Abstract

BackgroundContinuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit) relates to improved health outcomes and service use.MethodsWe linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period.ResultsPatient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality.ConclusionOur results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality.

Highlights

  • Continuity of care (CoC) is widely considered to be an essential component of high-quality patient care [1, 2], especially for older adults and those with multiple chronic conditions requiring consistent management and follow-up

  • There has not been a comprehensive evaluation of the association of continuity of care with subsequent health outcomes and health services use, especially for older adults, a few studies focusing on single outcomes like mortality and hospitalization for ambulatory care sensitive conditions have recently been reported [5, 6]

  • Continuity of care is considered a hallmark of high-performing primary care

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Summary

Introduction

Continuity of care (CoC) is widely considered to be an essential component of high-quality patient care [1, 2], especially for older adults and those with multiple chronic conditions requiring consistent management and follow-up. There has not been a comprehensive evaluation of the association of continuity of care with subsequent health outcomes and health services use, especially for older adults, a few studies focusing on single outcomes like mortality and hospitalization for ambulatory care sensitive conditions have recently been reported [5, 6]. Methods: We linked claims-based longitudinal continuity and survey-based selfreported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a fiveyear period. Conclusion: Our results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, PLOS ONE | DOI:10.1371/journal.pone.0115088 December 22, 2014

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