RT Journal Article SR Electronic T1 Visit Entropy Associated with Hospital Readmission Rates JF The Journal of the American Board of Family Medicine JO J Am Board Fam Med FD American Board of Family Medicine SP 63 OP 70 DO 10.3122/jabfm.2017.01.160186 VO 30 IS 1 A1 Gregory M. Garrison A1 Rachel Keuseman A1 Buck Bania A1 Paul Robelia A1 Jennifer Pecina YR 2017 UL http://www.jabfm.org/content/30/1/63.abstract AB Purpose: The chronic disease model suggests continuity of care and team-based care can improve outcomes for multimorbidity patients and reduce hospitalizations. Continuity of care following admission has had mixed effects on readmission rates; however, its effect before admission has not been well studied. Increased outpatient care organization and continuity before admission is hypothesized to reduce the odds of readmission.Methods: In a cohort of 14,662 primary care patients from a Patient-Centered Medical Home (PCMH) practice, continuity of care in the 12 months before admission was assessed using 3 established metrics; usual provider continuity (UPC), dispersion continuity of care (COC), and sequence continuity (SECON). In addition, because these established metrics may not accurately reflect continuity in planned team-based care, a new metric called visit entropy (VE) was used to quantify the disorganization of visits. Multivariate logistic regression was performed to examine the relationship between readmission within 30 days and continuity while controlling for known readmission risk factors abstracted from an electronic medical record.Results: Higher VE was associated with readmission (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19). The continuity measures of UPC, COC, and SECON were not associated with readmission.Conclusions: Disorganized medical care, characterized by a higher VE, is associated with higher odds of readmission among hospitalized primary care patients. An association between traditional measures of continuity (UPC, COC, and SECON) and readmission was not found.