Table 2

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

First author and year of publicationRatio (if available)Other result95% CIFor measureContinuity associated with mortality?Results summary
Bentler 201413 2.25†1.33 to 3.81AHR above vs below mean patient-reported care site continuity.YesPatient-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 0.8AHR, highest vs lowest tertile patient-reported duration continuity.
2.3†1.56 to 3.38AHR, highest vs lowest tertile, UPC.
1.8†1.12 to 2.88AHR, highest vs lowest tertile, inverse number of providers.
1.69†1.13 to 2.52AHR, highest vs lowest tertile, MMCI.
1.7†1.12 to 2.59AHR, highest vs lowest tertile, Ejlertsson’s Index K.
2.33†1.56 to 3.49AHR, highest vs lowest tertile, Bice-Boxerman CoC.
1.98†1.23 to 3.21AHR, highest vs lowest tertile, MCI.
2.35†1.59 to 3.49AHR, highest vs lowest tertile, sequential continuity.
Cerovečki 201314 12.6*3.001 to 53.253OR, loss of CoC.YesLoss of continuity of care one predictor of fatal outcome.
Spatz 201415 1.92*1.19 to 3.12AHR, no usual source of care vs strong USOC relationship.YesIn multivariable analysis, having no USOC associated with higher 12-month mortality.
van Walraven 201016 1.030.95 to 1.12AHR, increase of 0.1 in continuity score, preadmission physician.NoNo significant association found for death risk with continuity with any doctor type studied.
0.870.74 to 1.02AHR, increase of 0.1 in continuity score, hospital physician.
0.970.89 to 1.06AHR, increase of 0.1 in continuity score, postdischarge physician.
Blecker 201417 0.720.29 to 1.8AOR, UPC 1 (complete continuity) vs 0, no continuity.NoIncreased weekend UPC was significantly associated with decreased mortality in unadjusted analysis. No association after multivariate adjustment.
Brener 201618 0.87*0.82 to 0.93AOR, visited vs not, 90-day postdischarge.YesIn unadjusted model, visited patients more likely to die at 90 days. In unadjusted model, visited patients less likely to die at 90 days.
0.88*0.81 to 0.86AOR, visited vs not, 30-day postdischarge.
Hoertel 201419 0.83*0.83 to 0.83AHR, 0.1% increase in CoC index.Yes0.1 increase in CoC index associated with decreased likelihood of death.
0.53*0.52 to 0.54AHR, perfect continuity vs imperfect continuity.
Justiniano 201720 2.332.10 to 2.60AHR, readmitted to original hospital but with different surgeon vs same hospital, same surgeon.YesIn 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 0.96HR, 0.1 increase in CoC.YesIncrease 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.YesA 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 0.7OR, high vs low UPC, measured at the same time.YesPatients with a high UPC had lower risk of mortality. Not affected on adjusting for background characteristics.
0.7*0.56 to 0.88OR, high vs low UPC, measured in successive years.
Maarsingh 201624 1.2*1.01 to 1.42HR, lowest vs highest CoC.YesIn final model, participants in lowest CoC category showed greater mortality than those in maximum.
McAlister 201325 0.86HR, familiar vs unfamiliar (our calculation, CI not available).YesAfter 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.YesMore 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 0.48AHR high (>50%) vs low (≤50%) CoC score.YesPatients with diabetes with higher physician continuity had a lower risk of mortality.
Shin 201428 1.13*1.05 to 1.21AHR, below vs above median most frequent provider.YesAbove median continuity associated with lower all-cause mortality using three different measures.
1.13*1.05 to 1.21AHR, below vs above median MMCI.
1.12*1.04 to 1.21AHR, below vs above median CoC.
Sidhu 201429 *1.9% vs 1.4%, p<0.0001% mortality: follow-up by unfamiliar or familiar physician.YesMore 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 0.94AOR, high vs low UPC.YesHigh UPC associated with decreased mortality.
Worrall 201131 *9.0% vs 18.1%, (p=0.025, χ²)% mortality: high vs low continuity group.YesProportion of people dying significantly lower in high-continuity group.
Baker 201632 21 deaths−16 to 63Potential reduction in premature deaths in England in 1 year if there is a change of 1 percentile of patients expressing trust in their doctor.NoContinuity not associated with mortality (except in less deprived practices in a separate subgroup analysis).
−49 deaths−250 to 156Potential 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.
Honeyford 201333 0.994*0.989 to 1IRR, 1% change in survey response.YesAn increase in % of patients recalling being able to see their preferred GP was associated with decreased mortality.
Levene 201234 0.9990.997 to 1.01IRR, all-cause mortality.Depends on mortality measureNo 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 0.999IRR, all-cancer mortality.
0.9990.995 to 1.07IRR, coronary heart disease mortality.
1.00020.99 to 1.01IRR, stroke mortality.
0.993*0.98 to 0.998IRR, 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.