title: Continuity of care with a primary care physician and mortality in older adults.
abstract: BACKGROUND
  We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.
  
  
  METHODS
  Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.
  
  
  RESULTS
  Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure).
  
  
  CONCLUSIONS
  Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.
authors.affiliation: Departments of Health Management and Policy and General Internal Medicine, The University of Iowa, 200 Hawkins Drive, E-205 General Hospital, Iowa City, IA 52242, USA. fredric-wolinsky@uiowa.edu
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Bentler
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: John F
authors.initials: JF
authors.lastname: Geweke
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cook
authors.forename: Maksym
authors.initials: M
authors.lastname: Obrizan
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Kara B
authors.initials: KB
authors.lastname: Wright
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jones
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ohsfeldt
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006299:Health Services for the Aged / Q000592:standards; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D010821:Physicians, Family