Patient-reported care coordination: Associations with primary care continuity and specialty care use

David T. Liss, Jessica Chubak, Melissa L. Anderson, Kathleen W. Saunders, Leah Tuzzio, Robert J. Reid

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


PURPOSE Care coordination is increasingly recognized as a necessary elementof high-quality, patient-centered care. This study investigated (1) the associationbetween care coordination and continuity of primary care, and (2) differences inthis association by level of specialty care use.METHODS We conducted a cross-sectional study of Medicare enrollees with selectchronic conditions in an integrated health care delivery system in WashingtonState. We collected survey information on patient experiences and automatedhealth care utilization data for 1 year preceding survey completion. Coordinationwas defi ned by the coordination measure from the short form of the AmbulatoryCare Experiences Survey (ACES). Continuity was measured by primary care visitconcentration. Patients who had 10 or more specialty care visits were classifi ed ashigh users. Linear regression was used to estimate the association between coordinationand continuity, controlling for potential confounders and clustering withinclinicians. We used a continuity-by-specialty interaction term to determine whetherthe continuity-coordination association was modifi ed 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 coordinationscale (P <.001). In high specialty care users, we observed no associationbetween continuity and reported coordination (P =.77).CONCLUSIONS High use of specialty care may strain the ability of primary careclinicians to coordinate care effectively. Future studies should investigate carecoordination interventions that allow for appropriate specialty care referralswithout diminishing the ability of primary care physicians to manage overallpatient care.

Original languageEnglish (US)
Pages (from-to)323-329
Number of pages7
JournalAnnals of family medicine
Issue number4
StatePublished - 2011


  • Ambulatory care
  • Care coordination
  • Continuity of patient care
  • Primary health care

ASJC Scopus subject areas

  • Family Practice


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