Continuity of Care and the Risk of Preventable Hospitalization in Older Adults

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.

More evidence of the benefits of a long term relationship with a particular provider for elderly patients.

Importance

Preventable hospitalizations are common among older adults for reasons that are not well understood.

Objective

To determine whether Medicare patients with ambulatory visit patterns indicating higher continuity of care have a lower risk of preventable hospitalization.

Results

Of the 3 276 635 eligible patients, 12.6% had a preventable hospitalization during their 2-year observation period, most commonly for congestive heart failure (25%), bacterial pneumonia (22.7%), urinary infection (14.9%), or chronic obstructive pulmonary disease (12.5%). After adjustment for patient baseline characteristics and market-level factors, a 0.1 increase in continuity of care according to either continuity metric was associated with about a 2% lower rate of preventable hospitalization (continuity of care score hazard ratio [HR], 0.98 [95% CI, 0.98-0.99; usual provider continuity score HR, 0.98 [95% CI, 0.98-0.98). Continuity of care was not related to mortality rates.

Conclusions and Relevance

Among fee-for-service Medicare beneficiaries older than 65 years, higher continuity of ambulatory care is associated with a lower rate of preventable hospitalization.