title: Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Observational study using propensity score matching.
  
  
  METHODS
  Medicare fee-for-service, 2011-12.
  
  
  METHODS
  Beneficiaries aged 65 and older with multimorbidity.
  
  
  METHODS
  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.
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
authors.forename: Julie P W
authors.initials: JPW
authors.lastname: Bynum
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
authors.forename: Andrea
authors.initials: A
authors.lastname: Austin
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
authors.forename: Don
authors.initials: D
authors.lastname: Carmichael
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
authors.forename: Ellen
authors.initials: E
authors.lastname: Meara
mesh_terms: D000368:Aged; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D006278:Medicare; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D057216:Propensity Score; D013038:Specialization / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: continuity; multimorbidity; physician specialty; quality; spending