Table 1

Studies investigating the link between continuity and mortality that meet the inclusion criteria, ordered by study design

First author and year of publicationCountry of originPatientsStudy designNumber of patients if cohort studyContinuity measureContinuity withLength of time continuity measuredConfounding factors checked and/or adjusted forMortality measureQuality score
(mean (of two reviewers)
Mortality primary outcome?Length of time mortality counted
Bentler 201413 USA65 years+, community residing Medicare beneficiaries who completed NHHSUQ survey, not in managed care, not in MMC plan.PC12191, 2, 3, 5, 8Physician1–2 yearsA,B,C,D,E,F,G,
All-cause time to death9YesUp to 5 years
Cerovečki 201314 CroatiaWith opioid dependence, treated with methadone in family medicine setting.PC2877Family physician12 yearsA,B,M,O,SAll cause8.5Yes12 years
Spatz 201415 USA18 years+, hospitalised with acute myocardial infarction.PC24548DoctorN/AA,B,C,D,E,F,G,
All cause9Yes12 months
van Walraven 201016 Canada18 years+, discharged into community from medical or surgical services of 11 Ontario hospitals.PC38761Physician who saw patient before, during and/or after hospital stay6 monthsA,B,H,L,N,OAll cause9Yes6 months
Blecker 201417 USA18 years+, hospitalised at least 2 days including at least one at weekend.RC33911Discharge physician2 daysA,B,C,K,N,O,TIn hospital8NoLength of hospital stay
Brener 201618 Canada18 years+, discharged from hospital into community, family physician has history of hospital visits.RC164 0599Family physicianN/AA,B,D,L,O,QAll cause9Yes90 days postdischarge
Hoertel 201419 FranceIn CNAMTS insurance fund, saw a psychiatrist regularly.RC14 5152Psychiatrist3.5 yearsA,B,D,K,N,OAll cause8.5Yes3 years
Justiniano 201720 USA18 years+, underwent colorectal resection and readmitted within 30 days of DC.RC20 0160SurgeonN/AA,B,C,I,K,O,
All cause, colorectal cancer9Yes1 year
Leleu 201321 FranceNHI reimbursement patients, >2 visits in 6 months.RC325 7421, 2Primary care physician/GP3 yearsA,B,D,KAll cause9Yes3 years
Liao 201522 Taiwan31–99 years, with type 2 diabetes.RC89 4286Any physician1 yearA,B,H,K,N,
All cause8.5No4–9 years
Lustman 201523 Israel40–75 years, with type 2 diabetes, remained in area, saw primary care provider >3x.RC23 6791Primary care physician/GP2 yearsA,D,H,K,M,
All cause, diabetes related causes8.5Yes2 years
Maarsingh 201624 The Netherlands55–85 years, data available.RC17123GP17 yearsA,B,D,E,F,G,
All cause9Yes21 years
McAlister 201325 Canada20 years+, DC from hospital with 1st time heart failure.RC16 8550, 1Physician who saw patient x2 in year before or 1x during admissionN/AD,K,O,P,Q,RAll cause9Composite3 months/6 months
McAlister 201626 Canada20 years+, DC from hospital with 1st time heart failure.RC39 2490,1Any physicianN/AA,B,Q,K,M,
All cause8Composite30 days
Pan 201727 Taiwan35 years+, diagnosed with type 2 diabetes, in Taiwan NHI database.RC396 8382Any physician8 yearsA,B,D,K,O,
All cause8.5YesUp to 8 years
Shin 201428 South Korea20 years+, in Korean National Health Insurance, new diagnosis of hypertension, diabetes, hypercholesterolaemia or their complications.RC47 4332, 4, 5Physician2 yearsA,B,D,F,K,
All cause9YesUp to 5 years
Sidhu 201429 Canada‘Adults’ treated and released from 93 emergency departments with first-time diagnosis of heart failure.RC12 2850, 1Physician who saw patient x2 in year before or 1x during admission30 daysA,B,G,K,O,
All cause8.5Composite12 months but only give separate data for deaths for 30 days
Weir 201630 USA20 years+, with incident diabetes and at least 2 years insurance.RC285 2311Physician who saw patient the most2 yearsA,B,D,G,
All cause8.5Composite1 year
Worrall 201131 Canada65 years+, with diabetes, 2+ fee-for-service family physician visits.RC3051Family physician3 yearsA,B,NAll cause7Yes3 years
Baker 201632 EnglandRegistered with 7858 general practices, with complete data, in England.CSN/A8GPN/AC,D,F,G,J,PPremature- ratio observed to expected, age <758YesN/A
Honeyford 201333 EnglandRegistered with 229 general practices in the East Midlands between April 2006 and March 2009.CSN/A8GPN/AA,B,C,D,F,
CHD under 75 and all age.8Yes3 years
Levene 201234 England18 years+, registered with GP for at least 6/12 months of the year.CSN/A8GPN/AA,B,C,D,
All cause, COPD, all cancer, CHD9Yes2 years
  • Continuity measures: 1, usual provider of care index; 2, continuity of care index; 3, Herfindahl-Hirschmann Index; 4, Modified, Modified Continuity Index; 5, most frequent provider; 6, % consistency to physician; 7, loss of contact with family physician; 8, patient survey; 9, family physician visited patient in hospital; 0, follow-up by familiar doctor.

  • Confounding factors: A, age; B, sex; C, race; D, deprivation/social status/income; E, education; F, smoking; G, chronic conditions; H, prior hospitalisation; I, insurance; J, acute conditions; K, co-morbidity (including Charlston Index); L, LACE Index (risk of 30-day readmission or death after hospital discharge); M, marital/relationship status; N, number of healthcare visits/service intensity; O, other healthcare history; P, practice, hospital or doctor characteristics; Q, location; R, length of hospital stay; S, treatment plan; T, timing of admission; U, other.

  • CS, cross-sectional; CHD, Coronary heart disease; CNAMTS, Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés; COPD, Chronic Obstructive Pulmonary Disease; DC, discharged; GP, general practitioner; MMC, Medicare Managed Care; N/A, Not Applicable; NHHSUQ, National Health and Health Services Use Questionnaire; NHI, National Health Insurance; PC, prospective cohort; RC, retrospective cohort.