Gaps in the coordination of care for older adults with or at risk for cardiovascular disease.

Abstract

Objectives: We sought to determine whether patients with cardiovascular disease (CVD) or CVD risk factors and fragmented care (ie, care spread across multiple providers) perceive any gaps in communication among their providers and whether any gaps are perceived as clinically significant (ie, leading to adverse events).

Study design: We conducted a cross-sectional telephone survey of community-dwelling Medicare beneficiaries 65 years and older with CVD or at least 1 CVD risk factor and highly fragmented ambulatory care (reversed Bice-Boxerman Index score ≥ 0.85) who had been attributed to an accountable care organization in New York, New York.

Methods: Using a previously tested survey instrument, we asked about perceptions of communication among the respondents' providers, any adverse events (drug-drug interactions, duplicate tests, emergency department visits, or hospitalizations), and whether those events were preventable with better communication. We used descriptive statistics.

Results: Of 201 eligible individuals, 96 completed surveys (47.8% response rate). Of those, 94 (97.9%) reported having at least 2 ambulatory visits and at least 2 ambulatory providers in the past year and were included in our analytic sample. The mean (SD) age was 76 (6.8) years; approximately two-thirds (69%) were women. Approximately half of respondents (48%) reported a problem with, or "gap" in, communication among their providers. One in 14 respondents (7%) reported experiencing an adverse event that they thought could have been prevented with better communication.

Conclusions: Gaps in communication for patients with CVD or CVD risk factors are common and hazardous. Interventions are needed to leverage patients' observations to address gaps in communication before they cause harm.