Continuity of Care and Risk of Readmission: An Investigation into the Healthcare Journey of Heart Failure Patients

• 成果类型: Article
• 署名作者: Senot, Claire
• 署名单位: Tulane University
• 刊物名称: PRODUCTION AND OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1059-1478
• DOI: 10.1111/poms.13027
• 发表日期: 2019
• 页码: 2008-2030
• 关键词: service operations management; hospital readmissions; competing risks; medicare beneficiaries; performance; QUALITY; COSTS; MODEL; time; ORGANIZATIONS

摘要

We investigate the association between continuity of care mechanisms and a patient's risk of readmission in the context of one chronic condition, heart failure. We define continuity of care as the level of consistency across patient care episodes. We dynamically measure continuity of individual referring provider; continuity of physical location, which links multiple individual providers; and continuity of Accountable Care Organization, which spans a variety of individual and institutional providers. We compile a unique large-scale dataset that includes patient-level claims, to follow heart failure patients throughout inpatient and outpatient settings in 2014. Our final sample covers 44,129 episodes of care for 3263 patients. Using a competitive-risks survival model, we find that all three continuity mechanisms are associated with a patient's lower risk of readmission. This exploratory study contributes to operations management literature by identifying effective integration mechanisms in the setting of healthcare delivery. In addition, by providing the first quantitative evidence for the critical role of multiple simultaneous mechanisms in ensuring continuity of care, this study offers important preliminary insights for public policy efforts.