Ambulatory Care Fragmentation and Subsequent Hospitalization

Evidence From the REGARDS Study

Datos Bibliográficos

ID9103579
AutoresLisa M Kern (0000-0003-1191-8100, Weill Cornell Medicine, New York, NY, autor de correspondencia), Joanna Bryan Ringel (Cornell University, autor de correspondencia), Mangala Rajan (0000-0001-6129-6683, Weill Cornell Medicine, New York, NY, autor de correspondencia), Lisandro D Colantonio (0000-0001-8742-1788, University of Alabama at Birmingham, Birmingham, AL), Lawrence P Casalino (0000-0002-7927-7859, Weill Cornell Medicine, New York, NY, autor de correspondencia), Laura C Pinheiro (0000-0002-6920-8526, Weill Cornell Medicine, New York, NY, autor de correspondencia), Evgeniya Reshetnyak (0000-0001-9478-4405, Weill Cornell Medicine, New York, NY, autor de correspondencia), Monika M Safford (0000-0002-3060-0563, Weill Cornell Medicine, New York, NY, autor de correspondencia)
Año2021
Volumen59
Número4
Páginas334-340
Fecha de publicación2021-04-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001470
PMID33273294
OpenAlexW3107010015
IdiomaEN
Citas recibidas4
Referencias citadas25

BACKGROUND: Previous studies have suggested that highly fragmented ambulatory care increases the risk of subsequent hospitalization, but those studies used claims only and were not able to adjust for many clinical potential confounders. OBJECTIVE: The objective of this study was to determine the association between fragmented ambulatory care and subsequent hospitalization, adjusting for demographics, medical conditions, medications, health behaviors, psychosocial variables, and physiological variables. DESIGN: Longitudinal analysis of data (2003-2016) from the nationwide REasons for Geographic And Racial Differences in Stroke (REGARDS) study, linked to Medicare fee-for-service claims. SUBJECTS: A total of 12,693 Medicare beneficiaries 65 years and older from the REGARDS study who had at least 4 ambulatory visits in the first year of observation and did not have a hospitalization in the prior year. MEASURES: We defined high fragmentation as a reversed Bice-Boxerman score above the 75th percentile. We used Cox proportional hazards models to determine the association between fragmentation as a time-varying exposure and incident hospitalization in the 3 months following each exposure period. RESULTS: The mean age was 70.4 years; 54% were women, and 33% were African American. During the first year of observation, participants with high fragmentation had a median of 8 ambulatory visits with 6 providers, whereas participants with low fragmentation had a median of 7 visits with 3 providers. Over 11.8 years of follow-up, 6947 participants (55%) had a hospitalization. High fragmentation was associated with an increased hazard of hospitalization (adjusted hazard ratio=1.18; 95% confidence interval: 1.12, 1.24). CONCLUSION: Highly fragmented ambulatory care is an independent risk factor for hospitalization

Ambulatory · Ambulatory care · Confidence interval · Confounding · Hazard ratio · Health care · Proportional hazards model · Psychiatry · Psychosocial · Demography · Emergency Medicine · Healthcare Policy and Management · Heart Failure Treatment and Management · Internal Medicine · Medicine · Primary Care and Health Outcomes