Continuity of Care and Risk of Readmission: An Investigation into the Healthcare Journey of Heart Failure Patients

Abstract

We investigate the association between continuity of care mechanisms and a patient's risk of readmission in the context of one chronic condition, heart failure. We define continuity of care as the level of consistency across patient care episodes. We dynamically measure continuity of individual referring provider; continuity of physical location, which links multiple individual providers; and continuity of Accountable Care Organization, which spans a variety of individual and institutional providers. We compile a unique large‐scale dataset that includes patient‐level claims, to follow heart failure patients throughout inpatient and outpatient settings in 2014. Our final sample covers 44,129 episodes of care for 3263 patients. Using a competitive‐risks survival model, we find that all three continuity mechanisms are associated with a patient's lower risk of readmission. This exploratory study contributes to operations management literature by identifying effective integration mechanisms in the setting of healthcare delivery. In addition, by providing the first quantitative evidence for the critical role of multiple simultaneous mechanisms in ensuring continuity of care, this study offers important preliminary insights for public policy efforts.

Curbing the Opioid Epidemic at Its Root: The Effect of Provider Discordance After Opioid Initiation

“…This concept of routing during the early stages of opioid use is also related to studies on continuity of care. Such work typically focuses on the long-term management of patients who are already suffering from specific chronic conditions, e.g., heart failure (Senot 2019), diabetes (Ahuja et al 2020), or opioid dependence (Hallvik et al 2018). While most studies in these chronic settings find that patients benefit from repeated appointments with the same practitioner, we focus on patients prior to chronicity.…”

“…For those patients who continue seeking treatment in the primary care setting after opioid initiation, we therefore ask: who should revisit the treatment plan with the patient, the original prescriber (i.e., provider concordance) or another clinician (i.e., provider discordance)? 1 While a different clinician can expose the patient to a "fresh perspective" and prevent anchoring to the original opioid treatment course, it may also lead to more fragmented care and reduce physician "ownership" of the long-term health of the patient (Ahuja et al 2020, Ariely et al 2003, Senot 2019. Although prescriber continuity is typically recommended for patients already dependent on opioids (Hallvik et al 2018, Jena et al 2014, the overall impact of exposing a patient to variation in providers in the initial stages of opioid use is not immediately clear.…”

Patient Heal Thyself: Reducing Hospital Readmissions with Technology‐Enabled Continuity of Care and Patient Activation

“…The nascent stream of continuity of care research supports a positive relationship between continuity of care and health outcomes, including fewer hospital admissions (Cheng et al. , Senot , Van Servellen et al. , Van Walraven et al.…”

“…To be clear, Figure 1 Error Correction Framework Queenan, Cameron, Snell, Smalley, and Joglekar: Patient Heal Thyself Production and Operations Management 28(11), pp. 2841-2853, © 2019 patients without TECC are encouraged to see their primary care physician (standard care after discharge from the hospital), but do not have daily interaction with the health care provision system. Thus, patients without TECC have fewer opportunities for the health care provision system to learn from the patients regarding how to better support them, thus leading to lower PAM levels.…”

“…In addition to a positive relationship with PAM, theory suggests that TECC is negatively associated with patient readmissions. The nascent stream of continuity of care research supports a positive relationship between continuity of care and health outcomes, including fewer hospital admissions (Cheng et al 2010, Senot 2019, Van Servellen et al 2006, Van Walraven et al 2010. Similarly, when continuity of care is delivered virtually, it continues to provide similar benefits to face to face delivery.…”