Key result
High care fragmentation is linked to ~24% higher odds of self-reported care coordination gaps.
Why the study?
It was unclear whether individuals with claims-based care fragmentation perceive more gaps in provider communication, and whether those gaps lead to adverse events attributed to poor coordination.
Does high claims-based care fragmentation increase the risk of self-reported gaps in care coordination and adverse events in Medicare beneficiaries?
Cohort (n=4,296)
Yes
Does high claims-based care fragmentation increase the risk of self-reported gaps in care coordination and adverse events in Medicare beneficiaries?
High claims-based care fragmentation is associated with patient-reported gaps in care coordination and clinically significant adverse events among Medicare beneficiaries.
Claims-based fragmentation signals higher odds of perceived gaps and attributed adverse events; supports claims measures' validity but leaves causal links and practice change open.
BACKGROUND: Fragmentation of care (that is, the use of multiple ambulatory providers without a dominant provider) may increase the risk of gaps in communication among providers. However, it is unclear whether people with fragmented care (as measured in claims) perceive more gaps in communication among their providers. It is also unclear whether people who perceive gaps in communication experience them as clinically significant (that is, whether they experience adverse events that they attribute to poor coordination). METHODS: We conducted a longitudinal study using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including a survey on perceptions of healthcare (2017-2018) and linked fee-for-service Medicare claims (for the 12 months prior to the survey) (N = 4,296). We estimated correlation coefficients to determine associations between claims-based and self-reported numbers of ambulatory visits and ambulatory providers. We then used logistic regression to determine associations between claims-based fragmentation (measured with the reversed Bice-Boxerman Index [rBBI]) and self-reported gaps in care coordination and, separately, between claims-based fragmentation and self-reported adverse events that the respondent attributed to poor coordination. RESULTS: The correlation coefficient between claims-based and self-report was 0.37 for the number of visits and 0.38 for the number of providers (p < 0.0001 for each). Individuals with high fragmentation by claims (rBBI ≥ 0.85) had a 23% increased adjusted odds of reporting any gap in care coordination (95% CI 3%, 48%) and, separately, a 61% increased adjusted odds of reporting an adverse event that they attributed to poor coordination (95% CI 11%, 134%). CONCLUSIONS: Medicare beneficiaries with claims-based fragmentation also report gaps in communication among their providers. Moreover, these gaps appear to be clinically significant, with beneficiaries reporting adverse events that they attribute to poor coordination.
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Kern et al. (2024) conducted a cohort in Medicare beneficiaries (n=4,296). High claims-based care fragmentation (rBBI ≥ 0.85) vs. Low claims-based care fragmentation (rBBI < 0.70) was evaluated on Any self-reported gap in care coordination (OR 1.24, 95% CI 1.03-1.48). High claims-based care fragmentation was associated with a 24% increased adjusted odds of reporting any gap in care coordination compared to low fragmentation (OR 1.24).
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