Study Examines Effects of Primary Care Provider Turnover
BACKGROUND:
The benefits of having an ongoing, stable primary care provider (PCP) are well-documented, yet a key challenge to maintaining continuity of care for patients is the high rate of turnover among PCPs. Nationally, 7% of physicians are estimated to turnover per year. Among PCPs, 30% aged 35 to 49 and 50% aged 50 years and older stated that they planned to leave their practice within five years. As more and more PCPs leave their practice, little is known about the effect of this turnover on patient outcomes. Therefore, this observational, retrospective cohort study measured the effect of PCP turnover on patient experiences of care and ambulatory care quality. Using VA data, investigators identified two sets of Veterans enrolled in VA healthcare between 2010 and 2012: 1) 326,374 Veterans from the Survey of Healthcare Experiences of Patients (SHEP, used to measure patient experiences of care), associated with 8,411 PCPs; and 2) 184,501 Veterans from the External Peer Review Program (EPRP, used to measure ambulatory care quality), associated with 6,973 PCPs. Measures included 5 patient care experience measures from SHEP and 11 measures of quality of ambulatory care from EPRP. Analyses were then conducted to assess whether Veterans who experienced PCP turnover reported worse experiences of care or lower ambulatory quality of care compared with Veterans who did not experience PCP turnover.
FINDINGS:
- Nearly 9% of patients in this study experienced a PCP turnover. Primary care turnover was associated with worse patient experiences of care. For example, 75% who experienced no PCP turnover had a positive rating of their personal doctor compared with 68% of Veterans who had experienced PCP turnover. Also, 38% of Veterans with no PCP turnover had a positive rating of getting care quickly compared with 36% of patients who had experienced PCP turnover.
- In contract, PCP turnover was not associated with lower ambulatory care quality. In 9 measures of ambulatory care quality, the difference between patients who experienced no PCP turnover and those who had a PCP turnover was less than 1%.
LIMITATIONS:
- This study did not measure healthcare utilization patterns, e.g., the effect of losing a PCP that might be seen in increased emergency department use, hospitalizations, and total cost of care.
- Because the SHEP response rate was only 53%, results may not generalize to all Veterans who received outpatient care due to response bias.
IMPLICATIONS:
- The use of shared electronic medical records and team-based care may help mitigate the effects of the loss of a patient's PCP. It will be important to re-evaluate the effects of PCP turnover on patient outcomes as these new models develop.
AUTHOR/FUNDING INFORMATION:
Drs. Asch and Werner are part of HSR&D's Center for Health Equity Research & Promotion located in Pittsburgh and Philadelphia, PA.
Reddy A, Pollack C, Asch D, Canamucio A, and Werner R. The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care. Original Investigation, JAMA Internal Medicine. July 1, 2015;175(7):1157-62.
