Category Archives: Primary care

Greater continuity of care associated with fewer preventable hospitalizations

Clinical Question

In the elderly Medicare population, does greater continuity of care lower the risk of preventable hospitalizations?

Bottom Line

Elderly patients who are treated by a smaller set of providers or by a single provider (ie, have greater continuity of care) may be less likely to have preventable hospitalizations. (LOE = 2b)

Reference

Nyweide DJ, Anthony DL, Bynum JP, et al. Continuity of care and the risk of preventable hospitalization in older adults. JAMA Intern Med 2013;173(20):1879-1885.

Study Design:  Cohort (retrospective)  Setting:  Outpatient

Funding: Government  Allocation: Concealed

Synopsis

Using Medicare data, these investigators identified preventable hospitalizations for Medicare fee-for-service beneficiaries older than 65 years using definitions previously provided by the Agency for Healthcare Research and Quality.Preventable hospitalizations were conditions that can potentially be treated with good outpatient care, such as asthma, chronic obstructive pulmonary disease, congestive heart failure, and bacterial pneumonia. Continuity of care was defined by 2 metrics: the continuity of care score and the usual provider continuity score. The continuity of care score measures physicians’ shares of a patient’s visits, with higher scores indicating a greater number of visits with fewer providers, whereas the usual provider continuity score measures the percentage of a patient’s total visits to a single provider. Both are scored on a scale from 0 to 1, with higher scores indicating greater continuity of care. Only data from patients with 4 or more visits during a course of a year were analyzed.Of approximately 3.2 million patients, 13% of this cohort had a preventable hospitalization over a 24-month observation period. These patients were more likely to have a higher illness burden at baseline and were more likely to have Medicaid dual eligibility. The top 2 reasons for preventable hospitalizations were congestive heart failure and bacterial pneumonia. As compared with those without preventable hospitalizations, patients with preventable hospitalizations had lower scores on both continuity metrics. After adjusting for patient characteristics, illness burden, and regional market-related and practice-related characteristics, a 0.1-unit increase in either continuity metric was associated with a 2% decrease in preventable hospitalizations.

Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL

Advertisements