ArticleBMC family practice2018
Interpersonal continuity of primary care of veterans with diabetes: a cohort study using electronic health record data.
Article in BMC family practice, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Measuring the Impact of Primary Care Team Composition on Patient Activation Utilizing Electronic Health Record Big Data Analytics.Journal of patient-centered research and reviews · 2024Article
- Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study.BMJ open quality · 2023Article
- When is caring sharing? Primary care provider interdependence and continuity of care.JAAPA : official journal of the American Academy of Physician Assistants · 2023Article
- Teaming up in primary care: Membership boundaries, interdependence, and coordination.JAAPA : official journal of the American Academy of Physician Assistants · 2022Article
- Utilization and Costs by Primary Care Provider Type: Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants?Medical care · 2020Article
- Relational continuity of oral health care in Indigenous communities: a qualitative study.BMC oral health · 2019Article
- Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study.PloS one · 2019Article
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Authors and funding
9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundContinuity of care is a cornerstone of primary care and is important for patients with chronic diseases such as diabetes. The study objective was to examine patient, provider and contextual factors associated with interpersonal continuity of care (ICoC) among Veteran's Health Administration (VHA) primary care patients with diabetes.
methodsThis patient-level cohort study (N = 656,368) used electronic health record data of adult, pharmaceutically treated patients (96.5% male) with diabetes at national VHA primary care clinics in 2012 and 2013. Each patient was assigned a "home" VHA facility as the primary care clinic most frequently visited, and a primary care provider (PCP) within that home clinic who was most often seen. Patient demographic, medical and social complexity variables, provider type, and clinic contextual variables were utilized. We examined the association of ICoC, measured as maintaining the same PCP across both years, with all variables simultaneously using logistic regression fit with generalized estimating equations.
resultsAmong VHA patients with diabetes, 22.3% switched providers between 2012 and 2013. Twelve patient, two provider and two contextual factors were associated with ICoC. Patient characteristics associated with disruptions in ICoC included demographic factors, medical complexity, and social challenges (example: homeless at any time during the year OR = 0.79, CI = 0.75-0.83). However, disruption in ICoC was most likely experienced by patients whose providers left the clinic (OR = 0.09, CI = 0.07-0.11). One contextual factor impacting ICoC included NP regulation (most restrictive NP regulation (OR = 0.79 CI = 0.69-0.97; reference least restrictive regulation).
conclusionsICoC is an important mechanism for the delivery of quality primary care to patients with diabetes. By identifying patient, provider, and contextual factors that impact ICoC, this project can inform the development of interventions to improve continuity of chronic illness care.
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