ArticleJAMA network open2022
Outpatient Care Fragmentation and Acute Care Utilization in Veterans Affairs Home-Based Primary Care.
Article in JAMA network 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.
- Program of intensive support in emergency departments for care partners of cognitively impaired patients: A randomized controlled trial.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Trial
- Article
- Fragmented Financing in Emergency Department Use Among US Veterans.JAMA health forum · 2025Article
- Factors Associated With Veterans Use of Community vs VA Emergency Departments.JAMA network open · 2025Article
- Primary Care Utilization and Prehospital Emergency Demand Among Patients with Multimorbidity in Spain.Nursing reports (Pavia, Italy) · 2025Article
- 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
- Patient Priorities Care Increases Long-Term Service and Support Use: Propensity Match Cohort Study.Journal of the American Medical Directors Association · 2024Article
- Association between readmission care fragmentation and outcomes after interventions for peripheral arterial disease.Journal of vascular surgery · 2023Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
Importance: Veterans Affairs (VA) Home-Based Primary Care (HBPC) provides comprehensive, interdisciplinary primary care at home to patients with complex, chronic, disabling disease, but little is known about care fragmentation patterns and consequences among these patients. Objective: To examine outpatient care fragmentation patterns and subsequent acute care among HBPC-engaged patients at high risk of hospitalization or death. Design, Setting, and Participants: This retrospective cohort study included VA patients aged at least 65 years who were enrolled in the VA and Medicare, whose risk of hospitalization or death was in the top 10%, and who had at least 4 outpatient visits between October 1, 2013, and September 30, 2014. HBPC engagement was defined as having at least 2 HBPC encounters between July 1, 2014, and September 30, 2014. Data were analyzed from March 2020 to March 2022. Exposures: Two indices of outpatient care fragmentation: practitioner count and the Usual Provider Continuity Index (UPC), based on VA and non-VA health care use from October 1, 2013, to September 30, 2014. All care delivered by HBPC clinicians was analyzed as coming from a single practitioner. Main Outcomes and Measures: Emergency department (ED) visits and hospitalizations for ambulatory care sensitive conditions (ACSC) from VA records and Medicare claims from October 1, 2014, to September 30, 2015. Results: Among 8908 identified HBPC patients, 8606 (96.6%) were male, 1562 (17.5%) were Black, 249 (2.8%) were Hispanic, 6499 (73.0%) were White, 157 (1.8%) were other race or ethnicity, and 441 (5.0%) had unknown race or ethnicity; the mean (SD) age was 80.0 (9.02) years; patients had a mean (SD) of 11.25 (3.87) chronic conditions, and commonly had disabling conditions such as dementia (38.8% [n = 3457]). In adjusted models, a greater number of practitioners was associated with increased odds of an ED visit (adjusted odds ratio [aOR], 1.05 [95% CI, 1.03-1.07]) and hospitalization for an ACSC (aOR, 1.04 [95% CI, 1.02-1.06]), whereas more concentrated care with a higher UPC was associated with reduced odds of these outcomes (highest vs lowest tertile of UPC: aOR for ED visit, 0.77 [95% CI, 0.67-0.88], aOR for ACSC hospitalization, 0.78 [95% CI, 0.68-0.88]). Conclusions and Relevance: Among patients in HBPC, fragmented care was associated with more ED visits and ACSC hospitalizations. These findings suggest that consolidating or coordinating fragmented care may be a target for reducing preventable acute care.
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