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Original Investigation | Health Care Reform

Continuity of Care and the Risk of Preventable Hospitalization in Older Adults

David J. Nyweide, PhD1; Denise L. Anthony, PhD2; Julie P. W. Bynum, MD, MPH3,4; Robert L. Strawderman, ScD5; William B. Weeks, MD, MBA3; Lawrence. P. Casalino, MD, PhD6; Elliott S. Fisher, MD, MPH3
[+] Author Affiliations
1Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation, Baltimore, Maryland
2Department of Sociology, Dartmouth College, Hanover, New Hampshire
3The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
4Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire
5Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
6Department of Public Health, Weill Cornell Medical College, New York, New York
JAMA Intern Med. 2013;173(20):1879-1885. doi:10.1001/jamainternmed.2013.10059.
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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.

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