142nd APHA Annual Meeting and Exposition

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Interpersonal Care Continuity and the Overuse of Medical Procedures

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Max Romano, MPH , Department of Epidemiology, Johns Hopkins University, Baltimore, MD
Jodi Segal, MD, MPH , Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD
Craig Pollack, MD, MHS , Department of Epidemiology, Johns Hopkins University, Baltimore, MD
Importance: Overuse of unnecessary medical procedures is driving healthcare spending up and driving quality down in the United States. Many reform efforts aim to improve continuity of care in order to decrease overuse.

Objective: To investigate the association between care continuity and use of potentially unnecessary procedures.

Design and Setting: Observational retrospective cohort using 5% Medicare fee-for-service claims from 2008.

Participants: 1,377,575 patients over age 65

Exposure: Bice-Boxerman Continuity of Care index (COC).

Outcome: Overuse, measured using a previously validated set of 19 potentially over-used procedures.

Results: Altogether 13% of patients received at least one potentially overused procedure. Patients with 0.1 unit higher continuity scores had 0.934 times the odds of receiving overused procedures than those with lower scores (95% CI 0.932-0.937). Increased continuity was associated with decreased overuse of 9 procedures and increased overuse of 3 procedures. Higher continuity was associated with decreased overuse of all three therapeutic procedures and increased overuse of the sole monitoring test. Continuity had both positive and negative associations with different diagnostic tests.

Conclusions and Relevance: Claims-based measures of continuity were associated with some measures of overuse, though not always in the expected direction. Increased continuity was associated with an overall decrease in overuse, however the association varied based on which procedure was measured and when outcomes were assessed.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology

Learning Objectives:
Identify relationships between the claims-based continuity of medical care and the overuse of potentially unnecessary procedures using Medicare data.

Keyword(s): Health Care Delivery, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical student and health services researcher with multiple publications using large databases to conduct research on a variety of health care quality measures. My co-authors have published extensively in the fields of continuity and medical care overuse and we have collaborated for over a year developing this research project and preparing it for submission.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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