title: The association of longitudinal and interpersonal continuity of care with emergency department use, hospitalization, and mortality among Medicare beneficiaries.
abstract: BACKGROUND
  Continuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit) relates to improved health outcomes and service use.
  
  
  METHODS
  We linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period.
  
  
  RESULTS
  Patient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality.
  
  
  CONCLUSIONS
  Our results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality.
authors.affiliation: The Public Policy Center, The University of Iowa, 217 South Quad, Iowa City, IA 52242, United States of America.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Bentler
authors.affiliation: Division of Management, Policy, and Community Health, The University of Texas School of Public Health, 1200 Herman Pressler, E343, Houston, TX 77030, United States of America.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
authors.affiliation: Division of Health Services Research and Policy, University of Minnesota School of Public Health, N504 Boynton, 410 Church St SE, Minneapolis, MN 55455, United States of America.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.affiliation: Department of Health Management and Policy, The University of Iowa College of Public Health, N211-CPHB, 105 North River Street, Iowa City, IA 52246, United States of America.
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care; D003710:Demography; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D014481:United States