Association between Continuity and Team-Based Care and Health Care Utilization: An Observational Study of Medicare-Eligible Veterans in VA Patient Aligned Care Team
Corresponding Author
Ashok Reddy M.D., M.Sc.
VA Puget Sound HSR&D, Seattle
Department of Medicine, School of Medicine, University of Washington, Seattle, WA
Address correspondence to: Ashok Reddy, M.D., M.Sc., VA Puget Sound HSR&D, 1660 South Columbian Way, Seattle, WA 98108, and also Department of Medicine, School of Medicine, University of Washington, Seattle, WA; e-mail: [email protected]. Search for more papers by this authorEdwin Wong Ph.D.
VA Puget Sound Healthcare System Health Services Research & Development, Seattle, WA
Department of Health Services, University of Washington School of Public Health, Seattle, WA
Search for more papers by this authorAnne Canamucio M.S.
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA
Search for more papers by this authorKarin Nelson M.D., M.S.H.S.
Department of Medicine, School of Medicine, University of Washington, Seattle, WA
VA Puget Sound Healthcare System Health Services Research & Development, Seattle, WA
Department of Health Services, University of Washington School of Public Health, Seattle, WA
Search for more papers by this authorStephan D. Fihn M.D., M.P.H.
Department of Medicine, School of Medicine, University of Washington, Seattle, WA
Department of Health Services, University of Washington School of Public Health, Seattle, WA
Search for more papers by this authorJean Yoon Ph.D., M.H.S.
Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorRachel M. Werner M.D., Ph.D.
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA
Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA
Search for more papers by this authorCorresponding Author
Ashok Reddy M.D., M.Sc.
VA Puget Sound HSR&D, Seattle
Department of Medicine, School of Medicine, University of Washington, Seattle, WA
Address correspondence to: Ashok Reddy, M.D., M.Sc., VA Puget Sound HSR&D, 1660 South Columbian Way, Seattle, WA 98108, and also Department of Medicine, School of Medicine, University of Washington, Seattle, WA; e-mail: [email protected]. Search for more papers by this authorEdwin Wong Ph.D.
VA Puget Sound Healthcare System Health Services Research & Development, Seattle, WA
Department of Health Services, University of Washington School of Public Health, Seattle, WA
Search for more papers by this authorAnne Canamucio M.S.
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA
Search for more papers by this authorKarin Nelson M.D., M.S.H.S.
Department of Medicine, School of Medicine, University of Washington, Seattle, WA
VA Puget Sound Healthcare System Health Services Research & Development, Seattle, WA
Department of Health Services, University of Washington School of Public Health, Seattle, WA
Search for more papers by this authorStephan D. Fihn M.D., M.P.H.
Department of Medicine, School of Medicine, University of Washington, Seattle, WA
Department of Health Services, University of Washington School of Public Health, Seattle, WA
Search for more papers by this authorJean Yoon Ph.D., M.H.S.
Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorRachel M. Werner M.D., Ph.D.
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA
Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA
Search for more papers by this authorAbstract
Objective
It remains unknown whether high-functioning teams can compensate for poor continuity of care to support important patient outcomes.
Data Source
Linked VA administrative and Medicare claims data to measure the relationship of team-based care and continuity of care with high-cost utilization.
Study Design
Retrospective cohort study of 1.2 million VA-Medicare dual eligible Veterans assigned to a VA primary care provider (PCP) in 2012. Continuity was the proportion of primary care visits to the assigned VA provider of care. Clinics were categorized as low, average, or high-team functioning based on survey data. Our primary outcomes were the number of all-cause hospitalizations, ambulatory care sensitive (ACSC) hospitalizations, and emergency department (ED) visits in 2013.
Principal Findings
A 10-percentage point increase in continuity with a VA PCP was associated with 4.5 fewer hospitalizations (p < .001), 3.2 fewer ACSC hospitalizations (p < .001), and 2.6 more ED visits (p = .07) per 1,000 patients. Team-based care was not significantly associated with any high-cost utilization category. Associations were heterogeneous across VA-reliant and nonreliant Veterans. Finally, the interaction results demonstrated that the quality of team-based care functioning could not compensate for poor continuity on hospitalizations, ACSC hospitalizations, or ED visits. Conclusions: In Veterans who were reliant on the VA for services, increasing continuity with a VA PCP and high-functioning team-based care clinics was associated with fewer ED visits and hospitalizations. Furthermore, leveraging combined data from VA and Medicare allowed to better measure continuity and assess high-cost utilization among Veterans who are and are not reliant on the VA for services.
Supporting Information
| Filename | Description |
|---|---|
| hesr13042-sup-0001-AppendixSA1.pdfPDF document, 1.2 MB | Appendix SA1: Author Matrix. |
| hesr13042-sup-0002-AppendixSA2.docxWord document, 15.9 KB | Appendix SA2: Table of Full Negative Binomial Regression Results from Interaction Models. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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