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. 2017 Feb;32(2):175-181.
doi: 10.1007/s11606-016-3883-z. Epub 2016 Oct 27.

Healthcare Fragmentation and the Frequency of Radiology and Other Diagnostic Tests: A Cross-Sectional Study

Lisa M Kern  1   2 , Joanna K Seirup  3 , Lawrence P Casalino  3 , Monika M Safford  4
Affiliations

Healthcare Fragmentation and the Frequency of Radiology and Other Diagnostic Tests: A Cross-Sectional Study

Lisa M Kern et al. J Gen Intern Med. 2017 Feb.

Abstract

Background: Fragmented ambulatory care has been associated with high rates of emergency department visits and hospitalizations, but effects on other types of utilization are unclear.

Objective: To determine whether more fragmented care is associated with more radiology and other diagnostic tests, compared to less fragmented care.

Design: We conducted a cross-sectional study using claims from five commercial payers for 2010. The study took place in the Hudson Valley, a seven-county region in New York State.

Participants: We included adult patients who were insured through the participating payers and were attributed to a primary care physician in the region. We restricted the cohort to those with ≥4 ambulatory visits, as measures of fragmentation are not reliable if based on ≤3 visits (N = 126,801).

Main measures: For each patient, we calculated fragmentation using a reversed Bice-Boxerman Index, which we divided into seven categories. We used negative binomial regression to determine the association between fragmentation category and rates of radiology and other diagnostic tests, stratified by number of chronic conditions and adjusting for patient age, gender, and number of visits.

Key results: Patients with the most fragmented care had approximately twice as many radiology and other diagnostic tests as patients with the least fragmented care, across all groups stratified by number of chronic conditions (each adjusted p < 0.0001). For example, among patients with ≥5 chronic conditions, those with the least fragmented care had 258 tests per 100 patients, and those with the most fragmented care had 542 tests per 100 patients (+284 tests per 100 patients, or +110 %, adjusted p < 0.0001).

Conclusion: More fragmented care was independently associated with higher rates of radiology and other diagnostic tests than less fragmented care.

Keywords: ambulatory care; healthcare utilization; radiology.

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Conflict of interest statement

Compliance with Ethical Standards Institutional review boards at Weill Cornell Medical College and Kingston Hospital approved the protocol. Conflict of Interest The authors declare that they do not have a conflict of interest. Funders This study was funded by the Commonwealth Fund (grant #20140960), which supported efforts by Dr. Kern and Ms. Seirup. The funding source had no role in the study design, conduct, or reporting. Dr. Kern and Ms. Seirup had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Presentations This work was presented at the national meeting of the Society of General Internal Medicine on May 13, 2016.

Figures

Figure 1
Figure 1
Derivation of the study sample.
Figure 2
Figure 2
Adjusted mean number of radiology and other diagnostic tests per 100 patients, stratified by fragmentation category and by number of chronic conditions. Note: This analysis is among those patients with ≥4 visits. Fragmentation categories were derived from Bice-Boxerman Index scores that had been reversed (equal to 1 minus the raw Bice-Boxerman score) and divided into seven groups, as described in Table 2. Adjusted means were derived from negative binomial regression models, adjusted for patient age, gender, and number of visits.
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