Continuity and Relationships Among Patients, Physicians, and Care Teams (CARE PACT)

<h3>Context:</h3> A patient’s relationship with their primary care physician (PCP) or advanced practice provider (APP) is instrumental in their healthcare journey. Examining continuity and relationships in a new way— focusing on both PCP continuity from the physician/APP perspective, and looking at care team size from the patient perspective—will shine a new light on challenges in achieving continuity several years into the patient-centered medical home (PCMH) movement. Continuity is particularly critical in the resource constrained setting of federally qualified health centers (FQHCs) that treat populations with complex medical and behavioral health needs. <h3>Objective:</h3> 1) evaluate the number of providers involved in a patient’s care over time; 2) evaluate PCP continuity with patients in their own panel and patient continuity with their designated primary care provider; and 3) explore factors correlated with continuity measures. <h3>Study Design and Analysis:</h3> We conducted a secondary data analysis of EHR data which include n=10,279,755 encounters among n=278,406 unique patients. We also collected organizational characteristics from 19 FQHCs via survey. <h3>Dataset:</h3> EHR data include: PCP/APP characteristics (specialty, location), patient demographics (age, ethnicity, responsible provider), and encounter data (type, date, provider). Organizational characteristics include size, PCMH certification, and presence of central scheduling. <h3>Population Studied:</h3> Patients and PCPs/APPs within a national network of FQHCs over a 15-year period. <h3>Outcome Measures:</h3> Patient-level continuity metrics include the Usual Provider of Care Index (UPC), defined as the number of visits a patient has with their most frequent provider divided by their total number of visits. We also calculated the number of PCPs/APPs seen over 1- and 5-year intervals. The provider-level continuity index was calculated by dividing the number of in-panel visits by the total number of visits over the last year. <h3>Results:</h3> 43% of designated providers were from non-primary care specialties. Over the last year, the aggregate provider continuity index was 0.53 and the aggregate patient UPC was 0.74. When expanding the analysis to a 5-year interval, the aggregate patient UPC dropped to 0.47. Full results to be presented at the meeting. <h3>Conclusions:</h3> While continuity was relatively strong in the short term, it was less robust over the long term. Short term continuity measures may be inadequate in a longitudinal field like primary care