 1 preventable outcome, adjusting for potential confounders. Key Results The average age of the sample was 77.0 years; 55% were female, and 34% were African-American. More than one-third of participants (38.1%) reported ≥ 1 gap in care coordination and nearly one-tenth (9.8%) reported ≥ 1 preventable outcome. Having ≥ 1 gap in care coordination was associated with an increased odds of ≥ 1 preventable outcome (adjusted odds ratio 1.55; 95% confidence interval 1.33, 1.81). Conclusions Participants’ reports of gaps in care coordination were associated with an increased odds of preventable adverse outcomes. Future interventions should leverage patients’ observations to detect and resolve gaps in care coordination.