Primary Care Comprehensiveness and Care Coordination in Robust Specialist Networks Results in Lower Emergency Department Utilization: A Network Analysis of Medicaid Physician Networks

• Type of Material: Article
• Authors: Zhaowei She, Georgia Institute of Technology; Anne H. Gaglioti, Morehouse School of Medicine; Peter Baltrus, Morehouse School of Medicine; Chaohua Li, Morehouse School of Medicine; Miranda Moore, Emory University; Lilly Immergluck, Emory University; Arthi Rao, Georgia Institute of Technology; Turgay Ayer, Georgia Institute of Technology
• Language: English
• Date: 2020-01-01
• Publisher: SAGE Publications
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/2150132720924432
• Title of Journal or Parent Work: Journal of Primary Care and Community Health
• Volume: 11
• Start Page: 2150132720924432
• End Page: 2150132720924432
• Grant/Funding Information: This work was partially supported by the National Institutes of Health, National Institute on Minority Health and Health Disparities (Grant No. P20 1P20MD006881-02), and the Research Centers in Minority Institutions (Grant No. U54 8U54MD007588).
• Keywords: Emergency Service, Hospital; primary care; United States; Specialization; Cross-Sectional Studies; Texas; Adult; social network analysis; Humans; Primary Health Care; care coordination; Medicaid
• Research Categories: Sociology, Social Structure and Development; Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Background: Care coordination is an essential and difficult to measure function of primary care. Objective: Our objective was to assess the impact of network characteristics in primary/specialty physician networks on emergency department (ED) visits for patients with chronic ambulatory care sensitive conditions (ACSCs). Subjects and Measures: This cross-sectional social network analysis of primary care and specialty physicians caring for adult Medicaid beneficiaries with ACSCs was conducted using 2009 Texas Medicaid Analytic eXtract (MAX) files. Network characteristic measures were the main exposure variables. A negative binomial regression model analyzed the impact of network characteristics on the ED visits per patient in the panel. Results: There were 42 493 ACSC patients assigned to 5687 primary care physicians (PCPs) connected to 11 660 specialist physicians. PCPs whose continuity patients did not visit a specialist had 86% fewer ED visits per patient in their panel, compared with PCPs whose patients saw specialists. Among PCPs connected to specialists in the network, those with a higher number of specialist collaborators and those with a high degree of centrality had lower patient panel ED rates. Conclusions: PCPs providing comprehensive care (ie, without specialist consultation) for their patients with chronic ACSCs had lower ED utilization rates than those coordinating care with specialists. PCPs with robust specialty networks and a high degree of centrality in the network also had lower ED utilization. The right fit between comprehensiveness of primary care, care coordination, and adequate capacity of specialty availability in physician networks is needed to drive outcomes.