Bethesda, MD -- The patient-centered medical home is a strategy gaining international momentum. The Commonwealth Fund's annual international health survey, just released as a Web First by Health Affairs, surveyed patients with complex care needs in eleven countries and found that those who received care from a medical home were less likely to report medical errors, test duplication, and other care-coordination failures.
New 2011 Survey Of Patients With Complex Care Needs In Eleven Countries Finds That Care Is Often Poorly Coordinated
By Cathy Schoen, Robin Osborn, David Squires, Michelle Doty, Roz Pierson, and Sandra Appelbaum
Schoen, Osborn, Squires, and Doty are affiliated with The Commonwealth Fund in New York; Pierson and Applebaum are with Harris Interactive in New York.
This study, supported by The Commonwealth Fund, will also appear in the December issue of Health Affairs.
The study surveyed patients with serious illnesses, serious injuries, or chronic diseases in the following countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. These countries represent a diverse mix of care systems, provider payment systems, and insurance designs. Between March and June 2011, Harris Interactive and country contractors interviewed random samples of adults age eighteen or older who had complex health needs, A minimum of 750 samples were collected from each country. A few of the key findings:
- In all countries, between 91 and 100 percent of the patients reported having a regular doctor or place of care. When further asked about whether their provider is accessible, knows them, and helps coordinate care--to identify a medical home--the percentages dropped, ranging from a high of 74 percent in the United Kingdom to a low of 33 percent in Sweden. Fifty-six percent of US respondents belong to a medical home.
- When asked how quickly they saw a provider when last sick, the United Kingdom, Switzerland, France, New Zealand, and the Netherlands led the way: at least 70 percent of patients reported same-day or next-day appointments. (In the United States 59 percent of patients reported this degree of medical access.) Lack of evening and weekend care from a regular provider was a factor in several countries. Although only 21 percent of UK residents said that obtaining after-hours care was difficult, more than half of the samples in Australia, Canada, France, Sweden, and the United States voiced that concern. As a result, emergency department use rates in these five countries were significantly higher than elsewhere.
- Patient reports indicated that coordination gaps exist in all countries, putting them at greater risk for complications, medical errors, and duplicative testing. For example, anywhere between 16 percent (UK) and 62 percent (Norway) of respondents reported a pharmacist or doctor not reviewing prescriptions in the past year. For those who underwent surgery in the past two years, between 26 percent (UK) and 73 percent (France) experienced gaps in hospital or surgery discharge planning.
"Our study indicates a need--in all countries--for improvement in coordinating care for patients with complex conditions," concluded the authors. "While implementing health care reforms and experimenting with new initiatives, the United States in particular has opportunities to learn from abroad."
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