Background: Continuity of care — seeing one's own primary care clinician for most visits — is a basic tenet of primary care. This study examined continuity trends from 2019 through 2023 in a national sample of community-based health centers spanning the period before, during, and after the COVID-19 pandemic. Researchers used OCHIN Epic electronic health record (EHR) data to measure continuity among patients using the Usual Provider of Care (UPC) index (the proportion of visits with a patient's most frequently seen clinician). A score of 1 means all visits were with the same clinician.
What They Found: High rates of continuity were consistently observed over the five-year period: Among an annual average of 353,608 patients seen in an average of 186 community health centers, the median UPC score was 1 in each year. The average score dipped slightly in 2020 (0.822) at the start of the pandemic, then rebounded to levels slightly above the 2019 rate (0.825). In 2023, adults were more likely to have perfect continuity if they were older or had income above 138% of the Federal Poverty Line. Lower rates of continuity were associated with female gender, Hispanic ethnicity, Black/African American race, having multiple chronic conditions, telehealth use, and receiving care at large clinics. Among children, lower rates of continuity were associated with Hispanic ethnicity, telehealth use, and receiving care at high-volume clinics.
Implications: The high rates of continuity suggest that community health centers and their patients sustained strong patient-clinician relationships despite the disruptions of the COVID-19 pandemic and identify opportunities to improve continuity of care.
Continuity of Primary Care in Community Health Centers
Kurt C. Stange, MD, PhD, et al
Center for Community Health Integration, Departments of Family Medicine & Community
Health, Population and Quantitative Health Sciences, and Sociology, Case Western Reserve
University, Cleveland, Ohio
