Ambulatory Care Fragmentation and Incident Stroke

Area of Science:

• Geriatric Medicine
• Cardiovascular Epidemiology
• Health Services Research

Background:

• Fragmented ambulatory care is associated with increased healthcare utilization, including emergency department visits and hospitalizations.
• Understanding the impact of care fragmentation on specific health outcomes like stroke is crucial for targeted interventions.

Purpose of the Study:

• To investigate the association between fragmented ambulatory care and the risk of incident stroke.
• To stratify this association by participants' health status and race.

Main Methods:

• Secondary analysis of the REGARDS study (2003-2016) including 12,510 participants aged ≥65 years with linked Medicare claims and no prior stroke.
• Care fragmentation measured using the reversed Bice-Boxerman index.
• Poisson models used to assess the association between fragmentation and incident stroke.

Main Results:

• No overall association between high versus low care fragmentation and incident stroke.
• A trend towards higher stroke rates in participants with fair/poor health and high fragmentation (14.8 vs. 10.4 per 1000 person-years).
• A significant association between high fragmentation and higher stroke rates among Black participants with fair/poor health (19.3 vs. 10.3 per 1000 person-years; P=0.02).

Conclusions:

• Highly fragmented ambulatory care is an independent risk factor for incident stroke in Black individuals with fair or poor self-rated health.
• This highlights a critical disparity in stroke risk related to care coordination challenges within specific demographic groups.
• Further research into interventions addressing care fragmentation for vulnerable populations is warranted.