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Original Investigation
July 2015

The Association Between Continuity of Care and the Overuse of Medical Procedures

Author Affiliations
  • 1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Intern Med. 2015;175(7):1148-1154. doi:10.1001/jamainternmed.2015.1340

Importance  Both the overuse of unnecessary medical procedures and poor continuity of care are thought to contribute to high health care spending and poor patient outcomes.

Objective  To investigate the association between care continuity and use of potentially unnecessary procedures.

Design, Setting, and Participants  Observational retrospective cohort (n = 1 208 250 patients > 65 years) using 5% Medicare fee-for-service claims from 2008.

Main Outcomes and Measures  We evaluated continuity using the Bice-Boxerman continuity of care index. We measured overuse using a previously validated set of 19 potentially overused procedures.

Results  Altogether, 14.7% of patients received at least 1 potentially overused procedure during the calendar year. For each 0.1 increase in the continuity score (0.4 SDs), patients had 0.93 times the odds of receiving overused procedures than those with lower scores (95% CI, 0.93-0.94). Higher continuity was significantly associated with lower odds of 9 procedures (Holm-Bonferroni corrected P < .02 was significant: 6 of 13 diagnostic tests [with ORs, 0.84-0.99; P  < .001] and 3 therapeutic procedures [with ORs 0.81-0.87; P <.001]). Conversely, higher continuity was significantly associated with increased overuse for 3 procedures (1 diagnostic test [OR, 1.06; P < .001], 1 of 2 screening tests [OR, 1.05; P < .001], and the single monitoring test [OR, 1.03; P < .01]).

Conclusions and Relevance  Increased continuity was associated with an overall decrease in overuse, suggesting a potential benefit of high-continuity care; however, the strength and direction of the association varied according to the specific procedure.