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Health Services Research & Development

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Association between Continuity and Team-Based Care and Health Care Utilization: An Observational Study of Medicare-Eligible Veterans in VA Patient Aligned Care Team.

Reddy A, Wong E, Canamucio A, Nelson K, Fihn SD, Yoon J, Werner RM. Association between Continuity and Team-Based Care and Health Care Utilization: An Observational Study of Medicare-Eligible Veterans in VA Patient Aligned Care Team. Health services research. 2018 Dec 1; 53 Suppl 3:5201-5218.

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Abstract:

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.





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