%0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2010 %T Continuity of care with a primary care physician and mortality in older adults. %A Frederic D Wolinsky %A Suzanne E Bentler %A Li Liu %A John F Geweke %A Elizabeth A Cook %A Maksym Obrizan %A Elizabeth A Chrischilles %A Kara B Wright %A Michael P Jones %A Gary E Rosenthal %A Robert L. Ohsfeldt %A Robert B Wallace %K Aged %K Continuity of Patient Care %K Female %K Health Services for the Aged %K Humans %K Male %K Mortality %K Physicians, Family %X

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.

%B J Gerontol A Biol Sci Med Sci %I 65A %V 65 %P 421-8 %8 2010 Apr %G eng %N 4 %L newpubs20100519_Wolinsky.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19995831?dopt=Abstract %2 PMC2844057 %4 continuity of care/medicare/primary care physician/MORTALITY %$ 21950 %R 10.1093/gerona/glp188