Continuity-of-care-to-the-same-primary-care-doctor

INDICATOR NAME

Name

Continuity of care to the same primary care doctor

Alternate Name

Continuity of primary care

INDICATOR DESCRIPTION

Description

This indicator measures the percentage of people with more than 3 primary care physician visits in the past 2 years who had:

• less than 50% of their primary care visits to the same primary care physician (low continuity)

• 50% - 74% of their primary care visits to the same primary care physician (medium continuity)

• More than 75% of their primary care visits to the same primary care physician (high continuity)

Indicator Status

Active

HQO Reporting tool/product

Public reporting

Dimension

Effective

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

The calculation of this indicator starts at the individual person level by:

defining how many primary care physician visits each person had in the past two years,
looking at how many physicians contributed to these visits and
identifying the percentage of visits to their most regular (highest number of visits) provider.

Later the results are aggregated and grouped into people who had:

• <50% of their visits to the same (regular) primary care physician (the provider with the highest number of visits) in the past two years.

• 50% - 74% visits to the same (regular) primary care physician

• 75%+ visits to the same (regular) primary care physician

Numerator including inclusion/exclusion

Number of people with more than 3 visits in the past 2 year who had :

• <50% of their visits to the same primary care physician (the provider with the highest number of visits)

• 50% - 74% visits to the same primary care physician

• 75%+ visits to the same primary care physician

Denominator including inclusion/exclusion

Total number of people who had more than 3 primary care visits with a doctor in the past 2 years.

Inclusions:

All visits to primary care physicians obtained by specialty codes= 00, 05, 26 for the 2 year period preceding the index date for the following fee codes- A001, A003, A007,A903, E075, G212, G271, G372, G373, G365, G538, G539, G590, G591, K005, K013, K017, P004, A261, K267, K269, K130, K131, K132– core Primary Care codes

Adjustment (risk, age/sex standardization)- detailed

None

Data Source

Ontario Health Insurance Plan (OHIP) Claims History Database, Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

Reported Levels of comparability /stratifications (defined)

Age, Income, Region, Rurality, Sex, Time

OTHER RELEVANT INFORMATION

Caveats and Limitations

We do not know the reasons and other details for the visit. The visit to a different provider may be influenced by factors such as the time of the visit, geographic location, physician working hours (part time/vs full time), that are not captured by data. In addition, data does not capture visits to other non-physician providers of the teams or phone calls. Data does not include visits to specialists either and people with low continuity with the primary care doctor maybe regularly seeing the specialist. Additionally we are not able to assess continuity with NPs or for models of care that do not use billings (CHCs).

Comments Detailed

The data shows the continuity with the primary care doctors only.

Footnotes

1. Starfield B. Longitudinality and managed care. In: Primary Care: Concept, Evaluation, and Policy. Oxford, UK: Oxford University Press; 1992:41-50. 2. Guthrie B, Saultz JW, Freeman GK, Haggerty JL. Continuity of care matters. BMJ. 2007:337. 3. Adair C, McDougall GM, Mitton C, et al. Continuity of care and health outcomes among persons with severe mental illness. Psychiatr Serv. 2005;56(9):1061-1069. 4. Saultz J, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. 5. Ann Fam Med. 2005;3(2):159-166. Menec VH, Sirski M, Attawar D, Katz A. Does continuity of care with a family physician reduce hospitalizations among older adults? J Health Serv Res Policy. 2006;11(4):196-201. 6. Ionescu-Ittu R, McCusker J, Ciampi A, et al. Continuity of primary care and emergency department utilization among elderly people. CMAJ. 2007;177(11):1362-1368. 7. Knight JC, Dowden JJ, Worrall GJ, Gadag VG, Murphy MM. Does higher continuity of family physician care reduce hospitalizations in elderly people with diabetes? Popul Health Manag. 2009;12(2):81-86. 8. Saultz J, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2(5):445-451.