Primary care continuity and potentially avoidable hospitalization in persons with dementia

被引：35

作者：

Godard-Sebillotte, Claire ^{[1
,5
,6
]}

Strumpf, Erin ^{[2
,3
]}

Sourial, Nadia ^{[1
,7
]}

Rochette, Louis ^{[4
]}

Pelletier, Eric ^{[4
]}

Vedel, Isabelle ^{[1
]}

机构：

[1] McGill Univ, Dept Family Med, 5858 Cote Neiges Rd,3rd Floor, Montreal, PQ H3S 1Z1, Canada

[2] McGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, Canada

[3] McGill Univ, Dept Econ, Montreal, PQ, Canada

[4] Inst Natl Sante Publ Quebec INSPQ, Montreal, PQ, Canada

[5] McGill Univ, Dept Med, Div Geriatr, Montreal, PQ, Canada

[6] Res Inst McGill Univ Hlth Ctr RI MUHC, Montreal, PQ, Canada

[7] Univ Montreal, Ctr Rech, Ctr Hosp Univ Montreal CHUM, Dept Med Famille & Med Urgence, Montreal, PQ, Canada

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2021年 / 69卷 / 05期

基金：

加拿大健康研究院;

关键词：

dementia; health service research; primary care continuity; potentially avoidable hospitalization; propensity score; EMERGENCY-DEPARTMENT USE; OLDER-ADULTS; HEALTH-CARE; MEDICARE BENEFICIARIES; SENSITIVE CONDITIONS; ALZHEIMERS-DISEASE; INTERVENTION; DIAGNOSIS; PEOPLE; ASSOCIATION;

D O I：

10.1111/jgs.17049

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Background/Objective To measure the association between high primary care continuity and potentially avoidable hospitalization in community-dwelling persons with dementia. Our hypothesis was that high primary care continuity is associated with fewer potentially avoidable hospitalizations. Design Population-based retrospective cohort (2012-2016), with inverse probability of treatment weighting using the propensity score. Setting Quebec (Canada) health administrative database, recording most primary, secondary and tertiary care services provided via the public universal health insurance system. Participants Population-based sample of 22,060 community-dwelling 65 + persons with dementia on March 31st, 2015, with at least two primary care visits in the preceding year (mean age 81 years, 60% female). Participants were followed for 1 year, or until death or long-term care admission. Exposure High primary care continuity on March 31st, 2015, i.e., having had every primary care visit with the same primary care physician, during the preceding year. Main outcome measures Primary: Potentially avoidable hospitalization in the follow-up period as defined by ambulatory care sensitive conditions (ACSC) hospitalization (general and older population definitions), 30-day hospital readmission; Secondary: Hospitalization and emergency department visit. Results Among the 22,060 persons, compared with the persons with low primary care continuity, the 14,515 (65.8%) persons with high primary care continuity had a lower risk of ACSC hospitalization (general population definition) (relative risk reduction 0.82, 95% CI 0.72-0.94), ACSC hospitalization (older population definition) (0.87, 0.79-0.95), 30-day hospital readmission (0.81, 0.72-0.92), hospitalization (0.90, 0.86-0.94), and emergency department visit (0.92, 0.90-0.95). The number needed to treat to prevent one event were, respectively, 118 (69-356), 87 (52-252), 97 (60-247), 23 (17-34), and 29 (21-47). Conclusion Increasing continuity with a primary care physician might be an avenue to reduce potentially avoidable hospitalizations in community-dwelling persons with dementia on a population-wide level.

引用

页码：1208 / 1220

页数：13

共 50 条

[1] Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare [J].