The Role of Provider Continuity in Preventing Hospitalizations

OBJECTIVES: To examine the association between provider continuity and future hospitalization in a Medicaid population, and to determine if this association is greater for ambulatory care-sensitive conditions. DESIGN: Analysis of paid claims to the Delaware Medicaid program during a 2-year period (July 1, 1993, to June 30, 1995). Continuity with a single provider during year 1 of the study was computed for each participant. PARTICIPANTS: A total of 13,495 continuously enrolled fee-for-service Medicaid patients aged 0 to 64 years who had made at least 3 ambulatory physician visits during the first year of the study. MAIN OUTCOME MEASURE: Likelihood of hospitalization in year 2 of the study for all conditions and for ambulatory care-sensitive conditions. RESULTS: The mean continuity score was 0.50 in year 1 and 11.9% of patients were hospitalized in year 2. After controlling for demographics, number of ambulatory visits, and case mix, higher provider continuity was associated with a lower likelihood of hospitalization for any condition (odds ratio OR = 0.56; 95% confidence interval CI, 0.46-0.69). For chronic ambulatory care-sensitive conditions there was a similar association between provider continuity and hospitalization (OR = 0.54; 95% CI, 0.34-0.88), but for acute ambulatory care-sensitive conditions there was no significant association (OR = 0.80; 95% CI, 0.48-1.34). CONCLUSIONS: Continuity of care with a provider is associated with a decreased future likelihood of hospitalization in the Delaware Medicaid population. This suggests that policies that encourage patients to concentrate their care with a single provider may lead to lower hospitalization rates and possibly lower health care costs. This study does not support the hypothesis that a certain set of conditions are particularly ambulatory care sensitive.