RT Journal Article SR Electronic T1 Patient-Reported Care Coordination: Associations With Primary Care Continuity and Specialty Care Use JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP 323 OP 329 DO 10.1370/afm.1278 VO 9 IS 4 A1 David T. Liss A1 Jessica Chubak A1 Melissa L. Anderson A1 Kathleen W. Saunders A1 Leah Tuzzio A1 Robert J. Reid YR 2011 UL http://www.annfammed.org/content/9/4/323.abstract AB PURPOSE Care coordination is increasingly recognized as a necessary element of high-quality, patient-centered care. This study investigated (1) the association between care coordination and continuity of primary care, and (2) differences in this association by level of specialty care use. METHODS We conducted a cross-sectional study of Medicare enrollees with select chronic conditions in an integrated health care delivery system in Washington State. We collected survey information on patient experiences and automated health care utilization data for 1 year preceding survey completion. Coordination was defined by the coordination measure from the short form of the Ambulatory Care Experiences Survey (ACES). Continuity was measured by primary care visit concentration. Patients who had 10 or more specialty care visits were classified as high users. Linear regression was used to estimate the association between coordination and continuity, controlling for potential confounders and clustering within clinicians. We used a continuity-by-specialty interaction term to determine whether the continuity-coordination association was modified by high specialty care use. RESULTS Among low specialty care users, an increase of 1 standard deviation (SD) in continuity was associated with an increase of 2.71 in the ACES coordination scale (P <.001). In high specialty care users, we observed no association between continuity and reported coordination (P= .77). CONCLUSIONS High use of specialty care may strain the ability of primary care clinicians to coordinate care effectively. Future studies should investigate care coordination interventions that allow for appropriate specialty care referrals without diminishing the ability of primary care physicians to manage overall patient care.