Continuity of Care Declining for Medicare Beneficiaries

Less than a third of beneficiaries saw their PCP when they were hospitalized in 2006
By Jeff Muise
HealthDay Reporter

TUESDAY, April 21 (HealthDay News) -- Medicare beneficiaries in the hospital in 2006 were much less likely to be seen there by a familiar physician than those in the hospital a decade earlier, according to a study reported in the April 22/29 issue of the Journal of the American Medical Association.

Gulshan Sharma, M.D., of the University of Texas Medical Branch in Galveston, and colleagues studied 3,020,770 hospital admissions of Medicare beneficiaries between 1996 and 2006. The researchers looked at demographics, enrollment information, and Medicare claims for both hospital and physician services. As a measure of continuity of care, the researchers determined if beneficiaries in the hospital were seen by their primary care physician (PCP) or by a physician they had seen as an outpatient in the prior year.

In 1996, 44.3 percent of Medicare beneficiaries who were hospitalized were seen by their PCP, and 50.5 percent were seen by a physician who had cared for them as an outpatient. By 2006, these percentages had decreased to 31.9 percent and 39.8 percent, respectively. The discontinuities of care were especially common for weekend admissions, and for patients in New England and metropolitan areas. Hospitalists were linked to about one-third of the in-hospital care discontinuities.

"In conclusion, continuity of care from the outpatient to hospital setting is low and is decreasing. Only a part of this decrease appears to be related to the growth of the hospitalist model. Future research should explore whether the lack of continuity contributes to suboptimal care and whether interventions might ameliorate any detrimental effects of discontinuities in care," the authors write.

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