Background
Methods
Setting
Study design and data
Hospitalizations
Contextual factors
Analyses
Results
Number of priority chronic conditions at baseline | ||||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5+ | Total | |
Number of Individualsa
| 2844033 (47.7) | 1548197 (26.0) | 812429 (13.6) | 405766 (6.8) | 348089 (5.8) | 5958514 (100) |
Age (in years), mean (SD) | 44.9 (15.8) | 54.5 (16.2) | 62.4 (14.9) | 69.0 (13.5) | 73.6 (11.9) | 53.0 (18.0) |
Age Groups, N (%) | ||||||
<65 years | 2523875 (88.7) | 1124098 (72.6) | 440940 (54.3) | 157162 (38.7) | 78049 (22.4) | 4324124 (72.6) |
≥65 years | 320158 (11.3) | 424099 (27.4) | 371489 (45.7) | 248604 (61.3) | 270040 (77.6) | 1634390 (27.4) |
Female, N (%) | 1477561 (52.0) | 872671 (56.4) | 472030 (58.1) | 234217 (57.7) | 194732 (55.9) | 3251211 (54.6) |
Prevalence of Each Priority Condition, N (%) | ||||||
Osteoarthritis | 785297 (27.6) | 777387 (50.2) | 523568 (64.4) | 289806 (71.4) | 269393 (77.4) | 2645451 (44.4) |
Rheumatoid arthritis | 11447 (0.4) | 30963 (2.0) | 34028 (4.2) | 25879 (6.4) | 32116 (9.3) | 134433 (2.3) |
Cancer | 197688 (7.0) | 226464 (14.6) | 181622 (22.4) | 116682 (28.8) | 122160 (35.1) | 844616 (14.2) |
Arrhythmia | 26284 (0.9) | 44264 (2.7) | 57281 (7.1) | 59136 (14.6) | 116922 (33.6) | 303887 (5.1) |
Dementia | 8695 (0.3) | 20556 (1.3) | 29767 (3.7) | 30878 (7.6) | 58159 (16.7) | 148055 (2.5) |
Mood disorders | 470962 (16.6) | 401028 (25.9) | 233008 (28.7) | 125289 (30.9) | 119660 (34.4) | 1349947 (22.7) |
Osteoporosis | 41424 (1.5) | 72486 (4.7) | 70425 (8.7) | 48836 (12.0) | 52837 (15.2) | 286008 (4.8) |
Renal disease | 5581 (0.2) | 16568 (1.1) | 27301 (3.4) | 29958 (7.4) | 68164 (19.6) | 147572 (2.5) |
Stroke | 5549 (0.2) | 15923 (1.0) | 25059 (3.1) | 26025 (6.4) | 50319 (14.5) | 122875 (2.1) |
Coronary artery disease | 33552 (1.2) | 99472 (6.4) | 147047 (18.1) | 139099 (34.3) | 205730 (59.1) | 624900 (10.5) |
Asthma | 515746 (18.1) | 323609 (20.9) | 190172 (23.4) | 112921 (27.8) | 130775 (37.6) | 1273223 (21.4) |
Congestive heart failure | 2309 (0.1) | 10806 (0.7) | 27568 (3.4) | 44045 (10.9) | 131444 (37.8) | 216172 (3.6) |
Chronic obstructive pulmonary disease | 13215 (0.5) | 33266 (2.2) | 49300 (6.1) | 52272 (12.9) | 108959 (31.3) | 257012 (4.3) |
Hypertension | 573702 (20.2) | 756405 (48.7) | 585695 (72.1) | 346365 (85.4) | 326183 (93.7) | 2588350 (43.4) |
Diabetes mellitus | 152497 (5.4) | 266126 (17.2) | 253328 (31.2) | 173209 (42.7) | 190688 (54.8) | 1035848 (17.4) |
Acute myocardial infarction | 85 (0.0) | 1071 (0.1) | 2118 (0.3) | 2664 (0.7) | 7093 (2.0) | 13031 (0.2) |
Primary Care Practice Model,b N (%) | ||||||
Non-capitated | 1921317 (67.6) | 1020886 (65.9) | 535298 (65.9) | 267574 (65.9) | 231673 (66.6) | 3976748 (66.7) |
Capitated | 442850 (15.6) | 258985 (16.7) | 137301 (16.9) | 68569 (16.9) | 58198 (16.2) | 965903 (16.2) |
Capitated+ | 479866 (16.9) | 268326 (17.3) | 139830 (17.2) | 69623 (17.2) | 58218 (16.7) | 1015863 (17.1) |
Continuity of Carec
| ||||||
Mean (SD) | 0.6 (0.3) | 0.7 (0.3) | 0.7 (0.3) | 0.7 (0.3) | 0.6 (0.3) | 0.6 (0.3) |
Median (Q1-Q3) | 0.5 (0.3–0.8) | 0.5 (0.3–0.8) | 0.5 (0.3–0.8) | 0.5 (0.3–0.8) | 0.5 (0.3–0.7) | 0.5 (0.3–0.8) |
High (>0.52), N (%) | 1244438 (43.8) | 802231 (51.8) | 430849 (53.0) | 203662 (50.2) | 147651 (42.4) | 2828831 (47.5) |
Low (<=0.52), N (%) | 1599595 (56.2) | 745966 (48.2) | 381580 (47.0) | 202104 (49.8) | 200438 (57.6) | 3129683 (52.5) |
Number of priority chronic conditions | ||||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5+ | Total | |
Number of Individuals | 2844033 | 1548197 | 812429 | 405766 | 348089 | 5958514 |
Any hospitalization, N (%) | 131029 (4.6) | 108939 (7.0) | 87273 (10.7) | 64120 (15.8) | 93511 (26.9) | 484872 (8.1) |
3+ hospitalizations, N (%a) | 5581 (4.3) | 6680 (6.1) | 6893 (7.9) | 6048 (9.4) | 12907 (13.8) | 38109 (7.9) |
Hospitalizations | ||||||
Total Number of Hospitalizations | 156507 | 138190 | 116481 | 89293 | 145876 | 646347 |
Hospitalization for an existing chronic condition, N (%b) | 10,963 (7.0) | 20,304 (14.7) | 22,392 (19.2) | 19,305 (21.6) | 35,224 (24.1) | 108,188 (16.7) |
Hospitalization for a new chronic condition, N (%b) | 14503 (9.3) | 14700 (10.6) | 12381 (10.6) | 8949 (10.0) | 14401 (9.9) | 64934 (10.0) |
Length of stay, days Median (IQR) | 3 (1–5) | 3 (2–6) | 4 (2–8) | 5 (2–9) | 6 (3–11) | 4 (2–7) |
Non-medical discharge delay, N (%b) | 4832 (3.1) | 7769 (5.6) | 9477 (8.1) | 8901 (10.0) | 17622 (12.1) | 48601 (7.5) |
Discharge due to death, N (%b) | 3942 (3.0) | 6138 (5.6) | 7041 (8.1) | 6667 (10.4) | 14111 (15.1) | 37899 (7.8) |
30-day readmission among those discharged alive, N (%c) | 9284 (7.3) | 10076 (9.8) | 9503 (11.8) | 8171 (14.2) | 15842 (20.0) | 52876 (11.8) |
Number of chronic conditions | |||||
---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5+ | |
Any hospitalization, OR (95 % CI) | Ref | 1.6 (1.5–1.6) | 2.5 (2.5–2.5) | 3.9 (3.8–3.9) | 7.6 (7.5–7.6) |
Three or more hospitalizations among those hospitalized, OR (95 % CI) | Ref | 1.6 (1.5–1.6) | 2.1 (2.1–2.2) | 2.7 (2.7–2.8) | 4.3 (4.2–4.4) |
Any days with non-medical discharge delay among those hospitalized, OR (95 % CI) | Ref | 2.0 (2.0–2.1) | 3.2 (3.1–3.3) | 4.2 (4.1–4.4) | 6.0 (5.9–6.2) |
30-day readmission among those discharged alive, OR (95 % CI) | Ref | 1.4 (1.4–1.4) | 1.7 (1.7–1.8) | 2.1 (2.0–2.2) | 3.1 (3.1–3.2) |