The association of longitudinal and interpersonal continuity of care with emergency department use, hospitalization, and mortality among Medicare beneficiaries

PLoS One. 2014 Dec 22;9(12):e115088. doi: 10.1371/journal.pone.0115088. eCollection 2014.


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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Continuity of Patient Care*
  • Demography
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Longitudinal Studies
  • Male
  • Medicare
  • Proportional Hazards Models
  • Quality Assurance, Health Care*
  • Surveys and Questionnaires
  • United States

Grants and funding

This work was supported by an Alvin R. Tarlov & John E. Ware Jr. Doctoral Dissertation Award ( awarded to SB and funds from the University of Iowa John W. Colloton Chair awarded to FW. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.