The Association of Longitudinal and Interpersonal Continuity of Care with Emergency Department Use, Hospitalization, and Mortality among Medicare Beneficiaries

Bentler, Suzanne E.; Morgan, Robert O.; Virnig, Beth A; Wolinsky, Fredric D.

doi:10.1371/journal.pone.0115088

Cited by 50 publications

(68 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Optimal continuity of care is associated with decreased utilisation of EDs (12). Our results suggest an association between utilisation of multiple general practices and presentation to ED, in agreement with Wright and colleagues (7).…”

Section: Ed Utilisationsupporting

confidence: 91%

Characteristics of patients who access zero, one or multiple General Practices and reasons for their choices: a study in regional Australia.

Glenister

Guymer

Bourke

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care such as older people or those with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice or none.Methods: A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey.Results: Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance were reported as availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p<0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p=0.006) than single practice attendees.Conclusions: Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.

show abstract

Section: Ed Utilisationsupporting

confidence: 91%

Characteristics of patients who access zero, one or multiple General Practices and reasons for their choices: a study in regional Australia.

Glenister

Guymer

Bourke

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In a sensitivity analysis, the BB index score was divided into tertiles, not separating patients with scores of 0 and of 1. 24 The provider identification index 25 (see Supplementary Textbox 1, http://www.annfammed.org/content/15/6/515/suppl/DC1) requires an assigned clinician. The score for this index, which we termed appointed general practitioner index, is the proportion of visits during the study period to the general practitioner most recently visited before the index event of hospitalization for the case patients; we divided scores into quartiles.…”

Section: Measures Of Continuity Of Carementioning

confidence: 99%

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

et al. 2017

View full text Add to dashboard Cite

PURPOSE Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults. METHODSWe analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days. RESULTSIn the prospective cohort analysis, the BB index showed a graded, nonsignificant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity.CONCLUSIONS Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions. 2017;15:515-522. https://doi Ann Fam Med

show abstract

“…While numerous previous studies have shown associations between CoC and a wide range of health outcomes, the majority of these have dichotomised measures of CoC using arbitrary cut-points (e.g. CoC 0.75) (13,16,18), or score percentiles (12,14), while others have used CoC as a continuous variable (7,15). In this study, individuals with 'high' continuity (CoC ≥0.75) comprised both those with the highest (UPC or CoC Index 0.75-0.99) and lowest (UPC or CoC Index 1.0) odds of emergency hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

“…Empirical evidence suggests a beneficial effect of claimsbased CoC (11), mostly using density or dispersion measures, on health service utilisation (12)(13)(14)(15)(16), medication adherence (17), unnecessary medical procedures (7), cost (18) and health outcomes including mortality (12,19). However, little attention has been paid to further interrogating these associations, with most previous research assuming the linear effect of CoC on outcomes by treating this as a continuous (7,15) or a dichotomous variable (13,16,18).…”

Section: Introductionmentioning

confidence: 99%

Claims-based measures of continuity of care have non-linear associations with health: data linkage study

Tran¹,

Falster²,

Jorm³

2018

IJPDS

View full text Add to dashboard Cite

BackgroundContinuity of care (CoC) is considered a central element of good primary care and is often measured using medical claims data. Possible values of CoC depend on the number of claims which is related to health status. This study investigated the relationships between CoC and health status and risk of emergency hospitalisation. MethodsHealth insurance claims for consultations with general practitioners (GPs) in the 24 months following entry to the 45 and Up Study were used to calculate usual provider continuity (UPC) and the Continuity of Care Index (CoC Index). Relationships of CoC with number of claims, self-rated health and emergency hospitalisation were investigated using descriptive statistics and logistic regression models. ResultsBoth measures of CoC were strongly related to number of claims and to measures of health status, which were in turn highly associated. Multivariable logistic regression models showed a weak positive relationship between CoC and odds of emergency hospitalisation for those with CoC less than 1, while individuals with perfect CoC had significantly lower odds of hospitalisation compared to all other categories of CoC. However, analyses stratified by, or adjusting for, number of claims showed no clear associations between CoC and risk of hospitalisation. ConclusionsThe pattern of association between CoC categories and emergency hospitalisation was non-linear and was confounded by the effect of number of claims. Future studies should apply caution in using claims-based measures of CoC as a continuous variable or employing an arbitrary cut-point, and should adjust for number of claims.

show abstract

The Association of Longitudinal and Interpersonal Continuity of Care with Emergency Department Use, Hospitalization, and Mortality among Medicare Beneficiaries

Cited by 50 publications

References 38 publications

Characteristics of patients who access zero, one or multiple General Practices and reasons for their choices: a study in regional Australia.

Characteristics of patients who access zero, one or multiple General Practices and reasons for their choices: a study in regional Australia.

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

Claims-based measures of continuity of care have non-linear associations with health: data linkage study

Contact Info

Product

Resources

About