Why Continuity of Care Matters
New research shows one factor can help keep people out of the hospital for minor acute conditions: consistently seeing the same primary care doctor
For older adults, seemingly minor acute conditions — like urinary tract infections, ear infections or mild respiratory infections — can escalate quickly, sometimes triggering disruptive and costly hospital stays. What may appear on the surface to be a simple illness spirals into a major health event, leading to long hospital stays, higher medical bills and even additional health complications.
“If you provide good continuity of care, it leads to fewer hospitalizations.”
New research though shows that one factor can help keep people out of the hospital for these types of issues: consistently seeing the same primary care doctor instead of bouncing between different providers. Researchers, including Bijan J. Borah from the Mayo Clinic College of Medicine & Science, found that this so-called "continuity of care" isn't just comforting for patients — it can also reduce urgent and expensive hospital stays that might otherwise have been avoidable.
"Most studies up to this point have shown that continuity of care with a primary care provider is associated with preventing emergency room visits," says Borah. "We're confirming the association and showing that it's causal. If you provide good continuity of care, it leads to fewer hospitalizations. It's really about good access to care."
An 11+ Year Study
The study followed 54,376 Australians ages 45 and older over 11 years, tracking their visits to primary care providers as well as hospital stays. This allowed researchers to examine how ongoing relationships with a single primary care doctor affected the risk of hospitalization for acute, preventable conditions. Over half of the participants — 50.8% — experienced at least one acute preventable hospitalization during the study period.
To isolate the effect of continuity of care, the team used a sophisticated double machine learning approach, separating the impact of seeing the same doctor from other factors such as age, chronic illness, socioeconomic status and health behaviors. Acute preventable hospitalizations, which account for nearly half of all preventable hospital stays and can cost more than three times as much as non-acute preventable admissions, fell by 9.8% to 23.5% when patients' continuity of care increased modestly from the 45th percentile to the 50th percentile.
“Strengthening the patient-clinician relationship, the study suggests, can play a major role in reducing preventable hospital stays and improving outcomes.”
The benefits were most pronounced among the oldest adults: those ages 85 to 90 saw a 7% reduction in preventable hospitalizations, while those 91 and older saw a 6% reduction. People with multiple chronic conditions also saw significant improvement. But even adults without multiple conditions experienced meaningful benefits, underscoring that continuity of care matters for everyone.
Applying the findings to real population data from New South Wales, Borah and colleagues estimated that in 2018, roughly 127,000 people over age 45 experienced a preventable hospitalization. If continuity of care were improved for all at-risk patients, about 11,600 acute hospitalizations could have been avoided, resulting in fewer emergency room visits, reduced strain on hospital beds and substantial cost savings. Strengthening the patient-clinician relationship, the study suggests, can play a major role in reducing preventable hospital stays and improving outcomes.
'A Wake-Up Call'
"This study should be a wake-up call: visit your doctor regularly if you can, because it can help to prevent acute hospitalizations and high-cost care," Borah says. "You don't want to be hospitalized unnecessarily — it can expose you to other infections and complications. Regular check-ins with your doctor really matter."
For Beth Bernhardt of Winchester, Massachusetts, regularly seeing the same primary care doctor for the past 30 years has helped her receive prompt treatment for respiratory infections, which she's particularly susceptible to. That ongoing care has prevented minor illnesses from becoming serious enough to require urgent care or hospitalization.
“It's important to establish care with a doctor who sees you regularly.”
"I would have been in urgent care with this last round," Bernhardt says, had her doctor not quickly prescribed antibiotics. "What's helped our relationship is doing my annual check-ups on time and showing up regularly," she adds. That continuity builds trust and ensures her doctor can respond quickly when new symptoms appear, she says.
Audrey Chun, MD, professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York City, notes that good continuity of care also involves maintaining a complete record of medical history and understanding patients' goals and values to guide treatment decisions.
At Risk for Unnecessary Tests and ER Visits
For instance, Chun says, consider an 85-year-old woman with multiple conditions such as heart failure, recurrent urinary tract infections, mild memory impairment and diabetes who experiences chest pain and seeks care at an urgent care clinic. A clinician who has never seen her before would likely recommend an immediate ER visit, as this is the standard precaution.
"With continuity, her primary care provider knows she had a full cardiac workup in the last two months, including two hospital admissions that ruled out heart problems," says Chun. "Chances are, her pain doesn't warrant emergency care, and other safe options can be considered."
Without continuity, patients are at risk for unnecessary tests, emergency room visits, hospitalizations and treatments that may be neither wanted nor helpful. Often, tests are repeated simply because prior results aren't accessible or clinicians don't have a complete picture of the patient's health.
Chun emphasizes, "It's important to establish care with a doctor who sees you regularly. They should be available to discuss urgent or new symptoms and have a system in place to access all your medical records. That continuity can truly protect your health, save resources and prevent unnecessary stress for patients and families alike."
