Primary Care Comprehensiveness and Care Coordination in Robust Specialist Networks Results in Lower Emergency Department Utilization: A Network Analysis of Medicaid Physician Networks

Abstract

Background: Care coordination is an essential and difficult to measure function of primary care. Objective: Our objective was to assess the impact of network characteristics in primary/specialty physician networks on emergency department (ED) visits for patients with chronic ambulatory care sensitive conditions (ACSCs). Subjects and Measures: This cross-sectional social network analysis of primary care and specialty physicians caring for adult Medicaid beneficiaries with ACSCs was conducted using 2009 Texas Medicaid Analytic eXtract (MAX) files. Network characteristic measures were the main exposure variables. A negative binomial regression model analyzed the impact of network characteristics on the ED visits per patient in the panel. Results: There were 42 493 ACSC patients assigned to 5687 primary care physicians (PCPs) connected to 11 660 specialist physicians. PCPs whose continuity patients did not visit a specialist had 86% fewer ED visits per patient in their panel, compared with PCPs whose patients saw specialists. Among PCPs connected to specialists in the network, those with a higher number of specialist collaborators and those with a high degree of centrality had lower patient panel ED rates. Conclusions: PCPs providing comprehensive care (ie, without specialist consultation) for their patients with chronic ACSCs had lower ED utilization rates than those coordinating care with specialists. PCPs with robust specialty networks and a high degree of centrality in the network also had lower ED utilization. The right fit between comprehensiveness of primary care, care coordination, and adequate capacity of specialty availability in physician networks is needed to drive outcomes.

Racial/Ethnic Disparities in Health Care Setting Choice for Adults Seeking Severe Acute Respiratory Syndrome Coronavirus 2 Testing

“…43,44 Independent of race/ethnicity and insurance, we found that patients who did not have a PCP had a higher relative risk of seeking testing at the ED, UC, and MTU sites compared with OP care, consistent with prior literature that having a PCP is associated with decreased ED utilization. 45,46 In the summer of 2020, Atrium Health was able to operationalize the benefit of having an established PCP to reach patients in community clinics and provided them information on how to use OP care for testing. 37 However, similar to published literature, in our study, a lower percentage of Black and Hispanic patients had a PCP compared with White patients.…”

Atenção Especializada e transporte sanitário na perspectiva de integração às Redes de Atenção à Saúde

“…Diante de um sistema fragmentado, a população acaba por se "acomodar" ao atendimento de especialistas focais 15 . Estudos ratificam que provedores de APS que atuam em redes nas quais exercem baixo grau de centralidade, mesmo com disponibilidade de especialistas, não diminuem a utilização de serviços de emergência de seus pacientes com agravos crônicos, ao contrário daqueles que exercem alto grau de coordenação e cuidados abrangentes 2 .…”

“…As barreiras aos cuidados especializados são generalizadas e multifatoriais, com consequências no acesso oportuno, resultados e equidade em saúde, em contextos urbano e rural 1,2 . O "valor" dos sistemas de saúde envolve, entre outros aspectos, melhoria da qualidade, redução das hospitalizações, exames e procedimentos desnecessários a partir do reposicionamento da atenção especializada (AE), na interface com os serviços de Atenção Primária à Saúde (APS) 3 .…”

Specialized care and health transport from a Health Care Network integration perspective

“…In a fragmented system, the population "grows accustomed" to treatment by specialists 15 . Studies show that PHC providers in networks who have a low degree of centrality, even with the availability of specialists, do not reduce the utilization of emergency services by their patients with chronic conditions, in contrast to those who had a high degree of care coordination and a robust specialist network available 2 .…”

“…Barriers to specialized care (SC) are general and multifactorial, with consequences for timely care, outcomes, and health equity in both urban and rural settings 1,2 . Increasing the "value" of health systems entails, among other things, improving quality and reducing unnecessary hospitalizations, tests, and procedures by repositioning SC and creating an interface between SC and primary health care (PHC) services 3 .…”