An interpersonal continuity of care measure for Medicare Part B claims analyses

Abstract

Objectives: This article presents an interpersonal continuity of care measure.

Methods: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

Results: Interpersonal continuity with a primary care physician was 17.3%, and interpersonal continuity of care with any physician was 26.1%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

Discussion: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

Figure 1

Cumulative percentage distribution of the longest interval (in months) between visits during the 24-month period prior to baseline that were to the same primary care physician. Note that using 40 months of data, we could not fully adjudicate intervals beyond 8 months; therefore, the figure is based on the censored-out algorithm.

Figure 2

Cumulative percentage distribution of the longest interval (in months) between visits during the 24-month period prior to baseline that were to the same physician regardless of specialty. Note that using 40 months of data, we could not fully adjudicate intervals beyond 8 months; therefore, the figure is based on the censored-out algorithm.