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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
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  • For correspondence: abazemore@aafp.org
Stephen Petterson
1Robert Graham Center for Policy Studies, Washington, DC
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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
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Richard Bruno
4Baltimore Medical System, Baltimore, Maryland
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Yoonkyung Chung
1Robert Graham Center for Policy Studies, Washington, DC
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Robert L. Phillips Jr
2American Board of Family Medicine, Lexington, Kentucky
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    Figure 1

    Distribution of physician-level continuity scores for 4 common individual measures.

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    Figure 2

    Physician characteristics associated with providing continuity of care (BB-COC), adjusted. (N = 6,551)

    BB-COC = Bice-Boxerman continuity of care; USMG = US medical graduate; IMG = international medical graduate.

    Notes: Source is 2011 Medicare Claims Data.1 Outcome is mean BB-COC score for patients receiving care from a primary care physician. See Supplemental Table 2 for regression results (Supplemental Table 2 available at http://www.annfammed.org/content/16/6/492/suppl/DC1/).

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    Figure 3

    Association between physician-level continuity of care (BB-COC) and outcomes.

    BB-COC = Bice-Boxerman continuity of care; Q = quintile.

    Notes: Source is 2011 Medicare Claims Data.1 Outcomes are (1) the natural log of allowed patient charges, and (2) whether or not the beneficiary was hospitalized in in 2011. Multilevel analysis of 1,178,369 beneficiaries and 6,551 primary care physicians. Models include controls for physician and patient characteristics (see Supplemental Table 3, available at http://www.annfammed.org/content/16/6/492/suppl/DC1/).

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  • The Article in Brief

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

    Andrew Bazemore , and colleagues

    Background Although continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality, there has been little research of continuity as a quality measure linked to policy-relevant outcomes. This study examines the relationship between physician-level continuity and health care expenditures and hospitalizations.

    What This Study Found An ongoing patient-physician relationship is strongly associated with lower total health care costs and decreased hospitalization rates. Based on 2011 Medicare claims data for 1,448,952 beneficiaries receiving care from a nationally representative sample of 6,551 primary care physicians, researchers created physician-level claims-based measures of continuity of care utilizing four established methods. When tested, all four continuity measures were strongly correlated with health care expenditures and hospitalizations. Of the beneficiaries obtaining some care from primary care physicians in the sample, 1,178,369 (81 percent) obtained most of their care from these physicians. In analyses of one of the established continuity measures (the Bice-Boxerman Continuity of Care Index), adjusted expenditures for beneficiaries cared for by physicians in the highest continuity quintile were $6,920, 15 percent lower than those in the lowest quintile ($7,664). The odds of any hospitalization were 16 percent lower for those with the greatest continuity compared to the lowest levels.

    Implications

    • This study contributes to the overwhelming evidence of the value of continuity care, the authors suggest, and offers quality measures that can be used and prioritized in value-based payment models.
    • As the American health care system shifts from paying for services to paying for value, continuity of care is one of several core tenets of primary care that should be incorporated into official primary care measures, according to the authors.
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The Annals of Family Medicine: 16 (6)
The Annals of Family Medicine
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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Subjects

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

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  • primary care
  • measurement

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