title: The Association Between Continuity of Care and the Overuse of Medical Procedures.
abstract: OBJECTIVE
  Both the overuse of unnecessary medical procedures and poor continuity of care are thought to contribute to high health care spending and poor patient outcomes.
  
  
  OBJECTIVE
  To investigate the association between care continuity and use of potentially unnecessary procedures.
  
  
  METHODS
  Observational retrospective cohort (n = 1,208,250 patients > 65 years) using 5% Medicare fee-for-service claims from 2008.
  
  
  METHODS
  We evaluated continuity using the Bice-Boxerman continuity of care index. We measured overuse using a previously validated set of 19 potentially overused procedures.
  
  
  RESULTS
  Altogether, 14.7% of patients received at least 1 potentially overused procedure during the calendar year. For each 0.1 increase in the continuity score (0.4 SDs), patients had 0.93 times the odds of receiving overused procedures than those with lower scores (95% CI, 0.93-0.94). Higher continuity was significantly associated with lower odds of 9 procedures (Holm-Bonferroni corrected P < .02 was significant: 6 of 13 diagnostic tests [with ORs, 0.84-0.99; P  < .001] and 3 therapeutic procedures [with ORs 0.81-0.87; P <.001]). Conversely, higher continuity was significantly associated with increased overuse for 3 procedures (1 diagnostic test [OR, 1.06; P < .001], 1 of 2 screening tests [OR, 1.05; P < .001], and the single monitoring test [OR, 1.03; P < .01]).
  
  
  CONCLUSIONS
  Increased continuity was associated with an overall decrease in overuse, suggesting a potential benefit of high-continuity care; however, the strength and direction of the association varied according to the specific procedure.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Max J
authors.initials: MJ
authors.lastname: Romano
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Craig Evan
authors.initials: CE
authors.lastname: Pollack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*