Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

作者：Halima Amjad, Donald Carmichael, Andrea M. Austin, Chiang‐Hua Chang, Julie Bynum · 发表于：JAMA Internal Medicine · 年份：2016 · DOI：10.1001/jamainternmed.2016.3553 · 被引用次数：199 · 研究领域：Primary Care and Health Outcomes、Sepsis Diagnosis and Treatment、Frailty in Older Adults

IMPORTANCE: Poor continuity of care may contribute to high health care spending and adverse patient outcomes in dementia. OBJECTIVE: To examine the association between medical clinician continuity and health care utilization, testing, and spending in older adults with dementia. DESIGN, SETTING, AND PARTICIPANTS: This was a study of an observational retrospective cohort from the 2012 national sample in fee-for-service Medicare, conducted from July to December 2015, using inverse probability weighted analysis. A total of 1 416 369 continuously enrolled, community-dwelling, fee-for-service Medicare beneficiaries 65 years or older with a claims-based dementia diagnosis and at least 4 ambulatory visits in 2012 were included. EXPOSURES: Continuity of care score measured on patient visits across physicians over 12 months. A higher continuity score is assigned to visit patterns in which a larger share of the patient's total visits are with fewer clinicians. Score range from 0 to 1 was examined in low-, medium-, and high-continuity tertiles. MAIN OUTCOMES AND MEASURES: Outcomes include all-cause hospitalization, ambulatory care sensitive condition hospitalization, emergency department visit, imaging, and laboratory testing (computed tomographic [CT] scan of the head, chest radiography, urinalysis, and urine culture), and health care spending (overall, hospital and skilled nursing facility, and physician). RESULTS: Beneficiaries with dementia who had lower levels of continuity of care ...