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. 2014 Apr;29(4):594-601.
doi: 10.1007/s11606-013-2746-0. Epub 2014 Jan 10.

The intersection of patient complexity, prescriber continuity and acute care utilization

Matthew L Maciejewski  1 , Benjamin J Powers, Linda L Sanders, Joel F Farley, Richard A Hansen, Betsy Sleath, Corrine I Voils
Affiliations

The intersection of patient complexity, prescriber continuity and acute care utilization

Matthew L Maciejewski et al. J Gen Intern Med. 2014 Apr.

Abstract

Background: Care continuity is considered a critical characteristic of high-performing health systems. Few studies have examined the continuity of medication management of complex patients, who often have multiple providers and complex medication regimens.

Purpose: The purpose of this study was to characterize patient factors associated with having more prescribers and the association between number of prescribers and acute care utilization.

Design and subjects: A retrospective cohort study was conducted of 7,933 Veterans with one to four cardiometabolic conditions (diabetes, hypertension, hyperlipidemia or congestive heart failure) and prescribed medications for these conditions in 2008.

Main measures: The association between number of cardiometabolic conditions and prescribers was modeled using Poisson regression. The number of cardiometabolic conditions and number of prescribers were modeled to predict probability of inpatient admission, probability of emergency room (ER) visits, and number of ER visits among ER users. Demographic characteristics, number of cardiometabolic medications and comorbidities were included as covariates in all models.

Key results: Patients had more prescribers if they had more cardiometabolic conditions (p < 0.001). The adjusted odds of an ER visit increased with the number of prescribers (two prescribers, Odds Ratio (OR) = 1.16; three prescribers, OR = 1.21; 4+ prescribers, OR = 1.39), but not with the number of conditions. Among ER users, the number of ER visits was neither associated with the number of prescribers nor the number of conditions. The adjusted odds of an inpatient admission increased with the number of prescribers (two prescribers, OR = 1.27; three prescribers, OR = 1.30; 4+ prescribers, OR = 1.34), but not with the number of conditions.

Conclusions: Having more prescribers was associated with greater healthcare utilization for complex patients, despite adjustment for the number of conditions and medications. The number of prescribers may be an appropriate target for reducing acute care utilization by complex patients.

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Figures

Figure 1
Figure 1
Sample flow diagram for Durham VA patients.
Figure 2
Figure 2
Unadjusted proportion of patients with emergency room visits and inpatient admissions in 2008, stratified by number of conditions and number of unique prescribers.
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References

    1. Wong ND, Lopez V, Tang S, Williams GR. Prevalence, treatment, and control of combined hypertension and hypercholesterolemia in the United States. Am J Cardiol. 2006;98(2):204–208. doi: 10.1016/j.amjcard.2006.01.079. - DOI - PubMed
    1. Kerr EA, Heisler M, Krein SL, et al. Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients’ treatment priorities and self-management? J Gen Intern Med. 2007;22(12):1635–1640. doi: 10.1007/s11606-007-0313-2. - DOI - PMC - PubMed
    1. Bayliss EA, Ellis JL, Steiner JF. Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities. Ann Fam Med. 2007;5(5):395–402. doi: 10.1370/afm.722. - DOI - PMC - PubMed
    1. Starfield B, Lemke KW, Herbert R, Pavlovich WD, Anderson G. Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med. 2005;3(3):215–222. doi: 10.1370/afm.307. - DOI - PMC - PubMed
    1. Anderson G. Chronic conditions: making the case for ongoing care. 2010; http://www.rwjf.org/content/dam/farm/reports/reports/2010/rwjf54583. Accessed December 10, 2013.

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