A Mixed Methods Evaluation of Patient and Provider Perspectives of Chronic Illness Management Following Kidney Transplantation

Introduction: Inconsistent, fragmented care coordination in kidney transplant recipients (KTRs)—whose management requires long-term, complex care, and multiple handoffs among providers—has been shown to result in suboptimal care and higher costs. In order to move forward in improving long-term outcomes, it is necessary to fully assess current practice patterns with appropriate measures. With a full and accurate picture of how elements of the management plan influence both KTR and the health care provider (HCP), it will be possible to implement changes that improve long-term outcomes.Methods: The Chronic Care Model (CCM) was the framework for the study. A mixed method research approach was employed, integrating quantitative and qualitative methodologies in a single cross-sectional, correlational study with data collected from both KTRs and physicians. The 659 KTRs were selected from a list of KTRs who had received a kidney transplant at Methodist University Transplant Institute (MUTI). Physicians were recruited from a list of 96 referring nephrologists who practice in the region. The quantitative data were dichotomized results from Patient Assessment of Chronic Illness Care (PACIC) and Assessment of Chronic Illness Care (ACIC) questionnaires. Continuous data characteristics of the KTRs and HCPs were summarized, with means and standard deviations and medians and quartiles. Categorical data were reported as proportions. Chi-Square and Fisher’s Exact tests, as appropriate, were used to determine if any significant associations existed between categorical independent variables and the scale scores. Continuous variables were analyzed using t-tests and Wilcoxon Rank Sum, as appropriate.For qualitative data, NVivo 10 was used to organize the interviews and focus group discussion. Data were analyzed using five phase thematic content analysis.Results: There was variation in the perceptions of chronic illness management as assessed by the PACIC and the ACIC. The number of hospitalizations, time on dialysis and time with graft were the patient variables most associated with PACIC scores. Type of practice, embedded decision support, time in practice and age were the variables most associated with ACIC scores. Patients and providers recognized coordinated care/ follow- up, education, and community resources as barriers to chronic illness management.Discussion: The initial work presented here sought to clarify patient and provider perceptions of the influence of community resources and policies, as well as healthcare system organization using the CCM as a framework. An understanding of the perceptions and experiences of patients and providers will provide the foundation for future work that will address ways in which productive patient-provider interactions can be enhanced, thereby improving patient outcomes