St. Fleming, PRIMARY-CARE, AVOIDABLE HOSPITALIZATION, AND OUTCOMES OF CARE - A LITERATURE-REVIEW AND METHODOLOGICAL APPROACH, Medical care research and review, 52(1), 1995, pp. 88-108
The purpose of this article is to review the literature on the relatio
nships between primary care, potentially avoidable hospitalizations, a
nd outcomes of care and to develop a methodology to study these relati
onships. The methodological approach includes developing criteria to s
elect medical conditions, aggregating patient claims files of both amb
ulatory and acute care records, and delineating episodes of care. A ta
xonomy of physician visits is proposed that classifies visits on the b
asis of type of care, type of illness, and linkage to hospital episode
s. A structural model of use and outcomes is specified that includes h
azard rate models to estimate the likelihood of a potentially avoidabl
e hospitalization, primary care and ad hoc physician visits, and morta
lity; the latter suggests a modification of the Health Care Financing
Administration methodology that includes physician visit variables.