Primary Care Visit Regularity and Patient Outcomes: an Observational Study

Abstract

Background: Regular primary care visits may allow an opportunity to deliver high-value, proactive care. However, no previous study has examined whether more temporally regular primary care visits predict better outcomes. Objective: To examine the relationship between the temporal regularity of primary care (PC) visits and outcomes. Design: Retrospective cohort study. Participants: We used Medicare claims for 378,862 fee-for-service Medicare beneficiaries, who received PC at 1328 federally qualified health centers from 2010 to 2014. Main Measures: We created five beneficiary groups based upon their annual number of PC visits. We further subdivided those groups according to whether PC visits occurred with more or less regularity than the median value. We compared these 10 subgroups on three outcomes, adjusting for beneficiary characteristics: emergency department (ED) visits, hospitalizations, and total Medicare expenditures. We also aggregated to the clinic level and divided clinics into tertiles of more, less, and similarly regular to predicted. We compared these three groups of clinics on the same three outcomes of care. Key Results: Within each visit frequency group, beneficiaries in the subgroup with fewer regular visits had more ED visits, more hospitalizations, and higher costs. Among beneficiaries with the most frequent PC visits, the less regular subgroup had more ED visits (1.70 vs. 1.31 per person-year), more hospitalizations (0.69 vs. 0.57), and greater Medicare expenditures ($20,731 vs. $17,430, p < 0.001 for all comparisons). Clinics whose PC visits were more regular than predicted also had better outcomes than other clinics, although the effect sizes were smaller. Conclusions: Temporal patterns of PC visits are correlated with outcomes, even among beneficiaries who appear otherwise similar. Measuring the temporal regularity of PC visits may be useful for identifying beneficiaries at risk for adverse events, and as a barometer for and an impetus to clinic-level quality improvement.