Volume 53 | Number S3 | December 2018

Abstract List

Ashok Reddy M.D., M.Sc., Edwin Wong Ph.D., Anne Canamucio M.S., Karin Nelson M.D., M.S.H.S., Stephan D. Fihn, Jean Yoon Ph.D., Rachel M. Werner M.D., Ph.D.


It remains unknown whether high‐functioning teams can compensate for poor continuity of care to support important patient outcomes.

Data Source

Linked VA administrative and Medicare claims data to measure the relationship of team‐based care and continuity of care with high‐cost utilization.

Study Design

Retrospective cohort study of 1.2 million VA‐Medicare dual eligible Veterans assigned to a VA primary care provider (PCP) in 2012. Continuity was the proportion of primary care visits to the assigned VA provider of care. Clinics were categorized as low, average, or high‐team functioning based on survey data. Our primary outcomes were the number of all‐cause hospitalizations, ambulatory care sensitive (ACSC) hospitalizations, and emergency department (ED) visits in 2013.

Principal Findings

A 10‐percentage point increase in continuity with a VA PCP was associated with 4.5 fewer hospitalizations ( < .001), 3.2 fewer ACSC hospitalizations ( < .001), and 2.6 more ED visits ( = .07) per 1,000 patients. Team‐based care was not significantly associated with any high‐cost utilization category. Associations were heterogeneous across VA‐reliant and nonreliant Veterans. Finally, the interaction results demonstrated that the quality of team‐based care functioning could not compensate for poor continuity on hospitalizations, ACSC hospitalizations, or ED visits. Conclusions: In Veterans who were reliant on the VA for services, increasing continuity with a VA PCP and high‐functioning team‐based care clinics was associated with fewer ED visits and hospitalizations. Furthermore, leveraging combined data from VA and Medicare allowed to better measure continuity and assess high‐cost utilization among Veterans who are and are not reliant on the VA for services.