In this systematic review, the authors summarized the wide range of peer-reviewed literature that links continuity of the doctor-patient relationship to health care costs and care utilization. This information is important to establish continuity measurement in value-based payment design.
The authors conducted a literature review of articles published between 2002 and 2022 about "continuity of care" and "continuity of patient care," as well as payor-relevant outcome categories, such as cost of care, health care costs, total cost of care, utilization, ambulatory care sensitive conditions (ACSC), and ACSC hospitalizations.
The authors found interpersonal continuity between the doctor and patient continues to be significantly associated with reduced health care costs and increased appropriate care utilization across the literature. Out of 83 studies, 18 examined the association between continuity and health care costs; 79 assessed the association between continuity and utilization. Studies from 2002 through 2022 reported significantly lower costs associated with interpersonal continuity. Overall, the authors found that much of the literature found that interpersonal continuity between the doctor and patient remains significantly associated with lower health care costs and more appropriate care utilization.
What We Know: Research published from 1962 to the early 2000's found that continuity of care was associated with decreased costs, improved health care utilization through fewer hospitalizations, and greater use of preventive services. In the 20 years since this research was published, health systems have undergone a rapid transformation including the improvement of health care data systems; adoption of the patient-centered medical home model; and growth in the number of insured patients.
What this Study Adds: The new systematic review of published medical literature reaffirms the potential power of continuity and its effects on patient care, which are important in an age of value-based payment systems that strive to reduce unnecessary health care spending and inappropriate medical usage.
The Impact of Interpersonal Continuity of Primary Care on Health Care Costs and Use: A Critical Review
Andrew Bazemore, MD, MPH, et al
The American Board of Family Medicine, Lexington, Kentucky
