Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty.
OBJECTIVES
To determine whether receiving the predominance of ambulatory visits from a primary care provider compared to a specialty provider is associated with better outcomes in older adults with multi morbidity.


DESIGN
Observational study using propensity score matching.


SETTING
Medicare fee-for-service, 2011-12.


PARTICIPANTS
Beneficiaries aged 65 and older with multimorbidity.


MEASUREMENTS
The independent variable was an indicator for having a specialty (versus primary care) as the predominant provider of care (PPC). Main outcomes were 1-year mortality, hospitalization, standardized expenditures, and ambulatory visit patterns.


RESULTS
Two-thirds of 3,934,942 beneficiaries with multimorbidity had a primary care provider as their PPC. Individuals with a specialty PPC had more hospitalizations (40.3 more per 1,000) and higher spending ($1,781 more per beneficiary) than those with a primary care PPC, but there was little difference in mortality (0.2% higher) or preventable hospitalizations. Spending differences were largest for professional fees ($769 higher per beneficiary), inpatient stays ($572 higher per beneficiary), and outpatient facilities ($510 higher per beneficiary) (all P < .001). In addition, people with a specialist PPC had lower continuity of care and saw more providers.


CONCLUSIONS
Older adults with multimorbidity with a specialist as their main ambulatory care provider had higher spending and lower continuity of care than those whose PPC was in primary care but similar clinical outcomes.
['Bynum|Julie P W|JPW|', 'Chang|Chiang-Hua|CH|', 'Austin|Andrea|A|', 'Carmichael|Don|D|', 'Meara|Ellen|E|']
D000368:Aged D015897:Comorbidity D003266:Continuity of Patient Care D005260:Female D006801:Humans D057187:Independent Living D008297:Male D006278:Medicare D011320:Primary Health Care D057216:Propensity Score D013038:Specialization D014481:United States
multimorbidity spending continuity physician specialty quality