Table 2

Outcome measures of studies investigating the association of continuity of care with mortality

First author and year of publication	Ratio (if available)	Other result	95% CI	For measure	Continuity associated with mortality?	Results summary
Bentler 201413	2.25†		1.33 to 3.81	AHR above vs below mean patient-reported care site continuity.	Yes	Patient-reported duration continuity had significant, protective association with time to death. Seven claims-based continuity of care indicators and one patient-reported measure (site continuity) showed higher continuity associated with increased death hazard.
	0.54*		0.37 to 0.8	AHR, highest vs lowest tertile patient-reported duration continuity.
	2.3†		1.56 to 3.38	AHR, highest vs lowest tertile, UPC.
	1.8†		1.12 to 2.88	AHR, highest vs lowest tertile, inverse number of providers.
	1.69†		1.13 to 2.52	AHR, highest vs lowest tertile, MMCI.
	1.7†		1.12 to 2.59	AHR, highest vs lowest tertile, Ejlertsson’s Index K.
	2.33†		1.56 to 3.49	AHR, highest vs lowest tertile, Bice-Boxerman CoC.
	1.98†		1.23 to 3.21	AHR, highest vs lowest tertile, MCI.
	2.35†		1.59 to 3.49	AHR, highest vs lowest tertile, sequential continuity.
Cerovečki 201314	12.6*		3.001 to 53.253	OR, loss of CoC.	Yes	Loss of continuity of care one predictor of fatal outcome.
Spatz 201415	1.92*		1.19 to 3.12	AHR, no usual source of care vs strong USOC relationship.	Yes	In multivariable analysis, having no USOC associated with higher 12-month mortality.
van Walraven 201016	1.03		0.95 to 1.12	AHR, increase of 0.1 in continuity score, preadmission physician.	No	No significant association found for death risk with continuity with any doctor type studied.
	0.87		0.74 to 1.02	AHR, increase of 0.1 in continuity score, hospital physician.
	0.97		0.89 to 1.06	AHR, increase of 0.1 in continuity score, postdischarge physician.
Blecker 201417	0.72		0.29 to 1.8	AOR, UPC 1 (complete continuity) vs 0, no continuity.	No	Increased weekend UPC was significantly associated with decreased mortality in unadjusted analysis. No association after multivariate adjustment.
Brener 201618	0.87*		0.82 to 0.93	AOR, visited vs not, 90-day postdischarge.	Yes	In unadjusted model, visited patients more likely to die at 90 days. In unadjusted model, visited patients less likely to die at 90 days.
Brener 201618	0.88*		0.81 to 0.86	AOR, visited vs not, 30-day postdischarge.	Yes
Hoertel 201419	0.83*		0.83 to 0.83	AHR, 0.1% increase in CoC index.	Yes	0.1 increase in CoC index associated with decreased likelihood of death.
Hoertel 201419	0.53*		0.52 to 0.54	AHR, perfect continuity vs imperfect continuity.	Yes
Justiniano 201720	2.33		2.10 to 2.60	AHR, readmitted to original hospital but with different surgeon vs same hospital, same surgeon.	Yes	In comparison with patients readmitted to the same hospital and managed by the same surgeon, patients managed at the same hospital but by a different surgeon had > twofold risk of 1-year mortality.
Leleu 201321	0.96*		0.95 to 0.96	HR, 0.1 increase in CoC.	Yes	Increase in the CoC index associated with decrease in death risk.
Liao 201522	*	Significant trend (p<0.001, test for monotonic trend)		Decreasing consistency in medical care-seeking behaviour with decreasing adjusted survival.	Yes	A significant monotonic trend was observed between decreasing consistency in medical care-seeking behaviour (from high consistency to low consistency) and decreasing multivariate-adjusted survival.
Lustman 201623	0.59*		0.5 to 0.7	OR, high vs low UPC, measured at the same time.	Yes	Patients with a high UPC had lower risk of mortality. Not affected on adjusting for background characteristics.
	0.7*		0.56 to 0.88	OR, high vs low UPC, measured in successive years.
Maarsingh 201624	1.2*		1.01 to 1.42	HR, lowest vs highest CoC.	Yes	In final model, participants in lowest CoC category showed greater mortality than those in maximum.
McAlister 201325	0.86			HR, familiar vs unfamiliar (our calculation, CI not available).	Yes	After 6 months, death HR for familiar Dr 0.66 (95% CI 0.61 to 0.71) and 0.77 (0.68 to 0.88) with unfamiliar vs no follow-up. At 3 months, 1.6% of those who had a visit with a familiar Dr died, 3.3% who only saw an unfamiliar Dr, p<0.001.
McAlister 201626	*	3.1% vs 2.0%, p<0.0001		% mortality: follow-up by unfamiliar or familiar physician.	Yes	More died with follow-up with unfamiliar physician compared with those with at least one visit with familiar physician.
Pan 201727	0.47*		0.46 to 0.48	AHR high (>50%) vs low (≤50%) CoC score.	Yes	Patients with diabetes with higher physician continuity had a lower risk of mortality.
Shin 201428	1.13*		1.05 to 1.21	AHR, below vs above median most frequent provider.	Yes	Above median continuity associated with lower all-cause mortality using three different measures.
	1.13*		1.05 to 1.21	AHR, below vs above median MMCI.
	1.12*		1.04 to 1.21	AHR, below vs above median CoC.
Sidhu 201429	*	1.9% vs 1.4%, p<0.0001		% mortality: follow-up by unfamiliar or familiar physician.	Yes	More died with follow-up with unfamiliar physician compared with those with at least one visit with familiar physician.
Weir 201630	0.75*		0.61 to 0.94	AOR, high vs low UPC.	Yes	High UPC associated with decreased mortality.
Worrall 201131	*	9.0% vs 18.1%, (p=0.025, χ²)		% mortality: high vs low continuity group.	Yes	Proportion of people dying significantly lower in high-continuity group.
Baker 201632		21 deaths	−16 to 63	Potential reduction in premature deaths in England in 1 year if there is a change of 1 percentile of patients expressing trust in their doctor.	No	Continuity not associated with mortality (except in less deprived practices in a separate subgroup analysis).
Baker 201632		−49 deaths	−250 to 156	Potential reduction in premature deaths in England in 1 year if there is a change of 1 percentile of patients able to get an appointment in advance.	No
Honeyford 201333	0.994*		0.989 to 1	IRR, 1% change in survey response.	Yes	An increase in % of patients recalling being able to see their preferred GP was associated with decreased mortality.
Levene 201234	0.999		0.997 to 1.01	IRR, all-cause mortality.	Depends on mortality measure	No significant association with all-cause mortality. An increase in the % of patients recalling being better able to see their preferred doctor was associated with decreases in COPD mortality and in all-cancer mortality.
	0.997*		0.995 to 0.999	IRR, all-cancer mortality.
	0.999		0.995 to 1.07	IRR, coronary heart disease mortality.
	1.0002		0.99 to 1.01	IRR, stroke mortality.
	0.993*		0.98 to 0.998	IRR, COPD mortality.

*Significant result showing higher levels of continuity associated with lower mortality.
†Significant result showing higher levels of continuity associated with higher mortality.
AHR, adjusted HR; AOR, adjusted GP, general practitioner; OR; CoC, Continuity of Care Index; IRR, incident rate ratio; MCI, modified continuity index; MMCI, Modified Modified Continuity Index; UPC, Usual Provider of Care Index; USOC, usual source of care.