Ambulatory Care Fragmentation and Total Health Care Costs.
Med Care
; 62(4): 277-284, 2024 Apr 01.
Article
en En
| MEDLINE
| ID: mdl-38458986
ABSTRACT
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. RESEARCHDESIGN:
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.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Medicare
/
Planes de Aranceles por Servicios
Límite:
Aged
/
Female
/
Humans
/
Male
País como asunto:
America do norte
Idioma:
En
Año:
2024
Tipo del documento:
Article