Patient social risk factors and continuity of care for Medicare beneficiaries

Johnston, Kenton J.; Mittler, Jessica; Hockenberry, Jason M.

doi:10.1111/1475-6773.13272

Cited by 8 publications

(7 citation statements)

References 51 publications

(184 reference statements)

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“…Racial and ethnic minority beneficiaries experience lower rates of access and quality and worse outcomes in both programs . Racial and ethnic minority beneficiaries are less likely to receive annual wellness visits, preventive care, and specialty care and appear to be segregated within a smaller set of low-quality clinicians . They experience higher rates of hospitalization and mortality, as well as higher costs of care …”

Section: Introductionmentioning

confidence: 99%

Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures

Johnston

Hammond

Meyers

et al. 2021

JAMA

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IMPORTANCEThere are racial inequities in health care access and quality in the United States. It is unknown whether such differences for racial and ethnic minority beneficiaries differ between Medicare Advantage and traditional Medicare or whether access and quality are better for minority beneficiaries in 1 of the 2 programs. OBJECTIVE To compare differences in rates of enrollment, ambulatory care access, and ambulatory care quality by race and ethnicity in Medicare Advantage vs traditional Medicare. DESIGN, SETTING, AND PARTICIPANTS Exploratory observational cohort study of a nationally representative sample of 45 833 person-years (26 887 persons) in the Medicare Current Beneficiary Survey from 2015 to 2018, comparing differences in program enrollment and measures of access and quality by race and ethnicity. EXPOSURES Minority race and ethnicity (Black, Hispanic, Native American, or Asian/Pacific Islander) vs White or multiracial; Medicare Advantage vs traditional Medicare enrollment. MAIN OUTCOMES AND MEASURESSix patient-reported measures of ambulatory care access (whether a beneficiary had a usual source of care in the past year, had a primary care clinician usual source of care, or had a specialist visit) and quality (influenza vaccination, pneumonia vaccination, and colon cancer screening). RESULTSThe final sample included 6023 persons (mean age, 68.9 [SD, 12.6] years; 57.3% women) from minority groups and 20 864 persons (mean age, 71.9 [SD, 10.8] years; 54.9% women) from White or multiracial groups, who accounted for 9816 and 36 017 person-years, respectively. Comparing Medicare Advantage vs traditional Medicare among minority beneficiaries, those in Medicare Advantage had significantly better rates of access to a primary care clinician usual source of care (79.1% vs 72.5%; adjusted marginal difference, 4.0%; 95% CI, 1.0%-6.9%), influenza vaccinations (67.3% vs 63.0%; adjusted marginal difference, 5.2%; 95% CI, 1.9%-8.5%), pneumonia vaccinations (70.7% vs 64.6%; adjusted marginal difference, 6.1%; 95% CI, 2.7%-9.4%), and colon cancer screenings (69.4% vs 61.1%; adjusted marginal difference, 7.1%; 95% CI, 3.8%-10.3%). Comparing minority vs White or multiracial beneficiaries across both programs, minority beneficiaries had significantly lower rates of access to a primary care clinician usual source of care (adjusted marginal difference, 4.7%; 95% CI, 2.5%-6.8%), specialist visits (adjusted marginal difference, 10.8%; 95% CI, 8.3%-13.3%), influenza vaccinations (adjusted marginal difference, 4.3%; 95% CI, 1.2%-7.4%), and pneumonia vaccinations (adjusted marginal difference, 6.4%; 95% CI, 3.9%-9.0%). The interaction of race and ethnicity with insurance type was not statistically significant for any of the 6 outcome measures. CONCLUSIONS AND RELEVANCEIn this exploratory study of Medicare beneficiaries in 2015-2018, enrollment in Medicare Advantage vs traditional Medicare was significantly associated with better outcomes for access and quality among minority beneficiaries; however, minority beneficiaries were si...

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Section: Introductionmentioning

confidence: 99%

Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures

Johnston

Hammond

Meyers

et al. 2021

JAMA

Self Cite

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“…For example, adults aged 18+ in New York and children with complex medical needs have average Bice–Boxerman continuity of care indices around 0.3 (Arthur et al, 2018; Kern et al, 2018). Medicare beneficiaries of any age have an average continuity of care index around 0.4 (Johnston et al, 2020) and older adult Medicare beneficiaries have continuity of care indices ranging from 0.3 to 0.4 depending on the study sample (Johnston & Hockenberry, 2016; Romano et al, 2015). Autistic adults in our sample, however, had continuity of care indices ranging from 0.5 for Medicare beneficiaries to 0.6 for CAST patients and privately insured autistic adults.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for the higher continuity of care indices observed in our sample relative to prior studies is unclear but may be due to differing choices made in study design. For example, our study required at least four visits for continuity of care index calculations, while others have required only three or more visits (Johnston et al, 2020). In addition, our study controlled for age at first observed visit, sex, intellectual disability, number of outpatient visits, and duration (weeks) of observation while other studies controlled for different variables like social risk, medical complexity, and education in calculating adjusted Bice–Boxerman continuity of care indices (Johnston et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Specialized primary care medical home: A positive impact on continuity of care among autistic adults

Hand

Coury

White

et al. 2020

Autism

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While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice–Boxerman continuity of care index was 0.6 (interquartile range = 0.4–1.0) for CAST patients, 0.5 (interquartile range = 0.3–1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4–1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p < 0.0001). Continuity of care among CAST patients did not significantly differ from that of the national sample of privately insured autistic adults (p = 0.08). Our findings suggest that medical homes, like CAST, may be a promising solution to improve healthcare delivery for the growing population of autistic adults. Lay abstract There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the “medical home”. The medical home is not a residential home, but a system where a patient’s healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.

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“…Clinical nurses checked the messages or e-mails of the health platform at least 3 times a week, so as to inform patients about the importance of timing and quantitative drug use and notify the attending doctors to change the drugs or adjust the dosage. (4) With the outpatient follow-up assistant, patients' drug plans were optimized and adjusted according to the latest rehabilitation treatment of stroke [ 9 ], and a message would be sent to patients automatically 2 weeks after discharge to remind them to go to the stroke-specific clinic, with the specific process and address attached.…”

Section: Methodsmentioning

confidence: 99%

Effect of Continuous Care Combined with Constraint-Induced Movement Therapy Based on a Continuing Care Health Platform on MBI and FMA Scores of Acute Stroke Patients

Pan

Zang

Wang

et al. 2022

Journal of Healthcare Engineering

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Background and Objective. The study was carried out under the background that out-of-hospital rehabilitation of acute stroke patients is of great importance for the recovery of nerve and limb functions. We aimed to investigate the effects of continuous nursing combined with CIMT by a health platform on the limb motor function and quality of life in acute stroke patients. Methods. 68 acute stroke patients admitted to our hospital from July 2018 to July 2019 were selected as the study participants and divided into group A and group B based on the odd and even numbers of their admission numbers, with 34 cases in each group. Patients in group B accepted the routine rehabilitation exercise, while patients in group A accepted the continuous care combined with constraint-induced movement therapy (CIMT) under a health platform, so as to compare their upper limb function recovery by the Fugl–Meyer assessment (FMA) and improved median Barthel index (MBI). Results. The general information of the two groups were not obviously different ( P > 0.05) but comparable; after intervention, the FMA scores (38.42 ± 7.62 vs 31.22 ± 7.25) and MBI scores (78.63 ± 6.52 vs 70.24 ± 6.48) of patients in group A were significantly higher than those of group B ( P < 0.001); the activities of daily living (ADL) and trunk control test (TCT) scores at T1, T2, and T3 of group A were significantly higher than those of group B ( P < 0.05); at 6 months after discharge, the self-concept, self-care skills, self-care, self-responsibility, health knowledge level, and total ability scores of patients in group A were significantly higher than those in group B ( P < 0.05); the Generic Quality of Life Inventory-74 (GQOL-74) scores after intervention of the two groups were significantly higher than those before intervention ( P < 0.05) and those of group A were significantly higher than those of group B (72.13 ± 4.69 vs 63.19 ± 4.72; P < 0.05); when comparing with group B, group A presented significantly higher walking speed and gait period and lower support phase ( P < 0.05). Conclusion. The combination of continuous care and CIMT under a health platform can effectively promote the rehabilitation of upper limb functions and improve the activities of daily living and trunk control for acute stroke patients, with an effect better than conventional rehabilitation exercises, which is worthy of promotion.

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Patient social risk factors and continuity of care for Medicare beneficiaries

Cited by 8 publications

References 51 publications

Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures

Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures

Specialized primary care medical home: A positive impact on continuity of care among autistic adults

Effect of Continuous Care Combined with Constraint-Induced Movement Therapy Based on a Continuing Care Health Platform on MBI and FMA Scores of Acute Stroke Patients

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