title: Continuity of outpatient and inpatient care by primary care physicians for hospitalized older adults.
abstract: BACKGROUND
  Little is known about the extent of continuity of care across the transition from outpatient care to hospitalization.
  
  
  OBJECTIVE
  To describe continuity of care in older hospitalized patients, change in continuity over time, and factors associated with discontinuity.
  
  
  METHODS
  A retrospective cohort study of 3,020,770 hospital admissions between 1996 and 2006 using enrollment and claims data for a 5% national sample of Medicare beneficiaries older than 66 years. Data files were constructed to include the patients' demographic and enrollment information (denominator file) and claims for hospital stays (MEDPAR file) and physician services (carrier claims file). Characteristics of the hospitals were included in annual provider of services files. Being seen by a physician was defined as when a physician had submitted a bill for evaluation and management services for that patient.
  
  
  METHODS
  Percentage of patients who during hospitalization were seen by any outpatient physician they had visited in the year before hospitalization (continuity with any outpatient physician) or by their primary care physician (PCP) (continuity with a PCP).
  
  
  RESULTS
  In 1996, 50.5% (95% confidence interval [CI], 50.3%-50.7%) of hospitalized patients were seen by at least 1 physician that they had visited in an outpatient setting in the prior year, and 44.3% (95% CI, 44.1%-44.6%) of patients with an identifiable PCP were seen by that physician while hospitalized. These percentages decreased to 39.8% (95% CI, 39.6%-40.0%) and 31.9% (95% CI, 31.6%-32.1%), respectively, in 2006. Greater absolute decreases in continuity with any outpatient physician between 1996 and 2006 occurred in patients admitted on weekends (13.9%; 95% CI, 12.9%-14.7%) and those living in large metropolitan areas (11.7%; 95% CI, 11.1%-12.3%) and in New England (16.2%; 95% CI, 14.4%-18.0%). In multivariable multilevel models, increasing involvement of hospitalists was associated with approximately one-third of the decrease in continuity of care between 1996 and 2006.
  
  
  CONCLUSIONS
  Between 1996 and 2006, physician continuity from outpatient to inpatient settings decreased in the Medicare population.
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, JSA-5.112, Galveston, TX 77555-0561, USA. gulshan.sharma@utmb.edu
authors.forename: Gulshan
authors.initials: G
authors.lastname: Sharma
authors.forename: Kathlyn E
authors.initials: KE
authors.lastname: Fletcher
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Jean L
authors.initials: JL
authors.lastname: Freeman
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data / Q000639:trends; D020445:Hospitalists / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare; D010821:Physicians, Family / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States