The Association Between Continuity of Care and the Overuse of Medical Procedures

Romano, Max J.; Segal, Jodi B; Pollack, Craig Evan

doi:10.1001/jamainternmed.2015.1340

Cited by 120 publications

(130 citation statements)

References 28 publications

(30 reference statements)

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“…51 Decreased clinician continuity is also associated with an overall increase in overuse of unnecessary tests. 50,52,53 Regardless of patient-clinician concordance, Chinese and South Asian participants, most of whom were immigrants, reported much lower quality of care, which is similar to a previous study conducted only in British Columbia. 54 Although health care inequities are documented for these groups in the US 24,25 and UK, 55 more work is needed to examine why these groups report lower quality of care despite having concordant consultations.…”

Section: Open Researchsupporting

confidence: 79%

The influence of patient–clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis

Waibel

Wong

Katz

et al. 2018

cmajo

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Section: Open Researchsupporting

confidence: 79%

The influence of patient–clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis

Waibel

Wong

Katz

et al. 2018

cmajo

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“…Another study considered the relationship between fragmentation and rates of use for 19 "potentially overused" procedures among Medicare beneficiaries. 20 Greater fragmentation was associated with more testing for five of eight radiology tests considered. 20 That study adjusted for the number of chronic diseases rather than stratify by number of chronic diseases.…”

Section: Discussionmentioning

confidence: 96%

Healthcare Fragmentation and the Frequency of Radiology and Other Diagnostic Tests: A Cross-Sectional Study

et al. 2016

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BACKGROUND:Fragmented ambulatory care has been associated with high rates of emergency department visits and hospitalizations, but effects on other types of utilization are unclear. OBJECTIVE: To determine whether more fragmented care is associated with more radiology and other diagnostic tests, compared to less fragmented care. DESIGN: We conducted a cross-sectional study using claims from five commercial payers for 2010. The study took place in the Hudson Valley, a seven-county region in New York State. PARTICIPANTS: We included adult patients who were insured through the participating payers and were attributed to a primary care physician in the region. We restricted the cohort to those with ≥4 ambulatory visits, as measures of fragmentation are not reliable if based on ≤3 visits (N = 126,801). MAIN MEASURES: For each patient, we calculated fragmentation using a reversed Bice-Boxerman Index, which we divided into seven categories. We used negative binomial regression to determine the association between fragmentation category and rates of radiology and other diagnostic tests, stratified by number of chronic conditions and adjusting for patient age, gender, and number of visits. KEY RESULTS: Patients with the most fragmented care had approximately twice as many radiology and other diagnostic tests as patients with the least fragmented care, across all groups stratified by number of chronic conditions (each adjusted p < 0.0001). For example, among patients with ≥5 chronic conditions, those with the least fragmented care had 258 tests per 100 patients, and those with the most fragmented care had 542 tests per 100 patients (+284 tests per 100 patients, or +110 %, adjusted p < 0.0001). CONCLUSION: More fragmented care was independently associated with higher rates of radiology and other diagnostic tests than less fragmented care.

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“…The formula, (∑n i – N) / N(N-1), where n i = number of visits that the patient has with the i th physician and N = total visits, has been used previously. 22, 32, 34 Each National Provider Identifier in outpatient claims was considered a unique medical provider. The COC index is less meaningful with few visits as it is easy to attain a minimum score of 0 or maximum score of 1 so we restricted analyses to patients with ≥ 4 visits, 34–36 which represented approximately 85% of all older beneficiaries with a dementia diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…16–18 Recent healthcare reforms promote continuity of care through accountable care organizations and Patient Centered Medical Homes, models of care which emphasize care coordination. 22, 28, 29 The anticipated effects of such reforms on improving care in dementia are not fully understood. The objective of our study was to examine and understand the association of continuity of care with healthcare utilization and spending in the vulnerable population of community-dwelling older adults with dementia.…”

Section: Introductionmentioning

confidence: 99%

Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

et al. 2016

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The Association Between Continuity of Care and the Overuse of Medical Procedures

Cited by 120 publications

References 28 publications

The influence of patient–clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis

The influence of patient–clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis

Healthcare Fragmentation and the Frequency of Radiology and Other Diagnostic Tests: A Cross-Sectional Study

Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

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