Interpersonal Continuity of Primary Care of Veterans with Diabetes: a Cohort Study Using Electronic Health Record Data

Overview

Journal BMC Fam Pract

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2018 Aug 1

PMID 30060736

Citations 6

Authors

Christine M Everett

Perri Morgan

Valerie A Smith

Sandra Woolson

David Edelman

Cristina C Hendrix

Theodore Berkowitz

Brandolyn White

George L Jackson

Affiliations

Soon will be listed here.

Abstract

Background: Continuity of care is a cornerstone of primary care and is important for patients with chronic diseases such as diabetes. The study objective was to examine patient, provider and contextual factors associated with interpersonal continuity of care (ICoC) among Veteran's Health Administration (VHA) primary care patients with diabetes.

Methods: This patient-level cohort study (N = 656,368) used electronic health record data of adult, pharmaceutically treated patients (96.5% male) with diabetes at national VHA primary care clinics in 2012 and 2013. Each patient was assigned a "home" VHA facility as the primary care clinic most frequently visited, and a primary care provider (PCP) within that home clinic who was most often seen. Patient demographic, medical and social complexity variables, provider type, and clinic contextual variables were utilized. We examined the association of ICoC, measured as maintaining the same PCP across both years, with all variables simultaneously using logistic regression fit with generalized estimating equations.

Results: Among VHA patients with diabetes, 22.3% switched providers between 2012 and 2013. Twelve patient, two provider and two contextual factors were associated with ICoC. Patient characteristics associated with disruptions in ICoC included demographic factors, medical complexity, and social challenges (example: homeless at any time during the year OR = 0.79, CI = 0.75-0.83). However, disruption in ICoC was most likely experienced by patients whose providers left the clinic (OR = 0.09, CI = 0.07-0.11). One contextual factor impacting ICoC included NP regulation (most restrictive NP regulation (OR = 0.79 CI = 0.69-0.97; reference least restrictive regulation).

Conclusions: ICoC is an important mechanism for the delivery of quality primary care to patients with diabetes. By identifying patient, provider, and contextual factors that impact ICoC, this project can inform the development of interventions to improve continuity of chronic illness care.

Citing Articles

Measuring the Impact of Primary Care Team Composition on Patient Activation Utilizing Electronic Health Record Big Data Analytics.

Will K, Liang Y, Chi C, Lamb G, Todd M, Delaney C J Patient Cent Res Rev. 2024; 11(1):18-28.

PMID: 38596347 PMC: 11000700. DOI: 10.17294/2330-0698.2019.

Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study.

Everett C, Christy J, Batchelder H, Morgan P, Docherty S, Smith V BMJ Open Qual. 2023; 12(2).

PMID: 37311623 PMC: 10277144. DOI: 10.1136/bmjoq-2022-002229.

Teaming up in primary care: Membership boundaries, interdependence, and coordination.

Everett C, Docherty S, Matheson E, Morgan P, Price A, Christy J JAAPA. 2022; 35(2):1-10.

PMID: 34985006 PMC: 9869344. DOI: 10.1097/01.JAA.0000805840.00477.58.

Utilization and Costs by Primary Care Provider Type: Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants?.

Smith V, Morgan P, Edelman D, Woolson S, Berkowitz T, Van Houtven C Med Care. 2020; 58(8):681-688.

PMID: 32265355 PMC: 7375947. DOI: 10.1097/MLR.0000000000001326.

Relational continuity of oral health care in Indigenous communities: a qualitative study.

Shrivastava R, Couturier Y, Simard-Lebel S, Girard F, Aguirre N, Torrie J BMC Oral Health. 2019; 19(1):287.

PMID: 31865901 PMC: 6927186. DOI: 10.1186/s12903-019-0986-z.

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