Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries
Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries
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DOI：
10.37765/ajmc.2022.88843
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发表时间：
2022-03-01
影响因子：
3.2
通讯作者：
Rich, Eugene
中科院分区：
文献类型：
--
作者：
Timmins, Lori;Urato, Carol;Rich, Eugene
目的：确定大规模初级保健重新设计-综合初级保健+（CPC+）计划-与CPC+前3年期间医疗保险收费服务受益人的门诊护理连续性或分散性程度之间的关联。研究设计：我们使用了一个差异中的差异框架，比较组的做法是类似于CPC+的做法在基线（如，实践规模，人口统计，医疗保险支出）。回归控制聚类，基线患者特征和实践固定效应。我们的研究涵盖了2016年1月至2019年12月，包括1，085，707名受益人归因于2883个CPC+实践和2，274，068名受益人归因于6912个比较实践。方法：我们专注于基线时高度分散的护理受益人，因为他们可能对CPC+做出了最大的改变。关键的结果指标是门诊就诊次数和独特的医生，按专业类别报告;与通常的护理提供者的访问百分比（测量连续性）;和反向Bice-Boxerman指数（rBBI;测量碎片）。研究结果：基线时高度碎片化（rBBI >= 0.85）的医疗保险受益人（样本的40%）平均有13次门诊访视，7名医生;最频繁的护理提供者仅占28%的访视。相比之下，其余受益人平均有10次访问4个从业人员，最频繁的提供者占访问的54%。CPC+与对照受益人相比，在护理的连续性或分散性方面没有差异。结论：我们没有发现CPC+增加连续性或减少护理碎片的证据。
OBJECTIVES: To determine associations between a largescale primary care redesign-the Comprehensive Primary Care Plus (CPC+) Initiative-and the extent of continuity or fragmentation of ambulatory care for Medicare fee-for service beneficiaries during the first 3 years of CPC+. STUDY DESIGN: We used a difference-in-differences framework with a comparison group of practices that were similar to CPC+ practices at baseline (eg, practice size, demographics, Medicare spending). Regressions controlled for clustering, baseline patient characteristics, and practice fixed effects. Our study covered January 2016 through December 2019 and included 1,085,707 beneficiaries attributed to 2883 CPC+ practices and 2,274,068 beneficiaries attributed to 6912 comparison practices. METHODS: We focused on beneficiaries with highly fragmented care at baseline because they may have changed the most in response to CPC+. Key outcome measures were the numbers of ambulatory visits and unique practitioners, reported by specialty category; the percentage of visits with the usual provider of care (measuring continuity); and the reversed Bice-Boxerman Index (rBBI; measuring fragmentation). RESULTS: Medicare beneficiaries with high fragmentation (rBBI >= 0.85) at baseline (40% of the sample) had a mean of 13 ambulatory visits across 7 practitioners; the most frequent provider of care accounted for only 28% of visits. By contrast, the remaining beneficiaries had a mean of 10 visits across 4 practitioners, with the most frequent provider accounting for 54% of visits. There were no differences in continuity or fragmentation of care for CPC+ vs comparison beneficiaries. CONCLUSIONS: We find no evidence that CPC+ increased continuity or decreased fragmentation of care.