Continuity of care with a primary care physician and mortality in older adults.

TitleContinuity of care with a primary care physician and mortality in older adults.
Publication TypeJournal Article
Year of Publication2010
AuthorsWolinsky, FD, Bentler, SE, Liu, L, Geweke, JF, Cook, EA, Obrizan, M, Chrischilles, EA, Wright, KB, Jones, MP, Rosenthal, GE, Ohsfeldt, RL, Wallace, RB
JournalJ Gerontol A Biol Sci Med Sci
Date Published2010 Apr
ISSN Number1758-535X
Call Numbernewpubs20100519_Wolinsky.pdf
KeywordsAged, Continuity of Patient Care, Female, Health Services for the Aged, Humans, Male, Mortality, Physicians, Family

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

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Endnote Keywords

continuity of care/medicare/primary care physician/MORTALITY

Endnote ID


Alternate JournalJ Gerontol A Biol Sci Med Sci
Citation Key7443
PubMed ID19995831
PubMed Central IDPMC2844057
Grant ListU01 AG009740 / AG / NIA NIH HHS / United States