Matthew L Maciejewski1, Bradley G Hammill2, Laura Ding3, Lesley H Curtis2, Elizabeth A Bayliss4, Abby F Hoffman5, Virginia Wang6. 1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, USA; Department of Population Health Sciences, Duke University School of Medicine, USA; Division of General Internal Medicine, Duke University School of Medicine, USA; Duke Clinical Research Institute, Duke University Medical Center, USA. Electronic address: matthew.maciejewski@va.gov. 2. Division of General Internal Medicine, Duke University School of Medicine, USA; Duke Clinical Research Institute, Duke University Medical Center, USA. 3. Department of Biostatistics and Bioinformatics, Duke University, USA. 4. Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. 5. Department of Population Health Sciences, Duke University School of Medicine, USA. 6. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, USA; Department of Population Health Sciences, Duke University School of Medicine, USA; Division of General Internal Medicine, Duke University School of Medicine, USA; Duke Clinical Research Institute, Duke University Medical Center, USA.
Abstract
BACKGROUND: Older adults with cardiometabolic conditions are typically seen by multiple providers. Management by multiple providers may compromise care continuity and increase health expenditures for older adults, which may partly explain the inverse association between continuity and Medicare expenditures found in prior studies. This study sought to examine whether all-cause admission, outpatient expenditures or total expenditures were associated with the number of prescribers of cardiometabolic medications. METHODS: Medicare fee-for-service beneficiaries with diabetes (n = 100,191), hypertension (n = 299,949) or dyslipidemia (n = 243,598) living in 10 states were identified from claims data. The probability of an all-cause hospital admission in 2011 was estimated via logistic regression and Medicare (outpatient, total) expenditures in 2011 were estimated using generalized linear models, both as a function of the number of prescribers in 2010. Regressions were adjusted for demographic characteristics, Medicaid status, number of prescriptions, and 17 chronic conditions. RESULTS: In all three cohorts, older adults with more prescribers in 2010 had modestly higher adjusted odds of all-cause inpatient admission than older adults with a single prescriber. Compared to a single prescriber, outpatient and total expenditures in 2011 were 3-10% higher for older adults with diabetes and multiple prescribers, 2-6% higher for older adults with hypertension and multiple prescribers, and 2-5% higher for older adults with dyslipidemia and multiple prescribers. CONCLUSIONS AND IMPLICATIONS: These results provide some evidence that older adults with multiple prescribers also have modestly higher Medicare utilization than those with a single prescriber; thus care continuity may impact patient utilization. LEVEL OF EVIDENCE: Level III (retrospective cohort analysis).
BACKGROUND: Older adults with cardiometabolic conditions are typically seen by multiple providers. Management by multiple providers may compromise care continuity and increase health expenditures for older adults, which may partly explain the inverse association between continuity and Medicare expenditures found in prior studies. This study sought to examine whether all-cause admission, outpatient expenditures or total expenditures were associated with the number of prescribers of cardiometabolic medications. METHODS: Medicare fee-for-service beneficiaries with diabetes (n = 100,191), hypertension (n = 299,949) or dyslipidemia (n = 243,598) living in 10 states were identified from claims data. The probability of an all-cause hospital admission in 2011 was estimated via logistic regression and Medicare (outpatient, total) expenditures in 2011 were estimated using generalized linear models, both as a function of the number of prescribers in 2010. Regressions were adjusted for demographic characteristics, Medicaid status, number of prescriptions, and 17 chronic conditions. RESULTS: In all three cohorts, older adults with more prescribers in 2010 had modestly higher adjusted odds of all-cause inpatient admission than older adults with a single prescriber. Compared to a single prescriber, outpatient and total expenditures in 2011 were 3-10% higher for older adults with diabetes and multiple prescribers, 2-6% higher for older adults with hypertension and multiple prescribers, and 2-5% higher for older adults with dyslipidemia and multiple prescribers. CONCLUSIONS AND IMPLICATIONS: These results provide some evidence that older adults with multiple prescribers also have modestly higher Medicare utilization than those with a single prescriber; thus care continuity may impact patient utilization. LEVEL OF EVIDENCE: Level III (retrospective cohort analysis).
Authors: Evan S Cole; Coleman Drake; Ellen DiDomenico; Michael Sharbaugh; Joo Yeon Kim; Dylan Nagy; Gerald Cochran; Adam J Gordon; Walid F Gellad; Janice Pringle; Jack Warwick; Chung-Chou H Chang; Julie Kmiec; David Kelley; Julie M Donohue Journal: Drug Alcohol Depend Date: 2021-02-16 Impact factor: 4.492