ArticleHealth services research2022
Outpatient care fragmentation in Veterans Affairs patients at high-risk for hospitalization.
Article in Health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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Who cites it
12 citing papers in PubMed, 10 citations in OpenAlex.
- Article
- Continuity of Care and Risks of Hospitalization and Mortality in COPD: A Nationwide Cohort Study.International journal of chronic obstructive pulmonary disease · 2026Article
- Continuity of Care in Federally Qualified Health Centers: Examining Patient-Provider Relationships and Patient Centered Medical Home Recognition.Journal of the American Board of Family Medicine : JABFM · 2025Article
- Assessing Equitable Implementation of a Social Care Initiative Integrating Medical and Social Services for Medicaid Members.Health services research · 2025Article
- Experiences With VA-Purchased Community Care for US Veterans With Mental Health Conditions.JAMA network open · 2025Article
- Data-driven insights into interhospital care fragmentation: Implications for health policy and equity among older adults.PloS one · 2025Article
- Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan.BJGP open · 2024Article
- Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan.Journal of general and family medicine · 2023Article
- Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study.Frontiers in health services · 2023Article
- Association Between Mental Health Conditions and Outpatient Care Fragmentation: a National Study of Older High-Risk Veterans.Journal of general internal medicine · 2022Article
- Outpatient Care Fragmentation and Acute Care Utilization in Veterans Affairs Home-Based Primary Care.JAMA network open · 2022Article
- Outpatient care fragmentation in Veterans Affairs patients at high-risk for hospitalization.Health services research · 2022Article
Corrections and comments
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Authors and funding
12 authors at 7 institutions in 1 country.
Funding
Abstract
objectiveTo examine outpatient care fragmentation and its association with future hospitalization among patients at high risk for hospitalization. DATA SOURCES: Veterans Affairs (VA) and Medicare data. STUDY
designWe conducted a longitudinal study, using logistic regression to examine how outpatient care fragmentation in FY14 (as measured by number of unique providers, Breslau's Usual Provider of Care (UPC), Bice-Boxerman's Continuity of Care Index (COCI), and Modified Modified Continuity Index (MMCI)) was associated with all-cause hospitalizations and hospitalizations related to ambulatory care sensitive conditions (ACSC) in FY15. We also examined how fragmentation varied by patient's age, gender, race, ethnicity, marital status, rural status, history of homelessness, number of chronic conditions, Medicare utilization, and mental health care utilization. DATA EXTRACTION
methodsWe extracted data for 130,704 VA patients ≥65 years old with a hospitalization risk ≥90th percentile and ≥ four outpatient visits in the baseline year. PRINCIPAL
findingsThe mean (SD) of FY14 outpatient visits was 13.2 (8.6). Fragmented care (more providers, less care with a usual provider, more dispersed care based on COCI) was more common among patients with more chronic conditions and those receiving mental health care. In adjusted models, most fragmentation measures were not associated with all-cause hospitalization, and patients with low levels of fragmentation (more concentrated care based on UPC, COCI, and MMCI) had a higher likelihood of an ACSC-related hospitalization (AOR, 95% CI = 1.21 (1.09-1.35), 1.27 (1.14-1.42), and 1.28 (1.18-1.40), respectively).
conclusionsContrary to expectations, outpatient care fragmentation was not associated with elevated all-cause hospitalization rates among VA patients in the top 10th percentile for risk of admission; in fact, fragmented care was linked to lower rates of hospitalization for ACSCs. In integrated settings such as the VA, multiple providers, and dispersed care might offer access to timely or specialized care that offsets risks of fragmentation, particularly for conditions that are sensitive to ambulatory care.
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