Publication Type
Journal Article
Version
publishedVersion
Publication Date
4-2023
Abstract
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.
Keywords
Chronic Disease, Continuity of Patient Care, Cross-Sectional Studies, Healthcare Disparities, Logistic Regression, Medicaid, Primary Health Care
Discipline
Health and Medical Administration | Operations and Supply Chain Management
Research Areas
Operations Management
Publication
Journal of the American Board of Family Medicine
Volume
36
Issue
2
First Page
303
Last Page
312
ISSN
1558-7118
Identifier
10.3122/jabfm.2022.220015r1
Publisher
ABFM
Citation
Gaglioti, A.; Li, C.; Baltrus, P.; SHE, Zhaowei; Douglas, M.; Moore, M.; Rao, A.; Immergluck, L.; Ayer, T.; Bazemore, A.; Rust, G.; and Mack, D..
Interpersonal primary care continuity for chronic conditions is associated with fewer hospitalizations and emergency department visits among Medicaid enrollees. (2023). Journal of the American Board of Family Medicine. 36, (2), 303-312.
Available at: https://ink.library.smu.edu.sg/lkcsb_research/7685
Copyright Owner and License
Publisher
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/10.3122/jabfm.2022.220015r1
Included in
Health and Medical Administration Commons, Operations and Supply Chain Management Commons
