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Research ArticleOriginal Research

Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations

Andrew Bazemore, Stephen Petterson, Lars E. Peterson, Richard Bruno, Yoonkyung Chung and Robert L. Phillips
The Annals of Family Medicine November 2018, 16 (6) 492-497; DOI: https://doi.org/10.1370/afm.2308
Andrew Bazemore
1Robert Graham Center for Policy Studies, Washington, DC
MD, MPH
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  • For correspondence: abazemore@aafp.org
Stephen Petterson
1Robert Graham Center for Policy Studies, Washington, DC
PhD
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Lars E. Peterson
2American Board of Family Medicine, Lexington, Kentucky
3Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
MD, PhD
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Richard Bruno
4Baltimore Medical System, Baltimore, Maryland
MD, MPH
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Yoonkyung Chung
1Robert Graham Center for Policy Studies, Washington, DC
PhD
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Robert L. Phillips Jr
2American Board of Family Medicine, Lexington, Kentucky
MD, MSPH
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Abstract

PURPOSE Continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality. However, we lack provider-level measures of primary care continuity amenable to value-based payment, including the Medicare Quality Payment Program (QPP). We created 4 physician-level, claims-based continuity measures and tested their associations with health care expenditures and hospitalizations.

METHODS We used Medicare claims data for 1,448,952 beneficiaries obtaining care from a nationally representative sample of 6,551 primary care physicians to calculate continuity scores by 4 established methods. Patient-level continuity scores attributed to a single physician were averaged to create physician-level scores. We used beneficiary multilevel models, including beneficiary controls, physician characteristics, and practice rurality to estimate associations with total Medicare Part A & B expenditures (allowed charges, logged), and any hospitalization.

RESULTS Our continuity measures were highly correlated (correlation coefficients ranged from 0.86 to 0.99), with greater continuity associated with similar outcomes for each. Adjusted expenditures for beneficiaries cared for by physicians in the highest Bice-Boxerman continuity score quintile were 14.1% lower than for those in the lowest quintile ($8,092 vs $6,958; β = –0.151; 95% CI, –0.186 to –0.116), and the odds of hospitalization were 16.1% lower between the highest and lowest continuity quintiles (OR = 0.839; 95% CI, 0.787 to 0.893).

CONCLUSIONS All 4 continuity scores tested were significantly associated with lower total expenditures and hospitalization rates. Such indices are potentially useful as QPP measures, and may also serve as proxy resource-use measures, given the strength of association with lower costs and utilization.

Key words
  • continuity
  • primary care
  • measurement
  • Received for publication April 18, 2018.
  • Revision received August 1, 2018.
  • Accepted for publication August 10, 2018.
  • © 2018 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 16 (6)
The Annals of Family Medicine: 16 (6)
Vol. 16, Issue 6
November/December 2018
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Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations
Andrew Bazemore, Stephen Petterson, Lars E. Peterson, Richard Bruno, Yoonkyung Chung, Robert L. Phillips
The Annals of Family Medicine Nov 2018, 16 (6) 492-497; DOI: 10.1370/afm.2308

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Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations
Andrew Bazemore, Stephen Petterson, Lars E. Peterson, Richard Bruno, Yoonkyung Chung, Robert L. Phillips
The Annals of Family Medicine Nov 2018, 16 (6) 492-497; DOI: 10.1370/afm.2308
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More in this TOC Section

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Subjects

  • Person groups:
    • Vulnerable populations
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health services
  • Core values of primary care:
    • Continuity

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