Primary care physician visit continuity: a comparison of patient-reported and administratively derived measures.

Abstract

BACKGROUND: Studies find that primary care physician (PCP) visit continuity is positively associated with care quality. Some of the evidence base, however, relies on patient-reported continuity measures, which may be subject to response bias. OBJECTIVE: To assess the concordance of patient-reported and administratively derived visit continuity measures. DESIGN: Random samples of patients (n = 15,126) visiting 1 of 145 PCPs from a physician organization in Massachusetts were surveyed. Respondents reported their experienced visit continuity over the preceding 6 months. Usual Provider Continuity (UPC), an administratively derived measure, was calculated for each respondent. The concordance of patient reports and UPC was examined. Associations with patient-reported physician-patient interaction quality were assessed for both measures. RESULTS: Patient-reported and administratively derived visit continuity measures were moderately correlated for overall (r = 0.30) and urgent (r = 0.30) measures and modestly correlated for the routine (r = 0.17) measure. Although patient reports and UPC were significantly associated with the physician-patient interaction quality (p < 0.001), the effect size for patient-reports was approximately five times larger than the effect size for UPC. CONCLUSIONS: Studies and quality initiatives seeking to evaluate visit continuity should rely on administratively derived measures whenever possible. Patient-reported measures appear to be subject to biases that can overestimate the relationship between visit continuity and some patient-reported outcomes.