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The continuity of the doctor depends on the high level of primary care and hospitalization

  1. Robert L. Phillips ml, MD, MSPH2
  1. 1Robert Graham's Policy Research Center, Washington, DC
  2. 2American Family Medicine Administration, Lexington, Kentucky
  3. 3Kentucky, Lexington, Kentucky, Department of Family and Public Medicine
  4. 4Baltimore Medical System, Baltimore, MD
  1. COMMISSION Author: Andrew Basemor, MD, MPH, Robert Graham's Policy Research Center, 1133 Connecticut Ave NW, # 1100, Washington,
    DC 20036, abazemore {a}


THE GOAL Continuity of care is a description of the initial characteristics associated with the reduction of initial costs and improvement of health
care quality. However, there are no provider-level measures that ensure continuity of cost-based primary health care, including
Medicare Quality Program (QPP). At the level of four doctors, we have compiled the continuum-based claims and checked them
health and hospital-related associations.

METHODS We used Medicare claims data for 1 448 952 beneficiaries to get medical care
Calculation of indices of continuity of primary health care doctors by 4 fixed methods. Patients' continuity scores
it was common for a doctor to make a medical grade score. We used multi-level beneficiary samples, including beneficiaries
work in rural areas to evaluate Medicare Part A & B costs for monitoring, medical descriptions and community assessments
(allowance, registered) and hospitalization.

RESULTS Our continuity measures are highly correlated (correlation coefficients ranged from 0.86 to 0.99), continuity
with similar results for each. Adjustment costs for beneficiaries who expect the highest level of doctors
Bis-Bokerman's continuity index was 14.1% lower than the quintile lowest quintile ($ 8.092 to $ 6.958, β = -0.151;
95% CI, -0,186 -0,116), and hospitalization rates between highest and lowest continuous quintiles were 16.1% lower
(OR = 0.839, 95% CI, 0.787-0.893).

CONCLUSION All 4 uncertainty scores were significantly associated with the overall costs and reduced hospitalization rates. Such
indices are potentially useful as QPP measures, and can be used as resource proofing measures, given the strength of the community
low costs and use.



The Medical Institute has identified the continuity of treatment as the first aid care, Starfield and others
primary health care has had a positive impact on health, equity and mitigation.1-4 It is described as a concrete agreement between a doctor and a patient about the responsibility of the physician
patient,5 Continuity depends on the individuality of medical care, and the unselfishness of disability.6 Over time, the patient and the provider are motivated by the idea of ​​gaining knowledge, confidence, and respect
for interaction and communication,7 At the patient level, continuity is associated with many benefits.8

The first care has more activities than any other sector under the federal Quality Payroll Program (QPP), but most of them
Actual or procedural measures for diseases that do not include primary primary health care functions. Regardless of the various definitions
and as a quality measure for succession in the calculations of the last 40 years
Policy results in the United States or elsewhere.9 Taking into account the actions of the US to reducing procurement, based on the level of the provider's level, experience and value,
our study was to examine the relationship between continuity of the doctor's level and the relationship between health expenditure and hospitalization.



In 2011, we used a US national median complaint data for 1 448 952 beneficiaries in the United States to obtain primary health care
samples of primary care physicians (n ​​= 6,551), including family doctors, general practitioners and general practitioners
(but not gereriums), 4 measures for calculating the duration of treatment at the initial level of patients (regular providers' continuity
[UPC] index,10 The continuity of care provided by Bissauer [BB-COC],11 Modified modified index of continuity [MMCI],12 and the Herfindahl Index [HI]13). These four activities were selected after a comprehensive review of the relevant literature
and frequently used continuity measures. They are created in several different areas: (1) the density of the visitor's service
(UPC), (2) the prevalence of different ISPs (UPC, BB-COC, MMCI) and (3)
the actual provider (HI). According to the preliminary view, we handed over each beneficiary to a single primary healthcare professional
who provided the first aid to the outpatient patient with the same beneficiary.14 We have been using hospitals previously described methods,15 Beneficiaries under the age of 65 have one or more primary health care providers and doctors with less than 30 beneficiaries.

Continuity measures

For all patients with 2 or more visits, we calculated the 4 succession measures from the use data. Patient level continuity
Then, the average score makes up the level of medical scores using each of the 4 levels. The number of points was measured
thereby increasing the continuity of beneficiaries to obtain primary health care.


We have achieved 2 results: (1) natural recording of total costs based on the costs incurred for section A (stationary, qualified
nurse, hospice care) and section B (outpatient visits, laboratories, X-ray, prophylaxis services); and (2) or
The beneficiary was not hospitalized in 2011. We made the changed Charlson rating16 and the first aid to each patient. Using the postal code provided by your primary care provider
Most of their care was taken by two measures: (1) Categories of district codes in rural cities (urban, large rural,
small rural, isolated rural / border)17; and (2) the region. Data on medical specialty were identified from the protest data. From the American Medical Association's Masterfile,
we have identified the country of medical school and the year of graduation.


For the first time we used descriptive statistics and simple dual analysis to explore the 4 statistical continuity consolidation
patients, geographical and medical characteristics. We evaluated the multi-level model of the beneficiary we are evaluating
costs incurred by the beneficiary (age, sex, race, charleston) and hospitalization
points) and characteristics of a physician (graduation year, international training, gender, rural). Taking into account the accuracy of doctors
In smaller countries, we have included data for national data acquisition. We used commonly used the cost analysis
linear model with gamma distribution and log point. We used a logistic model for hospitalization. We value it separately
Models for each of the four successive measures.

All analyzes were made by Stata version 14.2 (StataCorp LLC).18 All tests of importance were 2-sided. Significant results have been identified P <.01. This study was endorsed by the Institutional Expertise Board of American Family Physicians.


We have found a strong correlation with four continuing measures; correlation coefficients ranged from 0.86 to 0.99 (see Appendix
Table 1, All of them were allocated in normal conditions, but negative (left) curves (Figure 1). After graduating from the doctors, many years, there were many drug addicts and people working in rural areas
continuous care provision. Primary health care practitioners in the West are unable to provide continuous care (see Figure 2, Annex 2 available at

Figure 1

Distribution of drug-grade continuity scores according to total 4 separate measures.

Picture 2
Picture 2

The characteristics of the care provider (BB-COC) have been corrected. (N = 6,551)

BB-COC = Bice-Boxer Care Continuity; USMG = US Medical Outlet; IMG = graduate of international medicine.

Note: Source: 2011 Medical complaints Data.1. The result is a mean score of BB-COC for patients who care for primary health care
doctor. See Table 2 in addition to the regression results (Annex 2 is available at

As a quality measure for children's care, the BB-COC affirms the quality forum and is closely linked.
With our sophisticated needs, we chose BB-COC to show our conclusions. Parallel result for other 3 continuity measures
are shown in Table 3 (Annex 3

Out of 1,448,952 beneficiaries, 6,551 primary health care providers have received 1,178,369 (81.1%) of our sample,
most of them took care of. Corrected expenses to beneficiaries who have sought medical help from the CB-COS
quintile ($ 6,958) was lower by 14.1% compared to the lower quintile ($ 8,092) (β = -0,151, 95% CI, -0,186 -0,116).
Any hospitalization opportunities are comparable to the lowest quintile (OR
= 0.839; 95% CI, 0.787-0.893) (Fig. 3). An analysis of alternative continuum measures has led to similar results (see Annex 3, available at Decrease in allowable payments from the highest quintiles was from 12.4% to 15.7% (UPC and HI). Similarly,
the incidence of hospitalization from the highest to the lower quintile was 15.7% to 17.1% (ICRC).

Figure 3Figure 3
Figure 3

The link between the drug's continuity (BB-COC) and its outcome.

BB-COC = Bice-Boxer Care Continuity; Q = quintile.

Note: Source: 2011 Medicare Claims Data.1. The results are: (1) a natural journal of patients' expense; and (2)
or the beneficiary was not hospitalized in 2011. Multi-level analysis of 1 178 369 beneficiaries and 6,551 primary health care services
doctors. The models include the control of the physician and the patient's characteristics (see


We found a high level of drug-grade uptake, basic principles of primary health care and strong relationships from lower levels
general health and hospitalization. These conclusions support international conclusions19 and previous expertise of Medicare beneficiaries with certain chronic illnesses,20 but there is much more and more generalized model. Decrease in costs by 14% is about $ 1000 / year beneficiary / year.
Recently, OB-KOC has been significantly associated with a high continuity reduction measured at the patient level
She provides urgent help to elderly people in England,21 a recent systematic review has identified significant, positive links between continuity and mortality.22 Continuity was approved by the National Quality Forum as a quality measure for children in need of comprehensive health care
These data indicate that continuity may be useful as a medicinal measure for quality and / or resource use
QPP. The BB-COC Continuity Index is temporarily locked as a measure of qualitative clinical data registration for QPP for participants
In the PRIME Registry, however, additional information on Medical and Medical Centers is unknown
it requires acceptance for a wider use. Very careful initial care, including homogeneity and completeness, can be achieved simultaneously
quality and resource usage metrics, taking into account that they are currently associated with significant costs / utilization
cut back.23

The initial care has the maximum number of EMPs, but most of them are intermittent, adapted and procedural,
which endangers the primary health care, reduces its basic functions and its value. Due to strong stimulation,
in particular, the payment, which poses a threat to the ongoing erosion of care about the continuity of primary care. Perhaps,
national health surveys suggest a decrease in people who identify the source of a simple care.21.24 Medicare providers have a strong, nationwide effort to pay on a valuable basis, including federal QPP and promotion.
Coordination with such high quality PHC functions is a priority.

Our research has limitations and further work is needed to understand how continuity measurement can affect the provider's behavior.
The result of this continuity for a population other than the Medicare beneficiaries at school is not excluded from our study,
as well as how communities change over a period of more than one year. Several
referenced research,3,4,5,19,20 however, associate benefits may not be age-related and may last longer
even worse than undesirable results.

In short, this study is a significant evidence of the value of continuity5,7,8,11-13,21,22,25,26 and 1 or more qualitative measures that can be used and prioritized in QPP or other value-based payment models.
Continuity – one of the basic principles of primary health care that should be included in formal primary health care services
we go for valuables. Future research should explore the relative impact of the provider
continuity of teams and experience, continuity in parameters (eg outpatient hospital) and further improvement of calculations
Continuity of the effect of longitudinal continuity. Also, research is needed to develop reliable measures
Like other basic principles of primary care, such as full-fledged and coordinating.


  • Conflict of Interests: Authors do not make any statements.

  • To read or post comments on this article, see

  • Previous presentations: Parts of reported results are presented at the NAPCRG Annual Meeting; November 12-16, 2016; Colorado Springs,
    Colorado and annual Academy of Science research meetings; June 25-27; New Orleans, Louisiana.

  • Additional Materials: Available at

  • Financing support: The Robert Graham Center received this study with the support of the American Family Medicine Foundation
    ongoing joint research contracts.

  • Received for publication April 18, 2018.
  • Verification accepted August 1, 2018.
  • Accepted to post August 10, 2018.

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