ArticleAnnals of family medicine
Impact of continuity of care on mortality and health care costs: a nationwide cohort study in Korea.
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75citing papers in PubMed, 4 pooled it
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Who cites it
75 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review.International journal of clinical pharmacy · 2023Pooled 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
- Primary medical care continuity and patient mortality: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Pooled it
- Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality.BMJ open · 2018Pooled it
- Optimising personal continuity for older patients in general practice: a cluster randomised stepped wedge pragmatic trial.BMJ open · 2024Trial
- Optimising personal continuity in general practice: process evaluation of a toolkit.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Article
- Effect of continuity of care on medical expenditures for hypertensive patients in high-altitude areas of China.Health policy and planning · 2026Article
- Categorizing continuity of care measures and why you have (probably) been doing it wrong: a methodological discussion and recommendations for researchers.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- Association between continuity of care and detection of hypertension in Dutch general practice: a 10-year cohort study.BMJ open · 2026Article
- Changes in patient-sharing patterns after oncologist departures in rural and urban settings: a Medicare cohort study.Applied network science · 2026Article
- Continuity of care for people with hypertension in primary health care: a scoping review.Revista da Escola de Enfermagem da U S P · 2026Article
- Diabetes management at the grass-root level without gatekeeping: exploring the association between primary care seeking and health outcomes.BMC primary care · 2025Article
- Evidence of Overlapping Roles Between Clinics and Hospitals in Primary Care.Journal of Korean medical science · 2025Article
- Article
- Impact of the Basic Mandatory Health Insurance "AMO-Tadamon" on Continuity of Care Among Breast Cancer Patients Treated at the Oncology Center of the CHU Mohammed VI in Tangier: A Mixed Longitudinal Cohort Study.Cancer management and research · 2025Article
- Association between continuity of primary care and preventable hospitalization in adults with asthma: A cohort study.PloS one · 2025Article
- Continuity of primary care and avoidable hospitalization in a young population with asthma: a population-based cohort study.Scientific reports · 2024Article
- Continuity of care and hospitalization frequency for ambulatory care-sensitive conditions after hearing-disability onset: a retrospective cohort study.Scientific reports · 2024Article
- Toward a universal definition of provider-patient attachment in primary care.Canadian family physician Medecin de famille canadien · 2024Review
15 more citing papers are in PubMed but not listed here.
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Authors and funding
10 authors.
Dong Wook ShinDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
Juhee ChoDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
Hyung Kook YangDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
Jae Hyun ParkDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
Hyejin LeeDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
Hyunsu KimDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
Juhwan OhDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
Soohee HwangDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.).
BeLong ChoDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.) belong@snu.ac.kr.
Eliseo GuallarDepartment of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea (D.W.S., H.L., H.K., B.C.); Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (D.W.S., H.L., B.C.); JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea (D.W.S.); Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (J.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C., E.G.); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.C.); Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea (H.K.Y.); Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (J.H.P.); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.O., H.K.Y.); Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea (S.H.); Department of Medicine and Welch Center for Prevention, Epidemiology, and Clincal Research, Johns Hopkins Medical Institutions, Baltimore, Maryland (E.G.); Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain (E.G.) eguallar@jhsph.edu.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeContinuity of care is considered a core element of high-quality primary care, but its impact on mortality and health care costs is unclear. We aimed to determine the impact of continuity of care on mortality, costs, and health outcomes in patients with newly diagnosed cardiovascular risk factors.
methodsWe conducted a cohort study of a 3% nationwide random sample of Korean National Health Insurance enrollees. A total of 47,433 patients who had received new diagnoses of hypertension, diabetes, hypercholesterolemia, or their complications in 2003 or 2004 were included. We determined standard indices of continuity of care-most frequent provider continuity (MFPC), modified, modified continuity index (MMCI), and continuity of care index (COC)-and evaluated their association with study outcomes over 5 years of follow-up. Outcome measures included overall mortality, cardiovascular mortality, incident cardiovascular events, and health care costs.
resultsThe multivariable-adjusted hazard ratios (HRs) for all-cause mortality, cardiovascular mortality, incident myocardial infarction, and incident ischemic stroke comparing participants with COC index below the median to those above the median were HR = 1.12 (95% CI, 1.04-1.21), 1.30 (1.13-1.50), 1.57 (1.28-1.95), and 1.44 (1.27-1.63), respectively. Similar findings were obtained for other indices of continuity of care. Lower continuity of care was also associated with increased inpatient and outpatient days and costs.
conclusionsLower indices of continuity of care in patients with newly diagnosed hypertension, diabetes, and hypercholesterolemia were associated with higher all-cause and cardiovascular mortality, cardiovascular events, and health care costs. Health care systems should be designed to support long-term trusting relationships between patients and physicians.
Indexed as
AdultAgedAged, 80 and overBrain IschemiaCohort StudiesContinuity of Patient CareDiabetes MellitusFemaleHealth Care CostsHumansHypercholesterolemiaHypertensionIncidenceMaleMiddle AgedMyocardial Infarctioncardiovascular diseasescontinuity of carehealth care costsmortality
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