Patient perceptions of integrated care and their relationship to utilization of emergency, inpatient and outpatient services

Background: Patients with multiple chronic conditions have garnered particular attention from policymakers and health service researchers because these patients utilize more services and contribute disproportionally to rising health care expenses. The growing prevalence of patients with multiple chronic conditions has increased the importance of achieving better health care integration for this patient population. Patients may be well positioned to assess integration of their care, but the relationship between patients' perceptions of care integration and use of health services has not been studied. We sought to understand how patient-perceived integrated care relates to utilization of health services. Methods: We fielded the Patient Perceptions of Integrated Care survey among a random sample of 3000 (<= 65 years) patients with multiple chronic conditions belonging to the Massachusetts General Hospital Physician Organization; 1503 responses were collected (50% response rate). We assessed relationships between provider performance on 11 domains of patient-reported integrated care and rates of emergency department (ED) visits, hospital admissions, and outpatient visits. Results: Better performance on two of the surveyed dimensions of integrated care (information flow to other providers in your doctor's office and responsiveness independent of visits, p < 0.05) was significantly associated with lower ED visit rates. Better performance on three dimensions of integrated care (information flow to your specialist, p < 0.05, post-visit information flow to the patient, p < 0.001, and continuous familiarity with patient over time, p < 0.05) was associated with lower outpatient visit rates. No dimensions of integration were associated with hospital admission rates. Conclusions: In a single health system, patient perceptions of integrated care were associated with ED and outpatient utilization but not inpatient utilization. With further development, patient reports of integration could be useful guides to improving health system efficiency.