JMIR Publications

ABSTRACT

Background:

Obesity affects nearly half of U.S. adults and is contributing substantially to an epidemic of obesity-associated chronic conditions (OCC) such as type 2 diabetes (T2D), hypertension, and arthritis. The OCC epidemic is particularly severe in low-income, medically underserved, predominantly African American areas in the southern U.S. “obesity belt”. Little is known regarding the impact of geographic, income, and racial disparities in continuity on major health outcomes for patients with OCC.

Objective:

To assess among patents with OCC and the subgroup with T2D (OCC+T2D): (1) whether continuity of care is associated with lower overall and potentially preventable emergency department (ED) and hospital utilization, (2) the effect of geographic, income, and racial disparities on continuity and healthcare utilizations (3) whether continuity particularly protects individuals at risk for disparities from adverse health outcomes, and (4) whether the characteristics of health systems are associated with higher continuity and better outcomes.

Methods:

Using 2015-2018 data from four practice-based research networks (PBRN) participating in the Southern Obesity and Diabetes Coalition, we will conduct a retrospective cohort analysis and distributed meta-analysis. OCC patients and the OCC+T2D subgroup will be assessed within each health system following a standardized study protocol. The protocol manuscript was prepared in accordance with cohort studies checklist set by the STROBE (strengthening the reporting of observational studies in epidemiology) version 4. The primary study outcomes are overall and preventable ED visits and hospitalizations. Continuity of care will be calculated at the facility level using a modified version of the Bice-Boxerman Continuity of Care Index. Race will be assessed using EMR data. Residence in a low-income area or a health professional shortage area (HPSA) respectively will be assessed by linking patient residence ZIP Codes to the CMS database.

Results:

Four regional health systems across Tennessee, Mississippi, Louisiana, and Arkansas including a total of 53 adult hospitals participated in the study. A total of 147,889 OCC patients were identified in these health systems who met full study criteria, of which 45,453 patients met criteria for inclusion in the OCC+T2D subgroup. Results are expected by the end of 2020.

Conclusions:

This study should reveal whether health system efforts to increase continuity of care for patients with obesity and diabetes have potential to improve outcomes and reduce costs. Analyzing disparities in continuity of care and their effect on major health outcomes can help demonstrate how to improve care and use of healthcare resources for vulnerable patients with OCC and OCC+T2D. The study will help generate hypotheses regarding the health system characteristics associated with highest continuity and best outcomes. Better understanding of the association between continuity and healthcare utilization for these vulnerable populations will contribute to the development of higher-value health systems in the Southern U.S.