PRIMARY-CARE, AVOIDABLE HOSPITALIZATION, AND OUTCOMES OF CARE - A LITERATURE-REVIEW AND METHODOLOGICAL APPROACH

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.