ArticleJAMA internal medicine2014
Continuity and the costs of care for chronic disease.
Article in JAMA internal medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 200 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
200 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The effectiveness of continuity of care in patients with inflammatory bowel disease: a systematic review.BMC gastroenterology · 2024Pooled it
- Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review.BMC family practice · 2021Pooled it
- Care Coordination and Hospitalization in Older Adults With or at Risk for Cardiovascular Disease: A Randomized Clinical Trial.JAMA network open · 2026Trial
- Optimising personal continuity for older patients in general practice: a cluster randomised stepped wedge pragmatic trial.BMJ open · 2024Trial
- Adherence to osteoporosis therapy after an upper extremity fracture: a pre-specified substudy of the C-STOP randomized controlled trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Trial
- Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis.Contemporary clinical trials · 2015Trial
- Cost savings from primary care clinic continuity among patients with chronic disease in Alberta, Canada: a retrospective population-level cross-sectional study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Association of Reduction in Continuity of Care During COVID-19 Pandemic With Cardiovascular Diseases, Kidney Failure and All-Cause Mortality for People With Diabetes: A Cohort Study in Hong Kong.Diabetes, obesity & metabolism · 2026Article
- Ambulatory Care Follow-Up and Fragmentation After Emergency Department Visits Among Older Adults.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2026Article
- The association between health literacy and out-of-pocket health expenditure: exploring heterogeneity by chronic disease in Zhejiang, China.International journal for equity in health · 2026Article
- Continuity of care and patient-reported experiences in Norwegian general practice: are they linked, and does the measurement of continuity matter?Family practice · 2026Article
- Article
- Assessing the importance and feasibility of quality measures for chiropractic care: a national survey of U.S. chiropractors.Chiropractic & manual therapies · 2026Article
- Patient-Physician Ethnic Concordance and its Impact on Care Continuity: First Evidence from Tibet.Journal of racial and ethnic health disparities · 2026Article
- Post-Intensive Care Fragmentation Among Rural Veterans: Transitions Between VA and Community Health Systems.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Continuity of care and risk of vision loss in patients with newly developed macular degeneration.Acta ophthalmologica · 2026Article
- A Proposed Checklist for Optimizing COPD Patient Discharge Processes in Italian Internal Medicine Wards.International journal of chronic obstructive pulmonary disease · 2026Review
- Continuous care based on hierarchical nursing for cirrhosis rehabilitation: a retrospective cohort study.Frontiers in medicine · 2026Article
- Examining the Intersectional and Structural Issues of Routine Healthcare Utilization and Access Inequities for LGB People with Chronic Diseases.International journal of environmental research and public health · 2025Article
- Continuity of Primary Care and Preventable Hospitalization for Acute Conditions: A Machine Learning-Based Record Linkage Study.Annals of family medicine · 2025Article
140 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
importanceBetter continuity of care is expected to improve patient outcomes and reduce health care costs, but patterns of use, costs, and clinical complications associated with the current patterns of care continuity have not been quantified.
objectiveTo measure the association between care continuity, costs, and rates of hospitalizations, emergency department visits, and complications for Medicare beneficiaries with chronic disease. DESIGN, SETTING, AND
participantsRetrospective cohort study of insurance claims data for a 5% sample of Medicare beneficiaries experiencing a 12-month episode of care for congestive heart failure (CHF, n = 53,488), chronic obstructive pulmonary disease (COPD, n = 76,520), or type 2 diabetes mellitus (DM, n = 166,654) in 2008 and 2009. MAIN OUTCOMES AND MEASURES: Hospitalizations, emergency department visits, complications, and costs of care associated with the Bice-Boxerman continuity of care (COC) index, a measure of the outpatient COC related to conditions of interest.
resultsThe mean (SD) COC index was 0.55 (0.31) for CHF, 0.60 (0.34) for COPD, and 0.50 (0.32) for DM. After multivariable adjustment, higher levels of continuity were associated with lower odds of inpatient hospitalization (odds ratios for a 0.1-unit increase in COC were 0.94 [95% CI, 0.93-0.95] for CHF, 0.95 [0.94-0.96] for COPD, and 0.95 [0.95-0.96] for DM), lower odds of emergency department visits (0.92 [0.91-0.92] for CHF, 0.93 [0.92-0.93] for COPD, and 0.94 [0.93-0.94] for DM), and lower odds of complications (odds ratio range, 0.92-0.96 across the 3 complication types and 3 conditions; all P < .001). For every 0.1-unit increase in the COC index, episode costs of care were 4.7% lower for CHF (95% CI, 4.4%-5.0%), 6.3% lower for COPD (6.0%-6.5%), and 5.1% lower for DM (5.0%-5.2%) in adjusted analyses. CONCLUSIONS AND RELEVANCE: Modest differences in care continuity for Medicare beneficiaries are associated with sizable differences in costs, use, and complications.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.