An examination of the relationship between the external environment and care coordination

This study addressed a gap in the care coordination literature by exploring the factors predictive of care coordination, with particular attention to the external environment. The first paper of this dissertation conducted a systematic review of empirical studies that looked at the predictors of care coordination. Based on the 22 papers that fulfilled the inclusion criteria, the evidence to support the relationships between care coordination and factors that are predictive of care coordination was shown to be weak to moderate depending on the types of factors you look at. This study has revealed a significant inconsistency in how predictors of care coordination were operationalized across studies. The second paper of this dissertation used the resource-dependence theory to examine the association between the external environment and care coordination activities. Data for this study were merged from Health Tracking Physician Survey (2008) conducted by Center for Studying Health System Change (CSHSC), Area Resource File (2008), American Medical Association (AMA), American Health Planning Association (AHPA) and Dartmouth Atlas (2008). The findings of our study indicated that several environmental factors, including the per capita income, fluctuations in HMO penetration and poverty levels, and the presence of malpractice crisis were significantly associated with selected care coordination activities, such as the level of communication and level of difficulty in obtaining needed medical and non-medical services. Finally, the third paper of this dissertation examined the mediating role of reimbursement and health information technology (HIT) availability on the relationship between the external environment and care coordination. Results of the structural equation modeling (SEM) showed that HIT availability and reimbursement for communication significantly mediated the relationship between the measures of the external environment and physician' reported level of communication. The findings of this dissertation are useful for both practitioners and researchers. Future research should strive to incorporate a unified definition of care coordination, simultaneously analyze multiple levels of predictors and apply it in different healthcare settings. The practitioners (e.g., providers and payers) should consider the possibility that an organization's external environment may influence the effectiveness of its care coordination activities.