The role of provider continuity in preventing hospitalizations.
OBJECTIVE
To examine the association between provider continuity and future hospitalization in a Medicaid population, and to determine if this association is greater for ambulatory care-sensitive conditions.


METHODS
Analysis of paid claims to the Delaware Medicaid program during a 2-year period (July 1, 1993, to June 30, 1995). Continuity with a single provider during year 1 of the study was computed for each participant.


METHODS
A total of 13,495 continuously enrolled fee-for-service Medicaid patients aged 0 to 64 years who had made at least 3 ambulatory physician visits during the first year of the study.


METHODS
Likelihood of hospitalization in year 2 of the study for all conditions and for ambulatory care-sensitive conditions.


RESULTS
The mean continuity score was 0.50 in year 1 and 11.9% of patients were hospitalized in year 2. After controlling for demographics, number of ambulatory visits, and case mix, higher provider continuity was associated with a lower likelihood of hospitalization for any condition (odds ratio [OR] = 0.56; 95% confidence interval [CI], 0.46-0.69). For chronic ambulatory care-sensitive conditions there was a similar association between provider continuity and hospitalization (OR = 0.54; 95% CI, 0.34-0.88), but for acute ambulatory care-sensitive conditions there was no significant association (OR = 0.80; 95% CI, 0.48-1.34).


CONCLUSIONS
Continuity of care with a provider is associated with a decreased future likelihood of hospitalization in the Delaware Medicaid population. This suggests that policies that encourage patients to concentrate their care with a single provider may lead to lower hospitalization rates and possibly lower health care costs. This study does not support the hypothesis that a certain set of conditions are particularly ambulatory care sensitive.
Department of Family and Community Medicine, Christiana Care Health System, Wilmington, Del., USA. Gill.J@christianacare.org
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D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D003691:Delaware; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D016017:Odds Ratio; D010817:Physician-Patient Relations; D014481:United States