Care Coordination and Hospitalization in Older Adults With or at Risk for Cardiovascular Disease

Does adding proactive care coordination before emergencies reduce emergency department (ED) visits and hospitalizations among Medicare beneficiaries with fragmented care who have cardiovascular disease (CVD) or CVD risk factors?In this randomized clinical trial with 400 participants, most Medicare beneficiaries who were offered proactive care coordination declined, saying they were coordinating care themselves. There was no difference in the outcome of ED visits or hospitalizations.Offering proactive care coordination by care managers in advance of hospitalization did not result in better outcomes compared with posthospitalization offers; many participants declined proactive assistance by care managers, choosing instead to do the care coordination themselves.

Corresponding Author: Lisa M. Kern, MD, MPH, Weill Cornell Medicine, 420 E 70th St, Box 331, New York, NY 10021 (lmk2003@med.cornell.edu).

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