Primary care physician continuity, survival, and end‐of‐life care intensity

• Published in: Health services research Vol. 57; no. 4; pp. 853 - 862
• Main Authors: Hung, Peiyin, Cramer, Laura D., Pollack, Craig E., Gross, Cary P., Wang, Shi‐Yi
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2022; Health Research and Educational Trust
• Subjects: Aged; Aged, 80 and over; Associations; Beneficiaries; Cancer; cancer/oncology; care continuity; Cohort analysis; Comorbidity; Confidence intervals; Continuity of Patient Care; Diagnosis; end of life; Epidemiology; Extraction; Forecasts and trends; Government programs; Government regulation; Health care; Health care reform; Health hazards; Humans; Laws, regulations and rules; Market trend/market analysis; Medical diagnosis; Medical prognosis; Medicare; Methods; Neoplasms - therapy; Palliative and End‐of‐life Care; Palliative care; Palliative treatment; Patients; Physicians; Physicians, Primary Care; Primary care; primary care physician; Prognosis; prospective cohort study; Retrospective Studies; Statistical models; Surveillance; Survival; survival analysis; Terminal Care; United States; United States; end of life; prospective cohort study; survival analysis; primary care physician; cancer/oncology; care continuity
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.13869

Objective To examine the associations of primary care physician (PCP) care continuity with cancer‐specific survival and end‐of‐life care intensity. Data Sources Surveillance, epidemiology, and end results linked to Medicare claims data from 2001 to 2015. Study Design Cox proportional hazards models with mixed effects and hierarchical generalized logistic models were used to examine the associations of PCP care continuity with cancer‐specific survival and end‐of‐life care intensity, respectively. PCP care continuity, defined as having visited the predominant PCP (who saw the patient most frequently before diagnosis) within 6 months of diagnosis. Data Extraction Methods We identified Medicare patients diagnosed at age 66.5–94 years with stage‐III or IV poor‐prognosis cancer during 2001–2012 and followed them up until 2015. Patients who died within 6 months after diagnosis were excluded. Principal Findings Primary study cohort consisted of 85,467 patients (median survival 22 months), 71.7% of whom had PCP care continuity. Patients with PCP care continuity tended to be older, married, nonblack, non‐Hispanic, and to have fewer comorbid conditions (p < 0.001 for all). Patients with PCP care continuity had lower cancer‐specific mortality (adjusted hazard ratio: 0.93; 95% confidence interval [CI]: 0.91 to 0.95; p = 0.001) than did those without PCP care continuity. Findings of the 2001–2003 cohorts (nearly all of whom died by 2015) show no associations of overall end‐of‐life care intensity measures with PCP care continuity (adjusted marginal effects: 0.005; 95% CI: −0.016 to 0.026; p = 0.264). Conclusions Among Medicare beneficiaries with advanced poor‐prognosis cancer, PCP continuity was associated with modestly improved survival without raising overall aggressive end‐of‐life care.