Yoon Jangho, Ghim Seungbeen, Luck Jeff
Department of Preventive Medicine & Biostatistics, F. Edward Hebert School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, United States.
Front Health Serv. 2025 Jun 26;5:1475140. doi: 10.3389/frhs.2025.1475140. eCollection 2025.
Accountable care organizations provide a framework for collaboration among providers and payers to improve patients' health and care experiences while reducing costs. However, there is limited research on the realization of these benefits for low-income individuals across varying degrees of rurality. This study examined the heterogeneous impact of Coordinated Care Organizations (CCOs), an accountable care model implemented in Oregon Medicaid, on preventable emergency department (ED) and hospital admissions by rurality of residence.
Using person-month panel data on 131,246 adults aged 18-64 continuously enrolled in Oregon Medicaid between 2011 and 2015, we employed a doubly-robust difference-in-differences approach to isolate the impacts of the CCO model on the number of ED visits and the probability of hospital admissions, separately for all-cause and preventable admissions.
The CCO model was associated with reductions of 25 all-cause ED visits and 22 preventable ED visits per 1,000 persons per month during the first three years. Significant decreases in all-cause and preventable ED visits were observed across different levels of rurality. However, the magnitude of these reductions decreased almost monotonically as rurality increased from urban to small/isolated rural areas. On average, the CCO model was associated with significant declines in preventable ED visits by 18, 9, and 5 visits per 1,000 persons per month among urban, large rural, and small/isolated rural residents, respectively. No statistically discernable relationship was found for hospital admissions.
The CCO model led to significant overall reductions in preventable ED visits. However, this beneficial effect may diminish with increased rurality.
责任医疗组织提供了一个框架，供医疗服务提供者和支付方合作，以改善患者的健康状况和就医体验，同时降低成本。然而，关于不同农村程度的低收入人群如何实现这些益处的研究有限。本研究考察了俄勒冈医疗补助计划中实施的一种责任医疗模式——协调医疗组织（CCO），对因居住农村程度不同而导致的可预防急诊室就诊和住院情况的异质性影响。
利用2011年至2015年期间连续参加俄勒冈医疗补助计划的131246名18至64岁成年人的人月面板数据，我们采用双重稳健的差分法，分别针对全因住院和可预防住院，分离出CCO模式对急诊室就诊次数和住院概率的影响。
在前三年中，CCO模式与每千人每月减少25次全因急诊室就诊和22次可预防急诊室就诊相关。在不同农村程度水平上，全因和可预防急诊室就诊次数均显著减少。然而，随着农村程度从城市地区增加到小/偏远农村地区，这些减少的幅度几乎呈单调下降。平均而言，CCO模式与城市、大农村和小/偏远农村居民每千人每月可预防急诊室就诊次数分别显著减少18次、9次和5次相关。未发现与住院情况有统计学上可辨别的关系。
CCO模式导致可预防急诊室就诊次数总体显著减少。然而，这种有益效果可能会随着农村程度的增加而减弱。
