Primary care, avoidable hospitalization, and outcomes of care: a literature review and methodological approach.
The purpose of this article is to review the literature on the relationships between primary care, potentially avoidable hospitalizations, and outcomes of care and to develop a methodology to study these relationships. The methodological approach includes developing criteria to select medical conditions, aggregating patient claims files of both ambulatory and acute care records, and delineating episodes of care. A taxonomy of physician visits is proposed that classifies visits on the basis of type of care, type of illness, and linkage to hospital episodes. A structural model of use and outcomes is specified that includes hazard rate models to estimate the likelihood of a potentially avoidable hospitalization, primary care and ad hoc physician visits, and mortality; the latter suggests a modification of the Health Care Financing Administration methodology that includes physician visit variables.
Fleming
S T
ST
University of Missouri-Columbia 65211, USA.
D014487:Centers for Medicare and Medicaid Services, U.S.; D017050:Episode of Care; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007345:Insurance Claim Review / Q000145:classification; D009819:Office Visits; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000145:classification / Q000592:standards*; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D014481:United States