ArticleJournal of general internal medicine2023
Ambulatory Care Fragmentation, Emergency Department Visits, and Race: a Nationwide Cohort Study in the U.S.
Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
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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.
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Who cites it
13 citing papers in PubMed, 8 citations in OpenAlex.
- Care Coordination and Hospitalization in Older Adults With or at Risk for Cardiovascular Disease: A Randomized Clinical Trial.JAMA network open · 2026Trial
- The Scope of Care Coordination for Older Adults Whose Dominant Provider Is a Nurse Practitioner Versus a Primary Care Physician.Medical care · 2026Article
- Health Care Contact Days Among Older Adults After Emergency Department Visits: A Cross-Sectional Analysis.Journal of the American Geriatrics Society · 2026Article
- Ambulatory Care Follow-Up and Fragmentation After Emergency Department Visits Among Older Adults.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2026Article
- Developing a Competency List for General Practitioners/Family Physicians Providing Care for Dual-Location Residents: Expert Consensus via the Delphi Technique.Journal of general and family medicine · 2026Article
- Determinants of polydoctoring among patients with multimorbidity: a Nationwide Longitudinal Fixed-Effects Study in Japan.Family medicine and community health · 2026Article
- Article
- Emergency cancer diagnosis in older adults: patterns, subgroups, and implications for health-care quality metrics.JNCI cancer spectrum · 2026Article
- Comparison of inpatient subspecialty care delivery models: Clinical outcomes and racial disparities in dedicated versus consultative pulmonary care.Journal of hospital medicine · 2025Article
- Gaps in the coordination of care for older adults with or at risk for cardiovascular disease.The American journal of managed care · 2025Article
- Parent-identified opportunities for improving asthma care for children insured by Medicaid following implementation of statewide Medicaid Accountable Care Organizations in Massachusetts.Frontiers in allergy · 2025Article
- Accessibility of Criteria to Exit Cervical Cancer Screening at Age 65 Years in the Electronic Health Record.O&G 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
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundIt is unclear whether highly fragmented ambulatory care (i.e., care spread across multiple providers without a dominant provider) increases the risk of an emergency department (ED) visit. Whether any such association varies with race is unknown.
objectiveWe sought to determine whether highly fragmented ambulatory care increases the risk of an ED visit, overall and by race. DESIGN AND
participantsWe analyzed data for 14,361 participants ≥ 65 years old from the nationwide prospective REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study, linked to Medicare claims (2003-2016). MAIN MEASURES: We defined high fragmentation as a reversed Bice-Boxerman Index ≥ 0.85 (≥ 75 KEY
resultsThe average participant was 70.5 years old; 53% were female, and 33% were Black individuals. Participants with high fragmentation had a median of 9 visits to 6 providers, with 29% of visits by the most frequently seen provider; participants with low fragmentation had a median of 7 visits to 3 providers, with 50% of visits by the most frequently seen provider. Overall, high fragmentation was associated with more ED visits than low fragmentation (adjusted risk ratio [aRR] 1.31, 95% confidence interval [CI] 1.29, 1.34). The magnitude of this association was larger among Black (aRR 1.48, 95% CI 1.44, 1.53) than White participants (aRR 1.23, 95% CI 1.20, 1.25).
conclusionsHighly fragmented ambulatory care was an independent predictor of ED visits, especially among Black individuals.
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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.