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JAMA Intern Med. 2013 Nov 11;173(20):1879-85. doi: 10.1001/jamainternmed.2013.10059.

Continuity of care and the risk of preventable hospitalization in older adults.

Author information

1
Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation, Baltimore, Maryland.

Abstract

IMPORTANCE:

Preventable hospitalizations are common among older adults for reasons that are not well understood.

OBJECTIVE:

To determine whether Medicare patients with ambulatory visit patterns indicating higher continuity of care have a lower risk of preventable hospitalization.

DESIGN:

Retrospective cohort study.

SETTING:

Ambulatory visits and hospital admissions.

PARTICIPANTS:

Continuously enrolled fee-for-service Medicare beneficiaries older than 65 years with at least 4 ambulatory visits in 2008.

EXPOSURES:

The concentration of patient visits with physicians measured for up to 24 months using the continuity of care score and usual provider continuity score on a scale from 0 to 1.

MAIN OUTCOMES AND MEASURES:

Index occurrence of any 1 of 13 preventable hospital admissions, censoring patients at the end of their 24-month follow-up period if no preventable hospital admissions occurred, or if they died.

RESULTS:

Of the 3,276,635 eligible patients, 12.6% had a preventable hospitalization during their 2-year observation period, most commonly for congestive heart failure (25%), bacterial pneumonia (22.7%), urinary infection (14.9%), or chronic obstructive pulmonary disease (12.5%). After adjustment for patient baseline characteristics and market-level factors, a 0.1 increase in continuity of care according to either continuity metric was associated with about a 2% lower rate of preventable hospitalization (continuity of care score hazard ratio [HR], 0.98 [95% CI, 0.98-0.99; usual provider continuity score HR, 0.98 [95% CI, 0.98-0.98). Continuity of care was not related to mortality rates.

CONCLUSIONS AND RELEVANCE:

Among fee-for-service Medicare beneficiaries older than 65 years, higher continuity of ambulatory care is associated with a lower rate of preventable hospitalization.

PMID:
24043127
PMCID:
PMC3877937
DOI:
10.1001/jamainternmed.2013.10059
[Indexed for MEDLINE]
Free PMC Article

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