Continuity of Care for Older Patients Weakens


The continuity of care for older patients decreased substantially from 1996 to 2006, according to a study published last month in the Journal of the American Medical Association (2009;301(16):1671-1680). And while the study period syncs up with the birth and development of HM, the study’s authors attribute only one-third of the decrease to the growth in hospitalist activity.

“In terms of the forces behind the phenomenon, I would not think hospitalists are the fundamental force behind decreasing continuity of care,” says James S. Goodwin, MD, who serves as director of the Sealy Center on Aging at the University of Texas Medical Branch in Galveston. The decrease, Dr. Goodwin says, can be better explained by a push from hospitals for more efficient and effective care at the lowest price possible.

Dr. Goodwin and other researchers analyzed Medicare records for more than 3 million hospital admissions, and concluded that outpatient-to-inpatient continuity with outpatient physicians decreased to 39.8% in 2006 from 50.5% in 1996. Accordingly, the study also found continuity to a primary-care physician (PCP) dropped to 31.9% from 44.3%. Patients with coexisting illnesses and the oldest patients were more likely to have continuity with their outpatient physicians and with their PCPs during hospitalization because of the severity and intricacies of their conditions.

Dr. Goodwin emphasizes that the study was based on a statistical analysis of Medicare data and doesn’t address quality of care issues or how the HM movement has tried to address efficiency concerns. He also acknowledges SHM and group leaders have been pushing quality initiatives in the past several years to improve the care continuum.

“Future research should explore whether the lack of continuity contributes to suboptimal care and whether interventions might ameliorate any detrimental effects of discontinuities,” the authors report.

To learn more about SHM’s quality initiative Project BOOST (Better Outcomes for Older Adults through Safe Transitions), visit

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