ArticleBMJ open2022
Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Polydoctoring and health outcomes among the very old population with multimorbidity: a retrospective cohort study in Japan.Scientific reports · 2025Article
- Determinants of polydoctoring among multimorbid older adults; a cross-sectional study in an urban area of Japan.Journal of general and family medicine · 2024Article
- Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan.BJGP open · 2024Article
- Health Statuses of People in Poverty Receiving Public Assistance in Japan: A Scoping Review.JMA journal · 2024Article
- Article
- Analysis of Effect of Six Sigma Method Combined with CI Strategy on Improving of Nursing Quality in Outpatient Infusion Rooms.BioMed research international · 2022Article
- Analysis of the Effect of the Communication Ability of Nurses in Outpatient Infusion Room on the Treatment Experience of Patients and Their Families.Computational and mathematical methods in medicine · 2022Article
- Improving InterRAI care processes in long-term care homes: A constructivist grounded theory.Digital healthArticle
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectivesContinuity of care is a core dimension of primary care, and better continuity is associated with better patient outcomes. Therefore, care fragmentation can be an indicator to assess the quality of primary care, especially in countries without formal gatekeeping system, such as Japan. Thus, this study aimed to describe care fragmentation among older adults in an ageing city in Japan.
designCross-sectional study.
settingThe most populated basic municipality in Japan.
participantsOlder adults aged 75 years and older.
interventionsThis study used a health claims database, including older adults who visited medical facilities at least four times a year in an urban city in Japan. The Fragmentation of Care Index (FCI) was used as an indicator of fragmentation. The FCI was developed from the Continuity of Care Index and is based on the total number of visits, different institutions visited and proportion of visits to each institution. We employed Tobit regression analysis to examine the association between the FCI and age, sex, type of insurance and most frequently visited facility.
resultsThe total number of participants was 413 600. The median age of the study population was 81 years, and 41.6% were men. The study population visited an average of 3.42 clinics/hospitals, and the maximum number of visited institutions was 20. The proportion of patients with FCI >0 was 85.0%, with a mean of 0.583. Multivariable analysis showed that patients receiving public assistance had a lower FCI compared with patients not receiving public assistance, with a coefficient of 0.137.
conclusionsTo our knowledge, this is the first study to demonstrate care fragmentation in Japan. Over 80% of the participants visited two or more medical facilities, and their mean FCI was 0.583. The FCI could be a basic indicator for assessing the quality of primary care.
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