Patient social risk factors and continuity of care for Medicare beneficiaries

Objective: To identify patient social risk factors associated with Continuity of Care (COC) index. Data Sources/Study Setting: Medicare Current Beneficiary Survey (MCBS), the Dartmouth Institute, and Area Resource File for 2006-2013. Study Design: We use regression methods to assess the effect of patient social risk factors on COC after adjusting for medical complexity. In secondary analyses, we assess the effect of social risk factors on annual utilization of physicians and specialists for evaluation and management (E&M). Data Collection/Extraction Methods: We retrospectively identified 59 499 patient years for Medicare beneficiaries with one year of enrollment and three or more E&M visits. Principal Findings: After adjustment for medical complexity, individual-level social risk factors such as lack of education, low income, and living alone are all associated with better patient COC (P <.05). Similarly, area-level social risk factors such as living in areas that are nonurban or high poverty, as well as in areas with low specialist or high primary care physician supply, are all associated with better patient COC (P <.05). We found the opposite pattern of associations between these same risk factors and annual patient utilization of physicians and specialists (P <.05). Conclusions: Medicare patients with multiple social risk factors have consistently better COC; these same social risk factors are associated with reduced patient-realized access to specialist physician care.