Health care experience: access, care coordination, utilization

Health care experience: access, care coordination, and utilization is a priority area across the lifespan, and in clinical and community settings.  There is a great need for more effective interventions to improve outcomes.

• Access to health services is a key component in efforts to achieve health equity and health quality for all people; this goal in Healthy People 2020 focuses on coverage, services, timeliness, and workforce needs.  Emerging issues in healthcare access include: appropriate, safe, and effective care, prevention programs, health disparities, long-term and palliative care, and measuring progress.¹
• “Care coordination is identified by the Institute of Medicine as a key strategy that has the potential to improve the effectiveness, safety, and efficiency of the American health care system. Well-designed, targeted care coordination that is delivered to the right people can improve outcomes for everyone: patients, providers, and payers.”²
• Research on care coordination is needed to identify specific patient education and psychosocial needs and examine outcomes related to medical utilization, medication errors, and self-management.³ 
• Utilization databases and quality indicators have been developed to help researchers and healthcare providers address “a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, state, and local market levels.⁴
• Health disparities and inequities are evident “across a wide range of diseases, behavioral risk factors, environmental exposures, social determinants, and health-care access by sex, race and ethnicity, income, education, disability status and other social characteristics.” The CDC Health Disparities and Inequalities Report - United States, 2013 outlines the urgent need for better measures and evidence-based programs and interventions that address activity limitations, work-related injuries and illness, and health-related quality of life issues.⁵

Urgent Need

Health care access, care coordination, and utilization have been identified as

• a critical issue for improving health and healthcare for many conditions and populations
• an area in which evidence-based measures and interventions are needed
• an area where application of the unique expertise of occupational therapy would be highly beneficial

The OT Lens

Occupational therapy knowledge of the complex interaction of person and environmental factors that facilitates or impedes engagement in health care may guide development of effective interventions to improve care and address health inequities. The focus of occupational therapy on client and relationship based care may introduce new avenues for improving access, care coordination, and utilization.

Current knowledge, research training, measures and interventions in the area of health care access, care coordination, and utilization are inadequate for addressing the needs of clinical and community populations. AOTF is committed to the development of a scientific network and body of evidence to achieve effective and efficient advances in the area of health care access, care coordination, and utilization to improve health outcomes.

Opportunity to Affect Progress

There are a few occupational therapy scientists who are building knowledge related to health care access, care coordination, and utilization.  However, there is not a coordinated network for occupational therapy research in this area, nor sufficient resources to train more occupational therapy researchers.  We believe a significant investment is needed to address needs of clinical and community populations across the lifespan in order to achieve better outcomes for all people and improve quality of life.

1. Office of Disease Prevention and Health Promotion. (July, 2016). Access to Health Care. Retrieved from 
https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

2. Agency for Healthcare Research and Quality. (May, 2015). Care Coordination.  Rockville, MD. Retrieved from 
http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html

3. Agency for Healthcare Research and Quality. (April, 2015). Care Management: Implications for Medical Practice, Health Policy, and Health Services Research. Rockville, MD. Retrieved from 
http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/caremanagement/index.html

4. Agency for Healthcare Research and Quality  (March, 2016). HCUP Overview. Healthcare Cost and Utilization Project (HCUP). Rockville, MD. Retrieved from 
www.hcup-us.ahrq.gov/overview.jsp

5. Centers for Disease Control and Prevention. (2013). CDC Health Disparities & Inequalities Report (CHDIR). Retrieved from 
https://www.cdc.gov/minorityhealth/chdireport.html