Ambulatory Care Fragmentation and Total Health Care Costs
Bibliographic Data
| ID | 9100255 |
|---|---|
| Authors | Lisa M Kern (0000-0003-1191-8100, Weill Cornell Medicine, corresponding author), Joanna Bryan Ringel (Cornell University, corresponding author), Mangala Rajan (0000-0001-6129-6683, Weill Cornell Medicine, corresponding author), Lawrence P Casalino (0000-0002-7927-7859, Weill Cornell Medicine), Michael F Pesko (0000-0002-9247-9703, University of Missouri), Laura C Pinheiro (0000-0002-6920-8526, Weill Cornell Medicine, corresponding author), Lisandro D Colantonio (0000-0001-8742-1788, University of Alabama at Birmingham), Monika M Safford (0000-0002-3060-0563, Weill Cornell Medicine, corresponding author) |
| Year | 2024 |
| Volume | 62 |
| Issue | 4 |
| Pages | 277-284 |
| Publication date | 2024-04-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000001982 |
| PMID | 38458986 |
| OpenAlex | W4392630831 |
| Language | EN |
| References cited | 24 |
BACKGROUND: The magnitude of the relationship between ambulatory care fragmentation and subsequent total health care costs is unclear. OBJECTIVE: To determine the association between ambulatory care fragmentation and total health care costs. RESEARCH DESIGN: Longitudinal analysis of 15 years of data (2004-2018) from the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, linked to Medicare fee-for-service claims. SUBJECTS: A total of 13,680 Medicare beneficiaries who are 65 years and older. MEASURES: We measured ambulatory care fragmentation in each calendar year, defining high fragmentation as a reversed Bice-Boxerman Index ≥0.85 and low as <0.85. We used generalized linear models to determine the association between ambulatory care fragmentation in 1 year and total Medicare expenditures (costs) in the following year, adjusting for baseline demographic and clinical characteristics, a time-varying comorbidity index, and accounting for geographic variation in reimbursement and inflation. RESULTS: The average participant was 70.9 years old; approximately half (53%) were women. One-fourth (26%) of participants had high fragmentation in the first year of observation. Those participants had a median of 9 visits to 6 providers, with the most frequently seen provider accounting for 29% of visits. By contrast, participants with low fragmentation had a median of 8 visits to 3 providers, with the most frequently seen provider accounting for 50% of visits. High fragmentation was associated with $1085 more in total adjusted costs per person per year (95% CI $713 to $1457) than low fragmentation. CONCLUSIONS: Highly fragmented ambulatory care in 1 year is independently associated with higher total costs the following year
Ambulatory · Ambulatory care · Comorbidity · Fragmentation (computing) · Health care · Psychiatry · Reimbursement · Demography · Emergency Medicine · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Primary Care and Health Outcomes · Surgery · Gerontology
The Reasons for Geographic and Racial Differences in Stroke Study
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
Eliminating Waste in US Health Care
How to measure comorbiditya critical review of available methods
A new method of classifying prognostic comorbidity in longitudinal studies
Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data
Ambulatory Care Fragmentation and Subsequent Hospitalization
A Quantitative Measure of Continuity of Care
Effect of Continuity of Care on Drug-Drug Interactions
| Citation velocity | historical |
|---|---|
| Highly cited | No |