ArticleBMC health services research2021
Super fragmented: a nationally representative cross-sectional study exploring the fragmentation of inpatient care among super-utilizers.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- 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
- Digital and Navigational Health Literacy in Swiss Cancer Survivors Compared With the General Population: Cross-Sectional Questionnaire Study.Journal of medical Internet research · 2026Article
- Association between patient continuity of care and physicians' hypoglycaemic medication prescription trends.International journal of health economics and management · 2026Article
- Review
- The Proliferation of Medical Clinics in Pakistani Street and Health Fragmentation: A Case Study.Asian bioethics review · 2025Article
- High Users of Primary Care Secure Messaging in the Veterans Health Administration.Annals of family medicine · 2025Article
- From marginalized to strength: Socio-ecological coping strategies of older Korean Americans with language barriers and healthcare needs.Journal of social service research · 2025Article
- Assessing Equitable Implementation of a Social Care Initiative Integrating Medical and Social Services for Medicaid Members.Health services research · 2025Article
- Using Photovoice to Improve Engagement in Community Health Assessments Addressing Behavioral Health.The journal of behavioral health services & research · 2025Article
- The Impact of Delivery Reform on Health Information Exchange with Behavioral Health Providers: Results from a National Representative Survey of Ambulatory Physicians.Administration and policy in mental health · 2024Article
- Digital health delivery in respiratory medicine: adjunct, replacement or cause for division?European respiratory review : an official journal of the European Respiratory Society · 2024Review
- Healthcare Professionals' Perspectives on Post-Diagnostic Care for People with Vascular Cognitive Impairment: When Help Is Needed in a "No-Man's Land".Journal of Alzheimer's disease : JAD · 2024Article
- Malnutrition-related mortality trends in older adults in the United States from 1999 to 2020.BMC medicine · 2023Article
- Care Fragmentation Following Hospitalization for Atrial Fibrillation in the United States.JACC. Advances · 2023Article
- Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada.BMC health services research · 2023Article
- Association Between Mental Health Conditions and Outpatient Care Fragmentation: a National Study of Older High-Risk Veterans.Journal of general internal medicine · 2022Article
- Article
- Characterizing pharmacogenetic programs using the consolidated framework for implementation research: A structured scoping review.Frontiers in medicine · 2022Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSuper-utilizers with 4 or more admissions per year frequently receive low-quality care and disproportionately contribute to healthcare costs. Inpatient care fragmentation (admission to multiple different hospitals) in this population has not been well described.
objectiveTo determine the prevalence of super-utilizers who receive fragmented care across different hospitals and to describe associated risks, costs, and health outcomes. RESEARCH
designWe analyzed inpatient data from the Health Care Utilization Project's State Inpatient and Emergency Department database from 6 states from 2013. After identifying hospital super-utilizers, we stratified by the number of different hospitals visited in a 1-year period. We determined how patient demographics, costs, and outcomes varied by degree of fragmentation. We then examined how fragmentation would influence a hospital's ability to identify super-utilizers. SUBJECTS: Adult patients with 4 or more inpatient stays in 1 year. MEASURES: Patient demographics, cost, 1-year hospital reported mortality, and probability that a single hospital could correctly identify a patient as a super-utilizer.
resultsOf the 167,515 hospital super-utilizers, 97,404 (58.1%) visited more than 1 hospital in a 1-year period. Fragmentation was more likely among younger, non-white, low-income, under-insured patients, in population-dense areas. Patients with fragmentation were more likely to be admitted for chronic disease management, psychiatric illness, and substance abuse. Inpatient fragmentation was associated with higher yearly costs and lower likelihood of being identified as a super-utilizer.
conclusionsInpatient care fragmentation is common among super-utilizers, disproportionately affects vulnerable populations. It is associated with high yearly costs and a decreased probability of correctly identifying super-utilizers.
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