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

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  • Suzanne E Bentler
  • Robert O Morgan
  • Beth A Virnig
  • Fredric D Wolinsky

Abstract

Background: Continuity 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. Methods: We 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. Results: Patient-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. Conclusion: Our 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.

Suggested Citation

  • Suzanne E Bentler & Robert O Morgan & Beth A Virnig & Fredric D Wolinsky, 2014. "The Association of Longitudinal and Interpersonal Continuity of Care with Emergency Department Use, Hospitalization, and Mortality among Medicare Beneficiaries," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-18, December.
  • Handle: RePEc:plo:pone00:0115088
    DOI: 10.1371/journal.pone.0115088
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    References listed on IDEAS

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    1. Fredric D. Wolinsky & Thomas R. Miller & John F. Geweke & Elizabeth A. Chrischilles & Hyonggin An & Robert B. Wallace & Claire E. Pavlik & Kara B. Wright & Robert L. Ohsfeldt & Gary E. Rosenthal, 2007. "An Interpersonal Continuity of Care Measure for Medicare Part B Claims Analyses," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 62(3), pages 160-168.
    2. Mainous III, A.G. & Gill, J.M., 1998. "The importance of continuity of care in the likelihood of future hospitalization: Is site of care equivalent to a primary clinician?," American Journal of Public Health, American Public Health Association, vol. 88(10), pages 1539-1541.
    3. Henri Leleu & Etienne Minvielle, 2013. "Relationship between Longitudinal Continuity of Primary Care and Likelihood of Death: Analysis of National Insurance Data," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-6, August.
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    1. Topuz, Kazim & Urban, Timothy L. & Yildirim, Mehmet B., 2024. "A Markovian score model for evaluating provider performance for continuity of care—An explainable analytics approach," European Journal of Operational Research, Elsevier, vol. 317(2), pages 341-351.
    2. Wu, Yansi, 2023. "Impacts of Interpersonal Continuity between General Practitioners (GPs) and Patients on Health Outcomes: A Systematic Review," HERO Online Working Paper Series 2023:2, University of Oslo, Health Economics Research Programme.
    3. Chien-Lung Chan & Wender Lin & Nan-Ping Yang & K Robert Lai & Hsin-Tsung Huang, 2015. "Pre-Emergency-Department Care-Seeking Patterns Are Associated with the Severity of Presenting Condition for Emergency Department Visit and Subsequent Adverse Events: A Timeframe Episode Analysis," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-16, June.

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