Continuity of Care in Federally Qualified Health Centers: Examining Patient-Provider Relationships and Patient...

Continuity of care between patients and physicians is a defining element of primary care and a pillar of the Patient Centered Medical Home (PCMH) program. We aimed to investigate the level of short- and long-term continuity within a network of Federally Qualified Health Centers (FQHCs) and the relationship of continuity to PCMH recognition.

This multi-method study utilized Electronic Health Record data to investigate patient continuity, and survey data to investigate PCMH history. The study population included patients with at least 2 visits between 2008 and 2023 to one of 18 FQHCs. Continuity was measured by calculating the number of primary care providers (PCPs) seen by the patient and the usual provider of care index (UPC Index [the number of visits with the most frequent PCP/total visits]).

Our population consisted of 1,323,547 patients and 19,768,516 encounters. The mean (SD) number of PCPs per patient over one year was 2.01 (1.1). For patients who had visits spanning at least 5 years, the mean was 7.2 (4.7). The mean one-year UPC was .72 (.25) and 5+ year UPC was .47 (.21). No meaningful association was found between continuity measures and PCMH recognition.

These findings show, on average, high numbers of PCPs and poor continuity with a single "usual provider of care" for each patient's care over time at FQHCs. Leveraging performance measures, such as PCMH recognition, to incentivize continuity may be inadequate. Different approaches should be considered to preserve the long-term continuity at the heart of primary care.