Ambulatory Care Fragmentation and Total Health Care Costs.

Autor:	Kern LM; Department of Medicine, Weill Cornell Medicine, New York, NY., Ringel JB; Department of Medicine, Weill Cornell Medicine, New York, NY., Rajan M; Department of Medicine, Weill Cornell Medicine, New York, NY., Casalino LP; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY., Pesko MF; Department of Economics, University of Missouri, Columbia, MO., Pinheiro LC; Department of Medicine, Weill Cornell Medicine, New York, NY., Colantonio LD; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL., Safford MM; Department of Medicine, Weill Cornell Medicine, New York, NY.
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2024 Apr 01; Vol. 62 (4), pp. 277-284. Date of Electronic Publication: 2024 Mar 08.
DOI:	10.1097/MLR.0000000000001982
Abstrakt:	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. Competing Interests: L.M.K. is a consultant to Mathematica, Inc. M.R. received fees from the Veterans Biomedical Research Institute. M.F.P. receives grant support from the American Cancer Society, National Institutes of Health, and the Food and Drug Administration, and consulting revenue from Health Canada, the Virginia Foundation for Healthy Youth, and the University of Kentucky’s Institute for the Study of Free Enterprise. L.D.C. and M.M.S. receive funds from Amgen, Inc. The remaining authors declare no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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