title: Are Two Heads Better Than One or Do Too Many Cooks Spoil the Broth? The Trade-Off between Physician Division of Labor and Patient Continuity of Care for Older Adults with Complex Chronic Conditions.
abstract: OBJECTIVE
  To examine the effects of physician division of labor and patient continuity of care (COC) on the care quality and outcomes of older adults with complex chronic conditions.
  
  
  METHODS
  Seven years (2006-2012) of panel data from the Medicare Current Beneficiary Survey (MCBS).
  
  
  METHODS
  Regression models were used to estimate the effect of the specialty-type of physicians involved in annual patient evaluation and management, as well as patient COC, on simultaneous care processes and following year outcomes.
  
  
  METHODS
  Multiyear cohorts of Medicare beneficiaries with diabetes and/or heart failure were retrospectively identified to create a panel of 15,389 person-year observations.
  
  
  RESULTS
  Involvement of both primary care physicians and disease-relevant specialists is associated with better compliance with process-of-care guidelines, but patients seeing disease-relevant specialists also receive more repeat cardiac imaging (p < .05). Patient COC is associated with less repeat cardiac imaging and compliance with some recommended care processes (p < .05), but the effects are small. Receiving care from a disease-relevant specialist is associated with lower rates of following year functional impairment, institutionalization in long-term care, and ambulatory care sensitive hospitalization (p < .05).
  
  
  CONCLUSIONS
  Annual involvement of disease-relevant specialists in the care of beneficiaries with complex chronic conditions leads to more resource use but has a beneficial effect on outcomes.
authors.affiliation: Department of Health Management and Policy and Center for Outcomes Research, College for Public Health and Social Justice, Saint Louis University, St Louis, MO.
authors.forename: Kenton J
authors.initials: KJ
authors.lastname: Johnston
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hockenberry
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy; D006333:Heart Failure / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008134:Long-Term Care; D006278:Medicare / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013038:Specialization / Q000706:statistics & numerical data*; D014481:United States
keywords: Patient continuity of care; chronic disease; older adults; physician division of labor; specialty care