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Whether Fragmented Care Is Hazardous Depends on How Many Chronic Conditions a Patient Has

person waiting in ER

The Issue

Many people, particularly those with chronic conditions, receive health services from a variety of providers, with no single provider responsible for coordinating all that care. This “fragmentation” of ambulatory care can lead to communication gaps and poorer outcomes for the patient. Fragmented care is also associated with higher rates of emergency department visits and hospital admissions, as well as greater costs.

To identify which patients are most affected by care fragmentation, researchers looked at the relationship between ambulatory care fragmentation and subsequent emergency department (ED) visits and hospital admissions for patients with chronic conditions. The researchers considered how many chronic conditions each patient had, out of 26 common chronic conditions, such as hypertension, diabetes, and depression, among others. The Commonwealth Fund-supported study, published in the American Journal of Managed Care (September 2018), included Medicare beneficiaries who received care from physicians in the Hudson Valley region of New York from 2010 to 2012.

Patients with one to two chronic conditions and highly fragmented care were

13%

more likely to visit the emergency department.

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What the Study Found

Among patients with one to four chronic conditions, those who had the most fragmented care were more likely to visit the ED and be admitted to the hospital than those who had the least fragmented care.

  • Patients with one to two chronic conditions and highly fragmented care were 13 percent more likely to visit the ED, and 14 percent more likely to have a hospital admission.
  • Patients with three to four chronic conditions and highly fragmented care were 14 percent more likely to visit the ED, and 6 percent more likely to have a hospital admission.
  • Among patients with five or more chronic conditions, having the most fragmented care increased the likelihood of an ED visit but decreased the likelihood of a hospital admission.
  • Among patients with no chronic conditions, having the most fragmented care was not associated with either outcome.

The Big Picture

Medicare patients with a moderate number of chronic conditions and a high degree of fragmented ambulatory care are significantly more likely to visit the ED and be admitted to the hospital than those with lower rates of care fragmentation. Many previous interventions to improve health care have focused on the sickest patients. This study’s results indicate that future interventions for patients who may be less sick but who have highly fragmented care could have a large impact overall health care costs and inefficiency.

The Bottom Line

Fragmented care increases the risk of excess ED visits and hospital admissions for Medicare beneficiaries with a moderate number of chronic conditions.

Publication Details

Publication Date: October 9, 2018
Contact: Lisa M. Kern, Associate Professor of Public Health and Medicine, Weill Cornell Medical College
Summary Writer: Joel T. Dodge
Citation:

Lisa M. Kern et al., “Fragmented Ambulatory Care and Subsequent Healthcare Utilization Among Medicare Beneficiaries,” American Journal of Managed Care 24, no. 9 (Sept. 1, 2018): 294–300.

Experts

Associate Professor of Public Health and Medicine, Weill Cornell Medical College