ORIGINAL RESEARCH
Mingliang Dai, PhD; Zachary Morgan, MS; Kyle Russel, MS; Beth Bortz, MPP; Lars Peterson, MD, PhD; Andrew Bazemore, MD, MPH
Corresponding Author: Mingliang Dai, PhD; American Board of Family Medicine
Email: mdai@theabfm.org
DOI: 10.3122/jabfm.2023.230119R1
Keywords: Continuity of Care, Cost, Cross-Sectional Studies, Medicare, Physicians, Primary Health Care, Virginia
Dates: Submitted: 03-24-2023; Revised: 07-05-2023; Accepted: 07-18-2023
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: Being one of the few existing measures of primary care functions, physician-level continuity of care (Phy-CoC) is measured by the weighted average of patient continuity scores. Compared to the well-researched patient-level continuity, Phy-CoC is a new instrument with limited evidence from Medicare beneficiaries. This study aimed to expand the patient sample to include patients of all ages and all types of insurance and re-assess the associations between full panel-based Phy-CoC scores and patient outcomes.
METHODS: Cross-sectional analysis at patient-level using Virginia All-Payer Claims Database. Phy-CoC scores were calculated by averaging patient’s Bice-Boxerman Index scores and weighted by the total number of visits. Patient outcomes included total cost and preventable hospitalization.
RESULTS: In a sample of 1.6 million Virginians, patients who lived in rural areas or had Medicare as primary insurance were more likely to be attributed to physicians with the highest Phy-CoC scores. Across all adult patient populations, we found that being attributed to physicians with higher Phy-CoC was associated with 7%-11.8% higher total costs, but was not associated with the odds of preventable hospitalization. Results from models with interactions revealed nuanced associations between Phy-CoC and total cost with patient’s age and comorbidity, insurance payer, and the specialty of their physician.
CONCLUSIONS: In this comprehensive examination of Phy-CoC using all populations from the VA-APCD, we found an overall positive association of higher full panel-based Phy-CoC with total cost, but a non-significant association with the risk of preventable hospitalization. Achieving higher full panel-based Phy-CoC may have unintended cost implications.