Primary care attributes and mortality: A national person-level study

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Abstract

PURPOSE Research demonstrates an association between the geographic concentration of primary care clinicians and mortality in the area, but there is limited evidence of a mortality benefi t of primary care at the individual patient level. We examined whether patient-reported access to selected primary care attributes, including some emphasized in the medical home literature, is associated with lower individual mortality risk. METHODS We analyzed data from 2000-2005 Medical Expenditure Panel Survey respondents aged 18 to 90 years (N = 52,241), linked to the National Death Index through 2006. A score was constructed from 5 yes/no items assessing whether the respondent's usual source of care had 3 attributes: comprehensiveness, patient-centeredness, and enhanced access. Scores ranged from 0 to 1 (higher scores = more attributes). We examined the association between the primary care attributes score and mortality during up to 6 years of follow-up using Cox survival analysis, adjusted for social, demographic, and health-related characteristics. RESULTS Racial/ethnic minorities, poorer and less educated persons, individuals without private insurance, healthier persons, and residents of regions other than the Northeast reported less access to primary care attributes than others. The primary care attributes score was inversely associated with mortality (adjusted hazard ratio = 0.79; 95% confi dence interval, 0.64-0.98; P =.03); supplementary analyses showed mortality decreased linearly with increasing score. CONCLUSIONS Greater reported patient access to selected primary care attributes was associated with lower mortality. The fi ndings support the current interest in ensuring that patients have access to a medical home encompassing these attributes.

Original languageEnglish (US)
Pages (from-to)34-41
Number of pages8
JournalAnnals of Family Medicine
Volume10
Issue number1
DOIs
StatePublished - Jan 2012

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Keywords

  • Access to health care
  • After-hours care
  • Comprehensive health care
  • Health care disparities
  • Mortality
  • Patient-centered care
  • Patient-centered medical home
  • Primary health care

ASJC Scopus subject areas

  • Family Practice

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