The Impact of Change in Hospital Admissions When Primary Care Is Provided by a Single Primary Care Physician: A Cohort Study Among HMO Patients in Israel

Fogelman, Yacov; Merzon, Eugene; Vinker, Shlomo; Kitai, Eliezer; Blumberg, G.; Golan‐Cohen, Avivit

doi:10.1007/5584_2021_693

Cited by 2 publications

(1 citation statement)

References 18 publications

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“…The goal of these initiatives is to help improve quality of care for these conditions, in many cases aiming for benchmarks that are set by Israel’s national set of quality measures, the Quality Indicators in Community Healthcare (QICH) measure set [ 43 ]. These LHS care coordination initiatives are built into the LHS electronic medical record and are supported by frequent events for providers and other kinds of administrative support [ 26 , 27 ]. The LHS initiative to support care for diabetes mellitus is particularly strong and longstanding [ 25 , 44 ], and there are a large number of quality measures for patients with diabetes that may encourage more regular contact with the health system [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Patient-level predictors of temporal regularity of primary care visits

Rose

Ahmad

Spolter

et al. 2023

BMC Health Serv Res

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Background Patients with chronic diseases should meet with their primary care doctor regularly to facilitate proactive care. Little is known about what factors are associated with more regular follow-up. Methods We studied 70,095 patients age 40 + with one of three chronic conditions (diabetes mellitus, heart failure, chronic obstructive pulmonary disease), cared for by Leumit Health Services, an Israeli health maintenance organization. Patients were divided into the quintile with the least temporally regular care (i.e., the most irregular intervals between visits) vs. the other four quintiles. We examined patient-level predictors of being in the least-temporally-regular quintile. We calculated the risk-adjusted regularity of care at 239 LHS clinics with at least 30 patients. For each clinic, compared the number of patients with the least temporally regular care with the number predicted to be in this group based on patient characteristics. Results Compared to older patients, younger patients (age 40–49), were more likely to be in the least-temporally-regular group. For example, age 70–79 had an adjusted odds ratio (AOR) of 0.82 compared to age 40–49 (p < 0.001 for all findings discussed here). Males were more likely to be in the least-regular group (AOR 1.18). Patients with previous myocardial infarction (AOR 1.07), atrial fibrillation (AOR 1.08), and current smokers (AOR 1.12) were more likely to have an irregular pattern of care. In contrast, patients with diabetes (AOR 0.79) or osteoporosis (AOR 0.86) were less likely to have an irregular pattern of care. Clinic-level number of patients with irregular care, compared with the predicted number, ranged from 0.36 (fewer patients with temporally irregular care) to 1.71 (more patients). Conclusions Some patient characteristics are associated with more or less temporally regular patterns of primary care visits. Clinics vary widely on the number of patients with a temporally irregular pattern of care, after adjusting for patient characteristics. Health systems can use the patient-level model to identify patients at high risk for temporally irregular patterns of primary care. The next step is to examine which strategies are employed by clinics that achieve the most temporally regular care, since these strategies may be possible to emulate elsewhere.

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Section: Discussionmentioning

confidence: 99%

Patient-level predictors of temporal regularity of primary care visits

Rose

Ahmad

Spolter

et al. 2023

BMC Health Serv Res

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Greater temporal regularity of primary care visits was associated with reduced hospitalizations and mortality, even after controlling for continuity of care

Khazen

Ahmad

Spolter

et al. 2023

BMC Health Serv Res

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Background Previous studies have shown that more temporally regular primary care visits are associated with improved patient outcomes. Objective To examine the association of temporal regularity (TR) of primary care with hospitalizations and mortality in patients with chronic illnesses. Also, to identify threshold values for TR for predicting outcomes. Design Retrospective cohort study. Participants We used data from the electronic health record of a health maintenance organization in Israel to study primary care visits of 70,095 patients age 40 + with one of three chronic conditions (diabetes mellitus, heart failure, chronic obstructive pulmonary disease). Main measures We calculated TR for each patient during a two-year period (2016–2017), and divided patients into quintiles based on TR. Outcomes (hospitalization, death) were observed in 2018–2019. Covariates included the Bice-Boxerman continuity of care score, demographics, and comorbidities. We used multivariable logistic regression to examine TR’s association with hospitalization and death, controlling for covariates. Key results Compared to patients receiving the most regular care, patients receiving less regular care had increased odds of hospitalization and mortality, with a dose–response curve observed across quintiles (p for linear trend < 0.001). For example, patients with the least regular care had an adjusted odds ratio of 1.40 for all-cause mortality, compared to patients with the most regular care. Analyses stratified by age, sex, ethnic group, area-level SES, and certain comorbid conditions did not show strong differential associations of TR across groups. Conclusions We found an association between more temporally regular care in antecedent years and reduced hospitalization and mortality of patients with chronic illness in subsequent years, after controlling for covariates. There was no clear threshold value for temporal regularity; rather, more regular primary care appeared to be better across the entire range of the variable.

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The Impact of Change in Hospital Admissions When Primary Care Is Provided by a Single Primary Care Physician: A Cohort Study Among HMO Patients in Israel

Cited by 2 publications

References 18 publications

Patient-level predictors of temporal regularity of primary care visits

Patient-level predictors of temporal regularity of primary care visits

Greater temporal regularity of primary care visits was associated with reduced hospitalizations and mortality, even after controlling for continuity of care

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