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. | |
0.88* | 0.81 to 0.86 | AOR, visited vs not, 30-day postdischarge. | ||||
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. | |
0.53* | 0.52 to 0.54 | AHR, perfect continuity vs imperfect continuity. | ||||
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). | |
−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. | ||||
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.