Impact of continuity of care on mortality and health care costs: A nationwide cohort study in Korea

Dong Wook Shin, Juhee Cho, Hyung Kook Yang, Jae Hyun Park, Hyejin Lee, Hyunsu Kim, Juhwan Oh, Soohee Hwang, Belong Cho, Eliseo Guallar

Research output: Contribution to journalArticlepeer-review


PURPOSE Continuity of care is considered a core element of high-quality primary care, but its impact on mortality and health care costs is unclear. We aimed to determine the impact of continuity of care on mortality, costs, and health outcomes in patients with newly diagnosed cardiovascular risk factors.

METHODS We conducted a cohort study of a 3% nationwide random sample of Korean National Health Insurance enrollees. A total of 47,433 patients who had received new diagnoses of hypertension, diabetes, hypercholesterolemia, or their complications in 2003 or 2004 were included. We determined standard indices of continuity of care—most frequent provider continuity (MFPC), modified, modified continuity index (MMCI), and continuity of care index (COC)-and evaluated their association with study outcomes over 5 years of follow-up. Outcome measures included overall mortality, cardiovascular mortality, incident cardiovascular events, and health care costs.

RESULTS The multivariable-adjusted hazard ratios (HRs) for all-cause mortality, cardiovascular mortality, incident myocardial infarction, and incident ischemic stroke comparing participants with COC index below the median to those above the median were HR = 1.12 (95% CI, 1.04-1.21), 1.30 (1.13-1.50), 1.57 (1.28- 1.95), and 1.44 (1.27-1.63), respectively. Similar findings were obtained for other indices of continuity of care. Lower continuity of care was also associated with increased inpatient and outpatient days and costs.

CONCLUSIONS Lower indices of continuity of care in patients with newly diagnosed hypertension, diabetes, and hypercholesterolemia were associated with higher all-cause and cardiovascular mortality, cardiovascular events, and health care costs. Health care systems should be designed to support long-term trusting relationships between patients and physicians.

Original languageEnglish (US)
Pages (from-to)534-541
Number of pages8
JournalAnnals of family medicine
Issue number6
StatePublished - Nov 1 2014


  • Cardiovascular diseases
  • Continuity of care
  • Health care costs
  • Mortality

ASJC Scopus subject areas

  • Family Practice

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