Relationship Between Continuity of Ambulatory Care and Risk of Emergency Department Episodes Among Older Adults

• Published in: Annals of emergency medicine 2017-04, Vol.69 (4), p.407-415.e3
• Main Authors: Nyweide, David J., PhD, Bynum, Julie P.W., MD, MPH
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Ambulatory Care - statistics & numerical data; Continuity of Patient Care - statistics & numerical data; Emergency; Emergency Service, Hospital - utilization; Female; Hospitalization - statistics & numerical data; Humans; Male; Medicare - statistics & numerical data; Sex Factors; United States
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2016.06.027

Study objective We determine whether visit patterns indicative of higher continuity are related to a lower risk of presenting at the emergency department (ED) among older adults. Methods This study was a survival analysis between 2011 and 2013 of a 20% random sample of fee-for-service Medicare beneficiaries aged 66 years or older. Ambulatory visit patterns were measured starting in 2011 for up to 24 months using 2 continuity metrics measured on a 0 to 1 scale—Continuity of Care (COC) score and the Usual Provider Continuity (UPC) score. The composite outcome of an ED episode was defined as occurrence of an ED visit with discharge home, an observation stay, or hospital admission. Time-dependent Cox proportional hazards regression models controlled for patient demographic characteristics, comorbidities, previous use, and regional factors, with censoring for death or occurrence of the composite outcome. In a secondary analysis, continuity was measured in the 12 months preceding an ED episode to test whether it was associated with type of ED episode. Results The relative rate of ED episodes decreased approximately 1% for every 0.1-point increase in the COC score (adjusted hazard ratio 0.99; 95% confidence interval 0.99 to 0.99; P