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Original Investigation
July 2015

The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care

Author Affiliations
  • 1VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
  • 2Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
  • 4Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia
  • 5Johns Hopkins School of Medicine, Baltimore, Maryland
JAMA Intern Med. 2015;175(7):1157-1162. doi:10.1001/jamainternmed.2015.1853
Abstract

Importance  Primary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care.

Objective  To measure the effect of PCP turnover on patient experiences of care and ambulatory care quality.

Design, Setting, and Participants  Observational, retrospective cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA). We included all patients enrolled in primary care at the VHA between 2010 and 2012 included in 1 of 2 national data sets used to measure our outcome variables: 326 374 patients in the Survey of Healthcare Experiences of Patients (SHEP; used to measure patient experience of care) associated with 8441 PCPs and 184 501 patients in the External Peer Review Program (EPRP; used to measure ambulatory care quality) associated with 6973 PCPs.

Exposures  Whether a patient experienced PCP turnover, defined as a patient whose provider (physician, nurse practitioner, or physician assistant) had left the VHA (ie, had no patient encounters for 12 months).

Main Outcomes and Measures  Five patient care experience measures (from SHEP) and 11 measures of quality of ambulatory care (from EPRP).

Results  Nine percent of patients experienced a PCP turnover in our study sample. Primary care provider turnover was associated with a worse rating in each domain of patient care experience. Turnover was associated with a reduced likelihood of having a positive rating of their personal physician of 68.2% vs 74.6% (adjusted percentage point difference, −5.3; 95% CI, −6.0 to −4.7) and a reduced likelihood of getting care quickly of 36.5% vs 38.5% (adjusted percentage point difference, −1.1; 95% CI, −2.1 to −0.1). In contrast, PCP turnover was not associated with lower quality of ambulatory care except for a lower likelihood of controlling blood pressure of 78.7% vs 80.4% (adjusted percentage point difference, −1.44; 95% CI, −2.2 to −0.7). In 9 measures of ambulatory care quality, the difference between patients who experienced no PCP turnover and those who had a PCP turnover was less than 1 percentage point. These effects were moderated by the patients’ continuity with their PCP prior to turnover, with a larger detrimental effect of PCP turnover among those with higher continuity prior to the turnover.

Conclusions and Relevance  Primary care provider turnover was associated with worse patient experiences of care but did not have a major effect on ambulatory care quality.

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