ArticleJournal of general internal medicine2021
Healthcare Fragmentation and Incident Acute Coronary Heart Disease Events: a Cohort Study.
Article in Journal of general internal medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Barriers for access and utilization of dementia care services in Europe: a systematic review.BMC geriatrics · 2025Pooled it
- The needs and unmet needs for people living with dementia, caregivers and care workers in dementia health care systems: a systematic review.Frontiers in public health · 2025Pooled it
- Fragmented care and chronic illness patient outcomes: A systematic review.Nursing open · 2023Pooled it
- The role of health financing system and pluralism in achieving sustainable development goal health outcomes in India: a multilevel analysis.International journal for equity in health · 2026Article
- Gaps in the coordination of care for older adults with or at risk for cardiovascular disease.The American journal of managed care · 2025Article
- Low Attainment of Treatment Targets for Cardiovascular Risk Factors in Indonesian Adults With Established Coronary Artery Disease.Journal of evaluation in clinical practice · 2025Article
- Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan.BJGP open · 2024Article
- Ambulatory Care Fragmentation, Emergency Department Visits, and Race: a Nationwide Cohort Study in the U.S.Journal of general internal medicine · 2023Article
- Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan.BMJ open · 2022Article
- Health care fragmentation and blood pressure control among adults taking antihypertensive medication.The American journal of managed care · 2022Article
- Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection.Journal of general internal medicine · 2021Article
- Fragmented Ambulatory Care and Medication Count among Older Adults.American journal of medical quality : the official journal of the American College of Medical QualityArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
Abstract
backgroundHighly fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with excess tests, procedures, emergency department visits, and hospitalizations. Whether fragmented care is associated with worse health outcomes, or whether any association varies with health status, is unclear.
objectiveTo determine whether fragmented care is associated with the risk of incident coronary heart disease (CHD) events, overall and stratified by self-rated general health. DESIGN AND
participantsWe conducted a secondary analysis of the nationwide prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study (2003-2016). We included participants who were ≥ 65 years old, had linked Medicare fee-for-service claims, and had no history of CHD (N = 10,556). MAIN MEASURES: We measured fragmentation with the reversed Bice-Boxerman Index. We used Cox proportional hazards models to determine the association between fragmentation as a time-varying exposure and adjudicated incident CHD events in the 3 months following each exposure period. KEY
resultsThe mean age was 70 years; 57% were women, and 34% were African-American. Over 11.8 years of follow-up, 569 participants had CHD events. Overall, the adjusted hazard ratio (HR) for the association between high fragmentation and incident CHD events was 1.14 (95% confidence interval (CI) 0.92, 1.39). Among those with very good or good self-rated health, high fragmentation was associated with an increased hazard of CHD events (adjusted HR 1.35; 95% CI 1.06, 1.73; p = 0.01). Among those with fair or poor self-rated health, high fragmentation was associated with a trend toward a decreased hazard of CHD events (adjusted HR 0.54; 95% CI 0.29, 1.01; p = 0.052). There was no association among those with excellent self-rated health.
conclusionHigh fragmentation was associated with an increased independent risk of incident CHD events among those with very good or good self-rated health.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.