Outpatient Care Fragmentation and Patient Satisfaction With Care

The aim of this study is to examine the association between outpatient care fragmentation and self-reported patient satisfaction for Medicare beneficiaries.

We measured outpatient fragmentation, that is, how dispersed patients' care was, at the physician and practice levels with a reverse Herfindahl-Hirschman concentration index (HHI). We used three domains of satisfaction with care: access, communication, and coordination and quality. We tested the relationship between fragmentation and patient satisfaction using ordinary least squares regressions, adjusting for age, income, race/ethnicity, clinical severity, and care utilization.

We conducted a retrospective analysis using secondary data from 2020 to 2022. We used the Medicare Current Beneficiary Survey and Medicare claims, both collected annually by CMS.

Outpatient fragmentation was common in our sample (n = 2294), with an average reverse HHI of 0.39 at the provider level and 0.22 at the practice level. Rural beneficiaries experienced more fragmentation at the practice level than their urban (reverse HHI 0.37 vs. 0.19, p < 0.001) or suburban (0.37 vs. 0.28, p < 0.001) counterparts. Provider-level fragmentation, although higher (reverse HHI 0.44 rural vs. 0.39 suburban vs. 0.39 urban), was not statistically different between populations. Non-urban beneficiaries reported lower satisfaction with accessibility (9.82 suburban vs. 10.05 urban and 9.65 rural vs. 10.05 urban, p-values 0.004 and 0.003) and coordination and quality (13.33 suburban vs. 13.64 urban and 13.37 rural vs. 13.64 urban, p-values 0.002 and 0.115). Communication scores were similar between populations. Our regression models did not establish a statistically significant relationship between outpatient fragmentation and any of our satisfaction with care scales.

Rurality was strongly linked to greater care fragmentation, while fragmentation was not linked to differences in patient satisfaction. Health systems should note that reduced fragmentation may improve health outcomes, but these may not immediately translate to improved patient experiences.