Continuity of Care with a Primary Care Physician and Mortality in Older Adults
Continuity of Care with a Primary Care Physician and Mortality in Older Adults
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DOI：
10.1093/gerona/glp188
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发表时间：
2010-04-01
影响因子：
5.1
通讯作者：
Wallace, Robert B.
中科院分区：
文献类型：
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作者：
Wolinsky, Fredric D.;Bentler, Suzanne E.;Wallace, Robert B.
背景我们研究了是否老年人有连续性的照顾与初级保健医生（PCP）有较低的死亡率。二次分析使用的基线访谈数据（1993-1994年），从全国代表性的资产和健康动态调查之间的最老的老人（AHEAD）。分析样本包括5，457名70岁或以上未参加管理式护理计划的自我受访者。AHEAD数据与1991-2005年的医疗保险索赔相关联，提供了长达12年的随访。两项时间依赖性连续性措施涉及在前2年期间，同一PCP的任何两次访视之间的间隔是否超过8个月。“当前暴露”测量每天计算该标准，并且可以每天“打开”或“关闭”，而“累积暴露”测量反映了随访天数的百分比，也是每天允许其每天打开或关闭，符合标准。2954名（54%）参与者在随访期间死亡。使用累积暴露措施，27%的人从未接受过连续性护理。而31%。分别有20%、14%和8%的患者在1%-33%、34%-67%、68%-99%和100%的随访日内具有连续性。经人口统计学、社会经济地位、社会支持、健康生活方式和发病率调整后，两种连续性指标均相关。（p < .001）死亡率较低（本暴露测量的调整风险比为0.84，1%-33%，34%-67%，68%-99%，和100%类别的累积暴露量）。通过两种不同的测量方法评估，使用PCP的持续护理与长期死亡率的大幅降低相关。
Background. We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.Methods. Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.Results. Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care. whereas 31%. 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure).Conclusion. Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.