AIM: One-third of patients visiting multiple acute-care sites
Of 3.6 million adults visiting an acute care site during a five-year period, almost a third sought care at two or more hospitals, according to an article in the Dec. 13/27 issue of Archives of Internal Medicine.
Fabienne Bourgeois, MD, MPH, of children's division of general pediatrics at Children’s Hospital Boston, and colleagues found that these patients accounted for more than half of all acute care visits in Massachusetts, as well as more frequent hospitalizations and greater costs.
In the study, Bourgeois and colleagues focused on visits to emergency departments from 2002 to 2007, as well as inpatient units and observation units at 77 nonfederal acute care hospitals and satellite emergency facilities. They collected data from three databases managed by the state's Division of Health Care Finance and Policy on a quarterly basis and tracked patients via unique health identification numbers.
Of the 3.6 million adult patients visiting an acute care site, 1.1 million (31 percent) visited two or more hospitals during the study period and accounted for 56.5 percent of all acute care visits. The authors also identified a subgroup of 43,794 patients (1 percent) that visited five or more different hospitals, accounting for roughly one-tenth of all acute visits.
Compared with patients with repeat visits to the same site, the researchers found that patients visiting multiple sites tended to be younger, were more likely to be male, were more frequently hospitalized, incurred higher charges at any one visit and were more likely to have a primary psychiatric diagnosis listed as the reason for their visit.
"It is significant to find that the odds of having a primary psychiatric diagnosis were higher among individuals who were seen at multiple sites of care, because studies have shown that this population is at particular risk for medical errors and adverse events," said Bourgeois. "At a broader level we know that treating patients with incomplete information can expose patients to medical errors, adverse events, duplicative tests and higher costs."
The authors noted that they were not able to directly assess the consequences of fragmentation in their study, but because of the length of the study period and state-wide scope of the research, they believe they were able to establish that a large number of patients navigating multiple healthcare systems are exposed to the risks of fragmented medical information, at least in the acute care setting.
The study did not address non-acute outpatient visits and the level of fragmentation including primary care and specialists, the researchers added.
Fabienne Bourgeois, MD, MPH, of children's division of general pediatrics at Children’s Hospital Boston, and colleagues found that these patients accounted for more than half of all acute care visits in Massachusetts, as well as more frequent hospitalizations and greater costs.
In the study, Bourgeois and colleagues focused on visits to emergency departments from 2002 to 2007, as well as inpatient units and observation units at 77 nonfederal acute care hospitals and satellite emergency facilities. They collected data from three databases managed by the state's Division of Health Care Finance and Policy on a quarterly basis and tracked patients via unique health identification numbers.
Of the 3.6 million adult patients visiting an acute care site, 1.1 million (31 percent) visited two or more hospitals during the study period and accounted for 56.5 percent of all acute care visits. The authors also identified a subgroup of 43,794 patients (1 percent) that visited five or more different hospitals, accounting for roughly one-tenth of all acute visits.
Compared with patients with repeat visits to the same site, the researchers found that patients visiting multiple sites tended to be younger, were more likely to be male, were more frequently hospitalized, incurred higher charges at any one visit and were more likely to have a primary psychiatric diagnosis listed as the reason for their visit.
"It is significant to find that the odds of having a primary psychiatric diagnosis were higher among individuals who were seen at multiple sites of care, because studies have shown that this population is at particular risk for medical errors and adverse events," said Bourgeois. "At a broader level we know that treating patients with incomplete information can expose patients to medical errors, adverse events, duplicative tests and higher costs."
The authors noted that they were not able to directly assess the consequences of fragmentation in their study, but because of the length of the study period and state-wide scope of the research, they believe they were able to establish that a large number of patients navigating multiple healthcare systems are exposed to the risks of fragmented medical information, at least in the acute care setting.
The study did not address non-acute outpatient visits and the level of fragmentation including primary care and specialists, the researchers added.