Select Journal or Resource JAMA & Archives Home JAMA Archives of   Dermatology   Facial Plastic Surgery   Family Medicine (1992-2000)   General Psychiatry   Internal Medicine   Neurology   Ophthalmology   Otolaryngology—Head & Neck Surgery   Pediatrics & Adolescent Medicine   Surgery JAMA-français JAMA & Archives CME Calendar of Events Physician Jobs For The Media Users’ Guides to the Medical Literature Peer Review Congress Student JAMA (1998-2004)

	Welcome   | My Account | E-mail Alerts | Access Rights | Sign In Vol. 7 No. 4, July 1998   Archives  •  Online Features Original Contribution  This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (89)  • Contact me when this article is cited  Related Content  • Similar articles in this journal The Role of Provider Continuity in Preventing Hospitalizations James M. Gill, MD, MPH; Arch G. Mainous III, PhD Arch Fam Med. 1998;7:352-357. 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 13495 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. From the Department of Family and Community Medicine, Christiana Care Health System, Wilmington, Del (Dr Gill); and the Department of Family Practice, University of Kentucky, Lexington (Dr Mainous). THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES The Association of Family Continuity with Infant Health Service Use Clark et al. J Am Board Fam Med 2008;21:385-391. ABSTRACT | FULL TEXT   Effects of Quality on Outcomes in Primary Care: A Review of the Literature Hsiao and Boult American Journal of Medical Quality 2008;23:302-310. ABSTRACT   Continuity-Structured Clinical Observations: Assessing the Multiple-Observer Evaluation in a Pediatric Resident Continuity Clinic Zimmer et al. Pediatrics 2008;121:e1633-e1645. ABSTRACT | FULL TEXT   Effects of Continuity of Care in Infancy on Receipt of Lead, Anemia, and Tuberculosis Screening Flores et al. Pediatrics 2008;121:e399-e406. ABSTRACT | FULL TEXT   Patient psychosocial factors and primary care consultation: a cohort study Bellon et al. Fam Pract 2007;24:562-569. ABSTRACT | FULL TEXT   Continuity of primary care and emergency department utilization among elderly people Ionescu-Ittu et al. CMAJ 2007;177:1362-1368. ABSTRACT | FULL TEXT   Do HMOs Reduce Preventable Hospitalizations for Medicare Beneficiaries? Basu and Mobley Med Care Res Rev 2007;64:544-567. ABSTRACT   Patients' perceptions of interpersonal continuity of care. Pandhi and Saultz J Am Board Fam Med 2006;19:390-397. ABSTRACT | FULL TEXT   Indices for continuity of care: a systematic review of the literature. Jee and Cabana Med Care Res Rev 2006;63:158-188. ABSTRACT   Enrolling Vulnerable, Uninsured but Eligible Children in Public Health Insurance: Association With Health Status and Primary Care Access Stevens et al. Pediatrics 2006;117:e751-e759. ABSTRACT | FULL TEXT   Continuity of care in medication management: Review of issues and considerations for pharmacy the ASHP Continuity of Care Task Force Am J Health Syst Pharm 2005;62:1714-1720. FULL TEXT   An Update On Safety-Net Hospitals: Coping With The Late 1990s And Early 2000s Bazzoli et al. Health Aff (Millwood) 2005;24:1047-1056. ABSTRACT | FULL TEXT   Interpersonal Continuity of Care and Care Outcomes: A Critical Review Saultz and Lochner Ann Fam Med 2005;3:159-166. ABSTRACT | FULL TEXT   When Do Older Patients Change Primary Care Physicians? Mold et al. J Am Board Fam Med 2004;17:453-460. ABSTRACT | FULL TEXT   Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation Kerse et al. Ann Fam Med 2004;2:455-461. ABSTRACT | FULL TEXT   Primary Care Pediatrics: 2004 and Beyond Cheng Pediatrics 2004;113:1802-1809. FULL TEXT   Familiarity breeds neglect? Unanticipated benefits of discontinuous primary care Broom Fam Pract 2003;20:503-507. ABSTRACT | FULL TEXT   Continuity of Care: Process or Outcome? Christakis Ann Fam Med 2003;1:131-133. FULL TEXT   Defining and Measuring Interpersonal Continuity of Care Saultz Ann Fam Med 2003;1:134-143. ABSTRACT | FULL TEXT   Provider Continuity in Family Medicine: Does It Make a Difference for Total Health Care Costs? De Maeseneer et al. Ann Fam Med 2003;1:144-148. ABSTRACT | FULL TEXT   Continuity of Primary Care: To Whom Does It Matter and When? Nutting et al. Ann Fam Med 2003;1:149-155. ABSTRACT | FULL TEXT   On Being New to an Insurance Plan: Health Care Use Associated With the First Years in a Health Insurance Plan Franks et al. Ann Fam Med 2003;1:156-161. ABSTRACT | FULL TEXT   Impact of Provider Continuity on Quality of Care for Persons With Diabetes Mellitus Gill et al. Ann Fam Med 2003;1:162-170. ABSTRACT | FULL TEXT   Continuity of Care and Recognition of Diabetes, Hypertension, and Hypercholesterolemia Koopman et al. Arch Intern Med 2003;163:1357-1361. ABSTRACT | FULL TEXT   Quality-of-Care Indicators for Early-Stage Prostate Cancer Spencer et al. JCO 2003;21:1928-1936. ABSTRACT | FULL TEXT   Towards a theory of continuity of care Gray et al. JRSM 2003;96:160-166. FULL TEXT   Racial and Ethnic Disparities in the Primary Care Experiences of Children: A Review of the Literature Stevens and Shi Med Care Res Rev 2003;60:3-30. ABSTRACT   Continuity of Care for Children in Foster Care DiGiuseppe and Christakis Pediatrics 2003;111:e208-213. ABSTRACT | FULL TEXT   Leaving Gatekeeping Behind -- Effects of Opening Access to Specialists for Adults in a Health Maintenance Organization Ferris et al. NEJM 2001;345:1312-1317. ABSTRACT | FULL TEXT   Continuity of Care: A Reconceptualization Donaldson Med Care Res Rev 2001;58:255-290. ABSTRACT   Fix what's wrong, not what's right, with general practice in Britain De Maeseneer et al. BMJ 2000;320:1616-1617. FULL TEXT   Fragmentation of Patient Care Between Chiropractors and Family Physicians Mainous III et al. Arch Fam Med 2000;9:446-450. ABSTRACT | FULL TEXT   The Effect of Continuity of Care on Emergency Department Use Gill et al. Arch Fam Med 2000;9:333-338. ABSTRACT | FULL TEXT   Development of a Vertically Integrated Program of Services for Persons With Schizophrenia Smith et al. Psychiatr. Serv. 1999;50:931-935. ABSTRACT | FULL TEXT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1998 American Medical Association. All Rights Reserved.