title: Continuity of care and the risk of preventable hospitalization in older adults.
abstract: OBJECTIVE
  Preventable hospitalizations are common among older adults for reasons that are not well understood.
  
  
  OBJECTIVE
  To determine whether Medicare patients with ambulatory visit patterns indicating higher continuity of care have a lower risk of preventable hospitalization.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Ambulatory visits and hospital admissions.
  
  
  METHODS
  Continuously enrolled fee-for-service Medicare beneficiaries older than 65 years with at least 4 ambulatory visits in 2008.
  
  
  METHODS
  The concentration of patient visits with physicians measured for up to 24 months using the continuity of care score and usual provider continuity score on a scale from 0 to 1.
  
  
  METHODS
  Index occurrence of any 1 of 13 preventable hospital admissions, censoring patients at the end of their 24-month follow-up period if no preventable hospital admissions occurred, or if they died.
  
  
  RESULTS
  Of the 3,276,635 eligible patients, 12.6% had a preventable hospitalization during their 2-year observation period, most commonly for congestive heart failure (25%), bacterial pneumonia (22.7%), urinary infection (14.9%), or chronic obstructive pulmonary disease (12.5%). After adjustment for patient baseline characteristics and market-level factors, a 0.1 increase in continuity of care according to either continuity metric was associated with about a 2% lower rate of preventable hospitalization (continuity of care score hazard ratio [HR], 0.98 [95% CI, 0.98-0.99; usual provider continuity score HR, 0.98 [95% CI, 0.98-0.98). Continuity of care was not related to mortality rates.
  
  
  CONCLUSIONS
  Among fee-for-service Medicare beneficiaries older than 65 years, higher continuity of ambulatory care is associated with a lower rate of preventable hospitalization.
authors.affiliation: Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation, Baltimore, Maryland.
authors.forename: David J
authors.initials: DJ
authors.lastname: Nyweide
authors.forename: Denise L
authors.initials: DL
authors.lastname: Anthony
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
authors.forename: Robert L
authors.initials: RL
authors.lastname: Strawderman
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.forename: Elliott S
authors.initials: ES
authors.lastname: Fisher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D018570:Risk Assessment; D014481:United States
references.citation: J Gen Intern Med. 2008 Sep;23(9):1499-502
references.pmid: 18563492
references.citation: Health Care Financ Rev. 2004 Summer;25(4):119-41
references.pmid: 15493448
references.citation: Health Care Financ Rev. 2008 Spring;29(3):27-42
references.pmid: 18567241
references.citation: Health Aff (Millwood). 2001 Mar-Apr;20(2):225-32
references.pmid: 11260947
references.citation: Med Care Res Rev. 2006 Apr;63(2):158-88
references.pmid: 16595410
references.citation: Arch Fam Med. 1999 Nov-Dec;8(6):487-91
references.pmid: 10575386
references.citation: BMJ. 2003 Nov 22;327(7425):1219-21
references.pmid: 14630762
references.citation: N Engl J Med. 2010 Jul 1;363(1):45-53
references.pmid: 20463332
references.citation: Med Care. 1976 May;14(5):377-91
references.pmid: 1271879
references.citation: Annu Rev Public Health. 1999;20:145-57
references.pmid: 10352854
references.citation: Ann Intern Med. 2004 Oct 5;141(7):533-6
references.pmid: 15466770
references.citation: J Med Educ. 1975 Oct;50(10):965-9
references.pmid: 1159765
references.citation: N Engl J Med. 2007 Mar 15;356(11):1130-9
references.pmid: 17360991
references.citation: Health Qual Life Outcomes. 2009 Sep 08;7:82
references.pmid: 19737412
references.citation: Am J Public Health. 1997 May;87(5):811-6
references.pmid: 9184511
references.citation: JAMA. 1984 Nov 2;252(17):2413-7
references.pmid: 6481927
references.citation: Arch Fam Med. 1998 Jul-Aug;7(4):352-7
references.pmid: 9682689
references.citation: Med Care. 1977 Apr;15(4):347-9
references.pmid: 859364
references.citation: JAMA. 1995 Jul 26;274(4):305-11
references.pmid: 7609259
references.citation: Arch Intern Med. 2010 Oct 11;170(18):1671-7
references.pmid: 20937927
references.citation: Public Health Rep. 2004 May-Jun;119(3):263-70
references.pmid: 15158105
references.citation: Pediatrics. 2001 Mar;107(3):524-9
references.pmid: 11230593
references.citation: Med Care. 1998 Jun;36(6):804-17
references.pmid: 9630122
references.citation: Pediatrics. 1999 Apr;103(4 Pt 1):738-42
references.pmid: 10103295
references.citation: JAMA. 2008 Aug 20;300(7):834-5
references.pmid: 18714064
references.citation: Health Aff (Millwood). 1998 Mar-Apr;17(2):177-89
references.pmid: 9558796