Within recent years there has been renewed interest in primary health care - the level of care at which the patient enters the medical system to receive comprehensive, basic services, and to be referred for further care. It has been estimated that up to eighty percent of decisions controlling health care expenditures are made at the primary level of care. Recent health care system reforms such as """"""""managed care"""""""" are founded upon traditional elements of primary care, including the concepts of continuity and coordination, which are considered present when care is received as an uninterrupted series of events, in part due to the smooth transfer of information between a patient's providers and/or visits. Managed care has been seen as a way to improve continuity and coordination and hence control costs and improve efficiency. Maryland recently initiated a Medicaid managed care program, it's top two objectives being """"""""increasing the continuity of care"""""""" and creating """"""""closer provider-patient relationships"""""""". The existence of continuity and coordination within the Maryland Medicaid program have not, however, been fully examined. This study has several objectives: 1. To assess levels of continuity and coordination in the medical care of chronically ill adult Medicaid patients, prior to the instigation of a managed car program, using several types of data: A) Two consecutive years of Medicaid claims data (n=approx. 10,000 patients), and; B) One year of claims data that has been augmented with data from intensive review of medical records (n=approx. 1,500 patients; 2. To compare continuity scores derived from claims alone with those derived from the combined claims/records data; 3. To determine whether levels of continuity vary according to the type of provider (private-practice MD, outpatient department, or community health center) which a patient sees for the majority of his or her care; and to determine among MDs whether continuity and coordination vary according to the MD's whether continuity and coordination vary according to the MD's specialty; 4. To examine the relationship between levels of continuity and coordination and the overall quality and cost of medical care, (using previously determined patient-level quality of care scores and provider cost levels). Study results may prove of interest methodologically, in that they may demonstrate whether readily-available claims data can yield valid information about levels of continuity and coordination. The study may also elucidate the types of providers who tend to deliver continuous, coordinated care, which may be useful to states as they reform their Medicaid programs. An examination of the relationship between continuity, coordination, and overall quality and cost of care may also prove interesting.
