Objectives
To determine whether receiving the predominance of ambulatory visits from a primary care provider compared to a specialty provider is associated with better outcomes in older adults with multi morbidity.
Design
Observational study using propensity score matching.
Setting
Medicare fee-for-service, 2011–12.
Participants
Beneficiaries aged 65 and older with multimorbidity.
Measurements
The independent variable was an indicator for having a specialty (versus primary care) as the predominant provider of care (PPC). Main outcomes were 1-year mortality, hospitalization, standardized expenditures, and ambulatory visit patterns.
RESULTS: Two-thirds of 3,934,942 beneficiaries with multimorbidity had a primary care provider as their PPC. Individuals with a specialty PPC had more hospitalizations (40.3 more per 1,000) and higher spending ($1,781 more per beneficiary) than those with a primary care PPC, but there was little difference in mortality (0.2% higher) or preventable hospitalizations. Spending differences were largest for professional fees ($769 higher per beneficiary), inpatient stays ($572 higher per beneficiary), and outpatient facilities ($510 higher per beneficiary) (all P < .001). In addition, people with a specialist PPC had lower continuity of care and saw more providers.
Conclusions
Older adults with multimorbidity with a specialist as their main ambulatory care provider had higher spending and lower continuity of care than those whose PPC was in primary care but similar clinical outcomes.
from Journal of the American Geriatrics Society http://ift.tt/2pdZHCz
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