Continuity of Care with a Primary Care Physician and Mortality in Older Adults

Wolinsky, Fredric D.; Bentler, Suzanne E.; Liu, Li; Geweke, John; Cook, Elizabeth; Obrizan, Maksym; Chrischilles, Elizabeth A.; Wright, Kara; Jones, Michael P.; Rosenthal, Gary E.; Ohsfeldt, Robert L.; Wallace, Robert B.

doi:10.1093/gerona/glp188

Cited by 94 publications

(130 citation statements)

References 23 publications

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“…19 This study adds to previous research by providing follow-up to 17 years, face-to-face interviews, and broad data coverage. It was hypothesised that discontinuity of general practice care is associated with a higher risk of mortality.…”

Section: Resultsmentioning

confidence: 95%

“…7,12,19,[27][28][29][30][31][32][33][34][35][36][37][38] Covariates were measured at the last cycle for which GP data were available. Sociodemographic characteristics included housing (independent or care institution), level of education, level of urbanicity, and partner status.…”

Section: How This Fits Inmentioning

confidence: 99%

“…7 According to Wolinsky et al, 19 mortality may be the most appropriate criterion to measure the effect of continuity of care, especially in older people. To date, only three studies have investigated the relationship between continuity of care in primary care and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study

et al. 2016

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BackgroundAlthough continuity of care is a widely accepted core principle of primary care, the evidence about its benefits is still weak. AimTo investigate whether continuity of care in general practice is associated with better survival in older people. Design and settingData were derived from the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people in the Netherlands. The study sample consisted of 1712 older adults aged ≥60 years, with 3-year follow-up cycles up to 17 years (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009), and mortality follow-up until 2013. MethodContinuity of care was defined as the duration of the ongoing therapeutic relationship between patient and GP. The Herfindahl-Hirschman Index was used to calculate the continuity of care (COC). A COC index value of 1 represented maximum continuity. COC index values <1 were divided into tertiles, with a fourth category for participants with maximum COC. Cox regression analysis was used to investigate the association between COC and survival time. ResultsSeven hundred and forty-two participants (43.3%) reported a maximum COC. Among the 759 participants surviving 17 years, 251 (33.1%) still had the same GP. The lowest COC category (index >0-0.500) showed significantly greater mortality than those in the maximum COC category (hazard ratio (HR) = 1.20, 95% CI = 1.01 to 1.42). There were no confounders that affected this HR. ConclusionThis study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care.

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Section: Resultsmentioning

confidence: 95%

Section: How This Fits Inmentioning

confidence: 99%

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Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study

et al. 2016

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“…1 Increasing continuity with an individual provider is associated with increased rates of guideline-concordant preventative care, 2 lower rates of hospitalization and emergency department (ED) utilization, 3,4 lower cost of care for patients with chronic disease, 5 and lower mortality among older adults. 6 However, it is unknown whether patients are more vulnerable to adverse outcomes in the period immediately following the transition to a new primary care provider.…”

Section: Introductionmentioning

confidence: 99%

Acute Care Utilization by Patients After Graduation of Their Resident Primary Care Physicians

et al. 2015

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BACKGROUND:The disruption in provider continuity caused by medical resident graduation may result in adverse patient outcomes. OBJECTIVE: Our aim was to investigate whether resident graduation was associated with increased acute care utilization by residents' primary care patients. DESIGN AND PARTICIPANTS: This was a retrospective cohort study of patients cared for by junior and senior residents finishing the academic year in 2010, 2011 and 2012. MAIN MEASURES: We compared rates of clinic visits, emergency department (ED) visits, and hospitalizations between transitioning patients whose residents were graduating and non-transitioning patients whose residents were not graduating. KEY RESULTS: Our study population comprised 90 residents, 4018 unique patients, and 5988 resident-patient dyads that transitioned (n=3136) or did not transition (n= 2852). For transitioning patients, the clinic visit rate per 100 patients in the 4 months before and after graduation was 129 and 102, respectively; for non-transitioning patients, the clinic visit rate was 119 and 94, respectively (difference-in-differences, +2 per 100 patients; p=0.12). For transitioning patients, the ED visit rate per 100 patients before and after graduation was 29 and 26, respectively; for non-transitioning patients, the ED visit rate was 28 and 25, respectively (difference-in-differences, 0; p=0.49). For transitioning patients, the hospitalization rate per 100 patients before and after graduation was 14 and 13, respectively; for non-transitioning patients, the hospitalization rate was 15 and 12, respectively (difference-in-differences, −2; p=0.20). In multivariable modeling there was no increased risk for transitioning patients for clinic visits (adjusted rate ratio [aRR], 1.03; 95 % confidence interval [CI], 0.97 to 1.10), ED visits (aRR, 1.05; 95 % CI, 0.92 to 1.20), or hospitalizations (aRR, 1.04; 95 % CI, 0.83 to 1.31). CONCLUSIONS: Acute care utilization by residents' patients did not increase or decrease after graduation. Acute care utilization was high before and after graduation. Interventions to decrease the need for acute care should be employed throughout the year.

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“…18,19 Despite broad consensus regarding these benefits, practice characteristics that improve IC remain poorly understood, and practice trends such as remote patient interactions and team-based care are leading to new dimensions of continuity outside of traditional face-to-face encounters. 20 With the advent of formal systems to evaluate and certify patient-centered medical homes (PCMHs), primary care practices increasingly are being asked to assess and report measures of continuity of care.…”

mentioning

confidence: 99%

Provider Practice Characteristics That Promote Interpersonal Continuity

Mittelstaedt

Mori²,

Lambert³

et al. 2013

The Journal of the American Board of Family Medicine

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Purpose: Becoming certified as a patient-centered medical home now requires practices to measure how effectively they provide continuity of care. To understand how continuity can be improved, we studied the association between provider practice characteristics and interpersonal continuity using the Usual Provider Continuity Index (UPC).Methods: We conducted a mixed-methods study of the relationship between provider practice characteristics and UPC in 4 university-based family medicine clinics. For the quantitative part of the study, we analyzed data extracted from monthly provider performance reports for 63 primary care providers (PCPs) between July 2009 and June 2010. We tested the association of 5 practice parameters on UPC:(1) clinic frequency; (2) panel size; (3) patient load (ratio of panel size to clinic frequency); (4) attendance ratio; and (5) duration in practice (number of years working in the current practice). Clinic, care team, provider sex, and provider type (physicians versus nonphysician providers) were analyzed as covariates. Simple and multiple linear regressions were used for statistical modeling. Findings from the quantitative part of the study were validated using qualitative data from provider focus groups that were analyzed using sequential thematic coding.Results: There were strong linear associations between UPC and both clinic frequency (␤ ‫؍‬ 0.94; 95% CI, 0.62-1.27) and patient load (␤ ‫؍‬ ؊0.37; 95% CI, ؊0.48 to ؊0.26). A multiple linear regression including clinic frequency, patient load, duration in practice, and provider type explained more than 60% of the variation in UPC (adjusted R 2 ‫؍‬ 0.629). UPC for nurse practitioners and physician assistants was more strongly dependent on clinic frequency and was at least as high as it was for physicians. Focus groups identified 6 themes as other potential sources of variability in UPC.Conclusions: Variability in UPC between providers is strongly correlated with variables that can be modified by practice managers. Our study suggests that patients assigned to nurse practitioners and physician assistants have continuity similar to those assigned to physicians. (J Am Board Fam Med 2013; 26:356 -365.)

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Continuity of Care with a Primary Care Physician and Mortality in Older Adults

Abstract: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

Cited by 94 publications

References 23 publications

Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study

Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study

Acute Care Utilization by Patients After Graduation of Their Resident Primary Care Physicians

Provider Practice Characteristics That Promote Interpersonal Continuity

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