Interpersonal Primary Care Continuity for Chronic Conditions Is Associated with Fewer Hospitalizations and Emergency Department Visits Among Medicaid Enrollees.

Autor:	Gaglioti AH; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR). ahg2@case.edu., Li C; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Baltrus PT; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., She Z; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Douglas MD; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Moore MA; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Rao A; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Cheng Immergluck L; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Ayer T; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Bazemore A; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Rust G; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR)., Mack DH; From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG, CL, PTB, MDD, DHM); Center for Community Health Integration and Population Health Research Institute, Case Western Reserve University, Cleveland, OH (AHG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PTB, MDD); Lee Kong Chian School of Business, Singapore Management University, Singapore (ZS); Department of Family and Preventive Medicine, Emory University, Atlanta, GA (MAM); Center for Quality Growth and Regional Development, Georgia Institute of Technology, Atlanta, GA (AR); Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (LCI); H. Milton Steward School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (TA); The Center for Professionalism and Value, American Board of Family Medicine, Washington, DC (AB); Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, FL (GR).
Jazyk:	angličtina
Zdroj:	Journal of the American Board of Family Medicine : JABFM [J Am Board Fam Med] 2023 Apr 03; Vol. 36 (2), pp. 303-312. Date of Electronic Publication: 2023 Mar 03.
DOI:	10.3122/jabfm.2022.220015R1
Abstrakt:	Background: Interpersonal primary care continuity or chronic condition continuity (CCC) is associated with improved health outcomes. Ambulatory care-sensitive conditions (ACSC) are best managed in a primary care setting, and chronic ACSC (CACSC) require management over time. However, current measures do not measure continuity for specific conditions or the impact of continuity for chronic conditions on health outcomes. The purpose of this study was to design a novel measure of CCC for CACSC in primary care and determine its association with health care utilization. Methods: We conducted a cross-sectional analysis of continuously enrolled, nondual eligible adult Medicaid enrollees with a diagnosis of a CACSC using 2009 Medicaid Analytic eXtract files from 26 states. We conducted adjusted and unadjusted logistic regression models of the relationship between patient continuity status and emergency department (ED) visits and hospitalizations. Models were adjusted for age, sex, race/ethnicity, comorbidity, and rurality. We defined CCC for CACSC as at least 2 outpatient visits with any primary care physician for a CACSC in the year, and (2) more than 50% of outpatient CACSC visits with a single PCP. Results: There were 2,674,587 enrollees with CACSC and 36.3% had CCC for CACSC visits. In fully adjusted models, enrollees with CCC were 28% less likely to have ED visits compared with those without CCC (aOR = 0.71, 95% CI = 0.71 - 0.72) and were 67% less likely to have hospitalization than those without CCC (aOR = 0.33, 95% CI = 0.32-0.33). Conclusions: CCC for CACSCs was associated with fewer ED visits and hospitalizations in a nationally representative sample of Medicaid enrollees. Competing Interests: Conflicts of interest: None. (© Copyright by the American Board of Family Medicine.)
Databáze:	MEDLINE
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