title: Visit Entropy Associated with Hospital Readmission Rates.
abstract: The chronic disease model suggests continuity of care and team-based care can improve outcomes for multimorbidity patients and reduce hospitalizations. Continuity of care following admission has had mixed effects on readmission rates; however, its effect before admission has not been well studied. Increased outpatient care organization and continuity before admission is hypothesized to reduce the odds of readmission.
  
  
  
  In a cohort of 14,662 primary care patients from a Patient-Centered Medical Home (PCMH) practice, continuity of care in the 12 months before admission was assessed using 3 established metrics; usual provider continuity (UPC), dispersion continuity of care (COC), and sequence continuity (SECON). In addition, because these established metrics may not accurately reflect continuity in planned team-based care, a new metric called visit entropy (VE) was used to quantify the disorganization of visits. Multivariate logistic regression was performed to examine the relationship between readmission within 30 days and continuity while controlling for known readmission risk factors abstracted from an electronic medical record.
  
  
  
  Higher VE was associated with readmission (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19). The continuity measures of UPC, COC, and SECON were not associated with readmission.
  
  
  
  Disorganized medical care, characterized by a higher VE, is associated with higher odds of readmission among hospitalized primary care patients. An association between traditional measures of continuity (UPC, COC, and SECON) and readmission was not found.
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN garrison.gregory@mayo.edu.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Garrison
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Rachel
authors.initials: R
authors.lastname: Keuseman
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Buck
authors.initials: B
authors.lastname: Bania
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Paul
authors.initials: P
authors.lastname: Robelia
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pecina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000458:organization & administration*; D016896:Treatment Outcome
keywords: Ambulatory Care; Chronic Disease; Continuity of Patient Care; Electronic Health Records; Entropy; Hospitalization; Logistic Models; Odds Ratio; Patient Readmission; Patient-centered Care; Primary Health Care; Risk Factors