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Journal of General Internal Medicine

, Volume 34, Issue 1, pp 82–89 | Cite as

Primary Care Visit Regularity and Patient Outcomes: an Observational Study

  • Adam J. RoseEmail author
  • Justin W. Timbie
  • Claude Setodji
  • Mark W. Friedberg
  • Rosalie Malsberger
  • Katherine L. Kahn
Original Research

Abstract

Background

Regular primary care visits may allow an opportunity to deliver high-value, proactive care. However, no previous study has examined whether more temporally regular primary care visits predict better outcomes.

Objective

To examine the relationship between the temporal regularity of primary care (PC) visits and outcomes.

Design

Retrospective cohort study.

Participants

We used Medicare claims for 378,862 fee-for-service Medicare beneficiaries, who received PC at 1328 federally qualified health centers from 2010 to 2014.

Main Measures

We created five beneficiary groups based upon their annual number of PC visits. We further subdivided those groups according to whether PC visits occurred with more or less regularity than the median value. We compared these 10 subgroups on three outcomes, adjusting for beneficiary characteristics: emergency department (ED) visits, hospitalizations, and total Medicare expenditures. We also aggregated to the clinic level and divided clinics into tertiles of more, less, and similarly regular to predicted. We compared these three groups of clinics on the same three outcomes of care.

Key Results

Within each visit frequency group, beneficiaries in the subgroup with fewer regular visits had more ED visits, more hospitalizations, and higher costs. Among beneficiaries with the most frequent PC visits, the less regular subgroup had more ED visits (1.70 vs. 1.31 per person-year), more hospitalizations (0.69 vs. 0.57), and greater Medicare expenditures ($20,731 vs. $17,430, p < 0.001 for all comparisons). Clinics whose PC visits were more regular than predicted also had better outcomes than other clinics, although the effect sizes were smaller.

Conclusions

Temporal patterns of PC visits are correlated with outcomes, even among beneficiaries who appear otherwise similar. Measuring the temporal regularity of PC visits may be useful for identifying beneficiaries at risk for adverse events, and as a barometer for and an impetus to clinic-level quality improvement.

KEY WORDS

quality of healthcare temporally regular care clinical practice variation primary care utilization cost 

Notes

Acknowledgements

We thank Suzanne Wensky and Katherine Giuriceo of the Center for Medicare and Medicaid Innovation for their helpful comments on prior drafts of this manuscript.

Funding

This study was supported by contract HHSM-500-2005-00028I with the Centers for Medicare and Medicaid Services.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The opinions expressed in this publication do not necessarily reflect the official policies of the Centers for Medicare and Medicaid Services.

Supplementary material

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Adam J. Rose
    • 1
    • 2
    Email author
  • Justin W. Timbie
    • 3
  • Claude Setodji
    • 4
  • Mark W. Friedberg
    • 1
    • 5
  • Rosalie Malsberger
    • 1
  • Katherine L. Kahn
    • 6
    • 7
  1. 1.RAND CorporationBostonUSA
  2. 2.Boston University School of MedicineBostonUSA
  3. 3.RAND CorporationArlingtonUSA
  4. 4.RAND CorporationPittsburghUSA
  5. 5.Harvard Medical SchoolBostonUSA
  6. 6.RAND CorporationSanta MonicaUSA
  7. 7.David Geffen School of Medicine at UCLALos AngelesUSA

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