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- Title
Primary Care Visit Cadence and Hospital Admissions in High-Risk Patients.
- Authors
Matsil, Adam; Shenfeld, Daniel; Fields, Clive; Yao, Aaron; Clair, Jen
- Abstract
OBJECTIVE: To determine whether high-cadence primary care visits are associated with reduced hospitalizations in high-risk patients with congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD). STUDY DESIGN: Retrospective cohort study using Medicare Advantage claims. METHODS: High-risk patients from 14 primary care clinics were encouraged to receive quarterly visits through a quality improvement program. Cadence was determined by the number of quarterly visits in a 12-month period. We compared the hospitalizations in 1342 high- and lowcadence patients during the base year and following year adjusting for patient characteristics and health risks. RESULTS: Patients with CHF and/or COPD had a mean Hierarchical Condition Category (HCC) score of 1.98 during the baseline year. High-cadence patients at the baseline year (n = 881) had comparable admissions per thousand (ADK) in both years (first year: 199; 95% CI, 174-227; second year: 196; 95% CI, 171-223; P = .88), and low-cadence patients (n = 461) had elevated ADK in the second year (first year: 62; 95% CI, 44-88; second year: 117; 95% CI, 90-149; P < .05). ADK also increased across all HCC quartiles among the low-cadence patients. In contrast, year-over-year ADK declined or was flat among the high-cadence population for the bottom 3 HCC quartiles. Adjusted regression analyses confirmed the suggestive evidence of reduced ADK in baseline high-cadence patients (coefficient, -0.63; 95% CI, -1.22 to -0.05; P = .033). CONCLUSIONS: High cadence of primary care visits was associated with a significant reduction in hospitalizations among high-risk patients. The impact of visit cadence on patient outcomes may need to be tested in randomized interventions.
- Subjects
TEXAS; RISK assessment; MEDICAL care use; HEALTH services accessibility; CRITICALLY ill; PATIENTS; SECONDARY analysis; T-test (Statistics); PRIMARY health care; LOGISTIC regression analysis; OUTPATIENT medical care; PATIENT readmissions; HEART failure; RETROSPECTIVE studies; DESCRIPTIVE statistics; LONGITUDINAL method; OBSTRUCTIVE lung diseases; ACCESS to primary care; HOSPITAL care of older people; COMPARATIVE studies; DATA analysis software; CLINICS; CONFIDENCE intervals; COVID-19 pandemic
- Publication
American Journal of Managed Care, 2024, Vol 30, Issue 6, p263
- ISSN
1088-0224
- Publication type
Article
- DOI
10.37765/ajmc.2024.89509