Publication Type
Journal Article
Version
publishedVersion
Publication Date
4-2020
Abstract
Background: Care coordination is an essential and difficult to measure function of primary care. Objective: Our objective was to assess the impact of network characteristics in primary/specialty physician networks on emergency department (ED) visits for patients with chronic ambulatory care sensitive conditions (ACSCs). Subjects and Measures: This cross-sectional social network analysis of primary care and specialty physicians caring for adult Medicaid beneficiaries with ACSCs was conducted using 2009 Texas Medicaid Analytic eXtract (MAX) files. Network characteristic measures were the main exposure variables. A negative binomial regression model analyzed the impact of network characteristics on the ED visits per patient in the panel. Results: There were 42 493 ACSC patients assigned to 5687 primary care physicians (PCPs) connected to 11 660 specialist physicians. PCPs whose continuity patients did not visit a specialist had 86% fewer ED visits per patient in their panel, compared with PCPs whose patients saw specialists. Among PCPs connected to specialists in the network, those with a higher number of specialist collaborators and those with a high degree of centrality had lower patient panel ED rates. Conclusions: PCPs providing comprehensive care (ie, without specialist consultation) for their patients with chronic ACSCs had lower ED utilization rates than those coordinating care with specialists. PCPs with robust specialty networks and a high degree of centrality in the network also had lower ED utilization. The right fit between comprehensiveness of primary care, care coordination, and adequate capacity of specialty availability in physician networks is needed to drive outcomes.
Keywords
primary care, care coordination, social network analysis, Medicaid
Discipline
Operations and Supply Chain Management
Research Areas
Operations Management
Publication
Journal of Primary Care & Community Health
Volume
11
First Page
1
Last Page
9
ISSN
2150-1319
Identifier
10.1177/2150132720924432
Publisher
SAGE Publications
Citation
SHE, Zhaowei; GAGLIOTI, Anne H.; BALTRUS, Peter; LI, Chaohua; MOORE, Miranda A.; IMMERGLUCK, Lilly C.; RAO, Arthi; and AYER, Turgay.
Primary care comprehensiveness and care coordination in robust specialist networks results in lower emergency department utilization: A network analysis of Medicaid physician networks. (2020). Journal of Primary Care & Community Health. 11, 1-9.
Available at: https://ink.library.smu.edu.sg/lkcsb_research/7123
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Additional URL
https://doi.org/10.1177/2150132720924432