Shirley Cohen-Mekelburg1, Akbar K Waljee2, Brooke C Kenney3, Elliot B Tapper4. 1. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan; Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: shcohen@umich.edu. 2. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan; Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, Michigan. 3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. 4. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan; Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND & AIMS: Improving care coordination for patients with high-intensity specialty care needs, such as cirrhosis, can increase quality of healthcare and reduce utilization. We examined the relationship between care concentration and risk of hospitalization for patients with cirrhosis. METHODS: We performed a retrospective cohort study of 26,006 Medicare enrollees with cirrhosis with more than 4 outpatient visits over 180 days. We collected data on 2 validated measures of care concentration: the usual provider of care (UPC) index, a measure of the proportion of a patient's total visits that is with their most regularly seen provider, and the continuity of care (COC) index, a measure of care density and dispersion. Both use a scale of 0 to 1. Time to death or liver transplantation was evaluated using a multivariable Cox proportional hazards model. Hospital days and 30-day readmissions per person-year were evaluated in negative binomial models. RESULTS: The median COC score was 0.40 (interquartile range, 0.26-0.60) and the median UPC was 0.60 (interquartile range, 0.50-0.80). Increasing care concentration (based on COC and UPC index scores) were associated with increased mortality and hospitalization. The highest 25th percentile of COC and UPC scores were associated with adjusted hazard ratios for mortality of 1.20 (95% CI, 1.10-1.31) and 1.14 (95% CI, 1.06-1.24), adjusted incidence rate ratios for hospital days of 1.12 (95% CI, 1.02-1.23) and 1.10 (95% CI, 1.01-1.20), and adjusted incidence rate ratios for readmissions of 1.19 (95% CI, 1.06-1.34) and 1.12 (95% CI, 1.00-1.25), respectively. CONCLUSIONS: Based on a study of Medicare enrollees, care concentration is low among patients with cirrhosis. However, increased concentration is associated with increased mortality and increased healthcare utilization. These data indicate that, to optimize outcomes for persons with cirrhosis, team-based care might be necessary.
BACKGROUND & AIMS: Improving care coordination for patients with high-intensity specialty care needs, such as cirrhosis, can increase quality of healthcare and reduce utilization. We examined the relationship between care concentration and risk of hospitalization for patients with cirrhosis. METHODS: We performed a retrospective cohort study of 26,006 Medicare enrollees with cirrhosis with more than 4 outpatient visits over 180 days. We collected data on 2 validated measures of care concentration: the usual provider of care (UPC) index, a measure of the proportion of a patient's total visits that is with their most regularly seen provider, and the continuity of care (COC) index, a measure of care density and dispersion. Both use a scale of 0 to 1. Time to death or liver transplantation was evaluated using a multivariable Cox proportional hazards model. Hospital days and 30-day readmissions per person-year were evaluated in negative binomial models. RESULTS: The median COC score was 0.40 (interquartile range, 0.26-0.60) and the median UPC was 0.60 (interquartile range, 0.50-0.80). Increasing care concentration (based on COC and UPC index scores) were associated with increased mortality and hospitalization. The highest 25th percentile of COC and UPC scores were associated with adjusted hazard ratios for mortality of 1.20 (95% CI, 1.10-1.31) and 1.14 (95% CI, 1.06-1.24), adjusted incidence rate ratios for hospital days of 1.12 (95% CI, 1.02-1.23) and 1.10 (95% CI, 1.01-1.20), and adjusted incidence rate ratios for readmissions of 1.19 (95% CI, 1.06-1.34) and 1.12 (95% CI, 1.00-1.25), respectively. CONCLUSIONS: Based on a study of Medicare enrollees, care concentration is low among patients with cirrhosis. However, increased concentration is associated with increased mortality and increased healthcare utilization. These data indicate that, to optimize outcomes for persons with cirrhosis, team-based care might be necessary.
Authors: Peter S Hussey; Eric C Schneider; Robert S Rudin; D Steven Fox; Julie Lai; Craig Evan Pollack Journal: JAMA Intern Med Date: 2014-05 Impact factor: 21.873
Authors: Caitlin A Hester; Nishika Karbhari; Nicole E Rich; Mathew Augustine; John C Mansour; Patricio M Polanco; Matthew R Porembka; Sam C Wang; Herbert J Zeh; Amit G Singal; Adam C Yopp Journal: Cancer Date: 2019-07-12 Impact factor: 6.860
Authors: David T Liss; Jessica Chubak; Melissa L Anderson; Kathleen W Saunders; Leah Tuzzio; Robert J Reid Journal: Ann Fam Med Date: 2011 Jul-Aug Impact factor: 5.166
Authors: Lauren A Beste; Steven L Leipertz; Pamela K Green; Jason A Dominitz; David Ross; George N Ioannou Journal: Gastroenterology Date: 2015-08-05 Impact factor: 22.682
Authors: Jessica L Mellinger; Stephanie Moser; Deborah E Welsh; Matheos T Yosef; Tony Van; Heather McCurdy; Mina O Rakoski; Richard H Moseley; Lisa Glass; Akbar K Waljee; Michael L Volk; Anne Sales; Grace L Su Journal: Am J Gastroenterol Date: 2016-03-29 Impact factor: 10.864
Authors: Ashwani K Singal; Andrea DiMartini; Lorenzo Leggio; Juan P Arab; Yong-Fang Kuo; Vijay H Shah Journal: Alcohol Alcohol Date: 2022-09-10 Impact factor: 3.913
Authors: Nneka N Ufere; Jan Hinson; Simon Finnigan; Elizabeth E Powell; John Donlan; Cathy Martin; Phil Clark; Patricia C Valery Journal: Curr Treat Options Gastroenterol Date: 2022-04-19