![]() We specifically sought to explore this issue while teasing apart the pattern of ambulatory care from the number of chronic conditions, because having fragmented care may affect patients differently depending on how many chronic conditions they have. The goal of this study was to determine if more fragmented ambulatory care is independently associated with more ED visits and hospital admissions, compared with less fragmented care, among Medicaid beneficiaries. 3,4 However, patterns observed in Medicare may not be generalizable to other populations. 1,2 When patients have fragmented care, it is often difficult for providers to communicate adequately with each other, and adverse events may follow. Having highly fragmented ambulatory care, which is care spread across multiple providers without a dominant provider, has been associated with higher rates of emergency department (ED) visits and hospital admissions among Medicare beneficiaries. Fragmented ambulatory care may be modifiable and may represent a novel target for improvement.Having more fragmented care was not associated with a change in the hazard of a hospital admission.For every 71 patients with high fragmentation, there is a risk of 1 additional ED visit. For every 0.1-point increase in fragmentation score, the adjusted hazard of an emergency department (ED) visit over 2 years of follow-up increased by 1.7% (95% CI, 0.5%-2.9%).To determine any association between fragmented ambulatory care and subsequent healthcare utilization, this retrospective cohort study analyzed claims for 19,330 adult Medicaid beneficiaries. Fragmented ambulatory care may be modifiable and may represent a novel target for improvement.Īm J Manag Care. Having more fragmented care was not associated with a change in the hazard of a hospital admission.Ĭonclusions: Among Medicaid beneficiaries, having more fragmented care was associated with a modest increase in the hazard of an ED visit, independent of chronic conditions. For every 0.1-point increase in fragmentation score, the adjusted hazard of an ED visit over 2 years of follow-up increased by 1.7% (95% CI, 0.5%-2.9%). One-fourth of the sample had more than 20 ambulatory visits and more than 7 providers, with the most frequently seen provider accounting for fewer than 33% of visits. Results: The average beneficiary had 15 ambulatory visits in the baseline year, spread across 5 providers, with the most frequently seen provider accounting for 48% of the visits. Cox proportional hazards models were used to determine associations between fragmentation score and ED visits or, separately, hospital admissions, adjusting for age, gender, and chronic conditions. Methods: We measured fragmentation using a modified Bice-Boxerman Index. We included 19,330 adult Medicaid beneficiaries who were continuously enrolled, were attributed to a primary care provider, and had 4 or more ambulatory visits in the baseline year. Study Design: We conducted a 3-year retrospective cohort study in the 7-county Hudson Valley region of New York. Whether this observation is generalizable to Medicaid beneficiaries is unknown. Objectives: Results of previous studies of Medicare beneficiaries have shown that more fragmented ambulatory care is associated with more emergency department (ED) visits and hospital admissions.
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