Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?

David A Katz; Kim D McCoy; Mary S Vaughan-Sarrazin

doi:10.1111/jgs.13841

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Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?

Journal article

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Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?

David A Katz, Kim D McCoy and Mary S Vaughan-Sarrazin

Journal of the American Geriatrics Society (JAGS), Vol.63(12), pp.2510-2518

12/2015

DOI: 10.1111/jgs.13841

PMCID: PMC5245105

PMID: 26659695

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Abstract

Objectives To evaluate the association between longitudinal continuity of primary care and use of emergency department (ED) and inpatient care in older veterans. Design Retrospective cohort study. Setting Department of Veterans Affairs (VA) primary care clinics in 15 regional health networks, ED and inpatient facilities. Participants Medicare-eligible veterans aged 65 and older with three or more VA primary care visits during fiscal year 2007–08 (baseline period) (N = 243,881). Measurements Two measures of longitudinal continuity were estimated using merged VA–Centers for Medicare and Medicaid Services administrative data: Usual Provider of Continuity (UPC) and Modified Modified Continuity Index (MMCI). Negative binomial and multivariable logistic regression models were used to predict ED use and inpatient hospitalization during fiscal year 2009, controlling for sociodemographic characteristics, medical and psychiatric comorbidity, and baseline use of health services. Results The incidence rate ratio (IRR) of ED visits was greater in patients with high (IRR = 1.05, 95% confidence interval (CI) = 1.02–1.07), intermediate (IRR = 1.04, 95% CI = 1.02–1.07), and low (IRR = 1.06, 95% CI = 1.03–1.09) UPC than in those with very high UPC (0.9–1.0). Patients with high (odds ratio (OR) = 1.04, 95% CI = 1.01–1.07), intermediate (OR = 1.03, 95% CI = 1.00–1.06), and low (OR = 1.04, 95% CI = 1.01–1.07) UPC were also more likely to be hospitalized during follow-up. Results were similar for MMCI continuity scores. Conclusion Even slightly lower primary care provider (PCP) continuity was associated with modestly greater ED use and inpatient hospitalization in older veterans. Additional efforts should be made to schedule older adults with their assigned PCP whenever possible.

emergency medical services

primary care

hospitalization

continuity of care

elderly

Details

Title: Subtitle: Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?
Creators: David A Katz - Veterans Integrated Service Network 23 Patient Aligned Care Team Demonstration Laboratory, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Kim D McCoy - Veterans Integrated Service Network 23 Patient Aligned Care Team Demonstration Laboratory, Iowa City Veterans Affairs Medical Center, Iowa, Iowa City
Mary S Vaughan-Sarrazin - Veterans Integrated Service Network 23 Patient Aligned Care Team Demonstration Laboratory, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Resource Type: Journal article
Publication Details: Journal of the American Geriatrics Society (JAGS), Vol.63(12), pp.2510-2518
DOI: 10.1111/jgs.13841
PMID: 26659695
PMCID: PMC5245105
NLM abbreviation: J Am Geriatr Soc
ISSN: 0002-8614
eISSN: 1532-5415
Publisher: Blackwell Publishing Ltd
Number of pages: 9
Language: English
Date published: 12/2015
Academic Unit: Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094386602771

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