ArticleAnnals of family medicine2018
Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations.
Article in Annals of family medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 122 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
122 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Attributes of family physician encounters valued by older adults: a systematic review.BMC primary care · 2025Pooled it
- Pooled it
- Challenges in Help-Seeking Behaviors among Rural Older People Mitigated through Family Physician-Driven Outreach: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- 'It's what we should be doing anyway': using financial incentives to promote relational continuity in Australian General Practice-a nested case study analysis.Family practice · 2025Trial
- Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study.BMC health services research · 2023Trial
- Effectiveness of Quality Incentive Payments in General Practice (EQuIP-GP) cluster randomized trial: impact on patient-reported experience.Family practice · 2022Trial
- A randomized clinical trial of a new perioperative practice model on anxiety and health-related quality of life in arthroplasty patients.Nursing open · 2021Trial
- Continuity of care in the context of a primary health care reform: a follow-up after the SwedishScandinavian journal of primary health care · 2026Article
- Frequent attenders in primary health care in Finland: use of primary care services and patient characteristics.Scandinavian journal of primary health care · 2026Article
- Continuity in a fragmented healthcare system: - organizational and individual determinants.Scandinavian journal of primary health care · 2026Article
- 'We can go hand in hand' - patients with COPD and their experiences of relational continuity of care in Swedish primary care: a qualitative study.Scandinavian journal of primary health care · 2026Article
- Adolescent anorexia nervosa treated in primary care with a family-based method - long-term outcomes.Scandinavian journal of primary health care · 2026Article
- Continuity of care measurement across health systems: UK and US insights for global primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- The Power of Primary Care to Improve Health.Annals of family medicine · 2026Article
- Heart of patient-centred care is at home: Part 8 of the 10-part series, "Foundations for tomorrow".Canadian family physician Medecin de famille canadien · 2026Article
- Article
- Association of General Practice Continuity With Hospital Admissions and Costs: A Retrospective Study.Annals of family medicine · 2026Article
- [Validity of Starfield́s model in the chronic care strategies of the Canary Islands (2015-2024)].Atencion primaria · 2026Article
- Stakeholder-Perceived Needs in Early Community Nursing Implementation: A Qualitative Study.Nursing reports (Pavia, Italy) · 2026Article
- Article
62 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeContinuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality. However, we lack provider-level measures of primary care continuity amenable to value-based payment, including the Medicare Quality Payment Program (QPP). We created 4 physician-level, claims-based continuity measures and tested their associations with health care expenditures and hospitalizations.
methodsWe used Medicare claims data for 1,448,952 beneficiaries obtaining care from a nationally representative sample of 6,551 primary care physicians to calculate continuity scores by 4 established methods. Patient-level continuity scores attributed to a single physician were averaged to create physician-level scores. We used beneficiary multilevel models, including beneficiary controls, physician characteristics, and practice rurality to estimate associations with total Medicare Part A & B expenditures (allowed charges, logged), and any hospitalization.
resultsOur continuity measures were highly correlated (correlation coefficients ranged from 0.86 to 0.99), with greater continuity associated with similar outcomes for each. Adjusted expenditures for beneficiaries cared for by physicians in the highest Bice-Boxerman continuity score quintile were 14.1% lower than for those in the lowest quintile ($8,092 vs $6,958; β = -0.151; 95% CI, -0.186 to -0.116), and the odds of hospitalization were 16.1% lower between the highest and lowest continuity quintiles (OR = 0.839; 95% CI, 0.787 to 0.893).
conclusionsAll 4 continuity scores tested were significantly associated with lower total expenditures and hospitalization rates. Such indices are potentially useful as QPP measures, and may also serve as proxy resource-use measures, given the strength of association with lower costs and utilization.
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