El conocimiento de la continuidad asistencial
http://www.annfammed.org/content/16/6/492.full

Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations

Andrew Bazemore, MD, MPH1⇑,

Abstract

PURPOSE Continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality. However, we lack provider-level measures of primary care continuity amenable to value-based payment, including the Medicare Quality Payment Program (QPP). We created 4 physician-level, claims-based continuity measures and tested their associations with health care expenditures and hospitalizations.

METHODS We used Medicare claims data for 1,448,952 beneficiaries obtaining care from a nationally representative sample of 6,551 primary care physicians to calculate continuity scores by 4 established methods. Patient-level continuity scores attributed to a single physician were averaged to create physician-level scores. We used beneficiary multilevel models, including beneficiary controls, physician characteristics, and practice rurality to estimate associations with total Medicare Part A & B expenditures (allowed charges, logged), and any hospitalization.

RESULTS Our continuity measures were highly correlated (correlation coefficients ranged from 0.86 to 0.99), with greater continuity associated with similar outcomes for each. Adjusted expenditures for beneficiaries cared for by physicians in the highest Bice-Boxerman continuity score quintile were 14.1% lower than for those in the lowest quintile ($8,092 vs $6,958; β = –0.151; 95% CI, –0.186 to –0.116), and the odds of hospitalization were 16.1% lower between the highest and lowest continuity quintiles (OR = 0.839; 95% CI, 0.787 to 0.893).

CONCLUSIONS All 4 continuity scores tested were significantly associated with lower total expenditures and hospitalization rates. Such indices are potentially useful as QPP measures, and may also serve as proxy resource-use measures, given the strength of association with lower costs and utilization.

INTRODUCTION

The Institute of Medicine labeled continuity of care a defining characteristic of primary care, one that Starfield and others demonstrated as essential to primary care's positive impact on health equity, cost reduction, and improved quality of care.^1-4 Described as an implicit contract between physician and patient in which the physician assumes ongoing responsibility for the patient,⁵ continuity frames the personal nature of medical care, in contrast to the dehumanizing nature of disjointed care.⁶ Building on the idea that knowledge, trust, and respect have developed between the patient and provider over time, allowing for better interaction and communication,⁷ continuity at the patient level is associated with a host of benefits.⁸

Primary care has more measures than any other sector under the federal Quality Payment Program (QPP), yet most of these are disease specific or process measures that do not capture the core primary care functions. Despite a variety of definitions and calculations over the last 40 years, little has been done to operationalize continuity as a quality measure linked to policy-relevant outcomes in the United States or other nations.⁹ Given current US attention to provider-level, vs practice-level, measures in its value-based purchasing reforms, the objective of our study was to examine the relationship between physician-level continuity and health care expenditures and hospitalizations.

Enviado desde mi iPhone