PCR055: Practice continuity of care and quality of preventive services

Mingliang Dai, PhD; Yoon-Kyung Chung, PhD; Zachary Morgan, MS; Zhou Yang, PhD

Abstract

Context: Studies have shown that patients who reported having a usual source of primary care, i.e., a physician or a practice, are more likely to obtain preventive care services such as cancer screenings. Yet, no study has assessed continuity of care as an indicator of quality for primary care practices and tested its association with the delivery of preventive services at practice level.
Objectives: 1) To assess variation in practice-level continuity of care in a national sample of primary care practices 2) To examine the association between practice-level continuity and performance of preventive services, by practice size.
Study design: Cross-sectional
Dataset: 2019 practice quality performance from the American Board of Family Medicine’s PRIME registry
Population studied: All 837 primary care practices enrolled in the PRIME registry, including 368 solo, 305 small, 119 medium, and 15 large practices
Outcome measures: We calculated annual quality measures on 6 preventive care services for each practice, including breast, cervical, colorectal cancer screening, body mass index, cholesterol, and depression. We measured continuity of care at practice level by averaging physician-patient continuity scores within the practice following the Bice-Boxerman algorithm.
Results: Overall, nearly 80 percent of the practices achieved a 70% or higher continuity of care score, a threshold attained by 92% of solo, 74% of small, 55% of medium and only 20% of large practices. Compared to practices with lower (<70%) continuity, practices with higher continuity, on average, performed considerably better on all six preventive care measures: 83% vs. 40% for breast cancer screening, 82% vs. 30% for cervical cancer screening, 85% vs. 42% for colorectal cancer screening, 86% vs. 31% for body mass index screening, 93% vs. 26% for cholesterol test, and 85% vs. 15% for depression screening. These differences were consistently observed across all practice sizes.
Conclusion: We found considerable variation in measured continuity of care among a national sample of primary care practices- the larger the practice size, the less likely a practice would achieve a continuity of care score of 70% or higher. Nevertheless, we observed a consistent pattern between higher continuity of care and higher preventive care quality in all 6 screening measures and across all sizes of practices. Interventions aimed at enhancing measurable continuity may help practices to improve preventive services.
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Jack Westfall
jwestfall@aafp.org 11/20/2021

primary care measures that matter. nice work on one of the 4 Cs of primary care. thanks for sharing at NAPCRG

Diane Harper
harperdi@med.umich.edu 11/21/2021

This is important work, done by very engaged researchers. I find it ironic that continuity of care can be measured in a cross-sectional database : ). Many struggle with what continuity of care means. As we move cervical and colorectal cancer screenings to home-based screenings for the majority of our average risked population, we, as PCPs, can spend more time discussing what the cancers are, how the cancers can be prevented rather than doing invasive procedures. Primary HPV testing for cervical cancer screening is already FDA approved.. and soon home based primary HPV testing will be available to our patients.

Larry Green
11/22/2021

This analysis matters a LOT given the rush to practice acquisitions by corporate entities and consolidation of small practices into larger systems. Thanks for doing it. If not already, please get it published and advertised.

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/23/2021

great to see a rigorous evaluation of this topic - I look forward to the publication of this important work.

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

As a provider in a small practice, I LOVE THIS STUDY!!! there is definitely more patient turn over in larger practices due to a number of factors but the bottom line is the care ends up suffering as a result

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