Continuity of Primary Care in Community Health Centers

We conducted a cross-sectional cohort study to assess how continuity of primary care within community-based health centers (CHCs) might have changed during the years surrounding the COVID-19 pandemic and how continuity varied by patient and visit characteristics.

In a national sample of CHCs providing primary care, we assessed the usual provider of care (UPC) index-the fraction of patient visits to the patient's most frequently seen clinician within the CHC-for patients with at least 2 primary care encounters within a calendar year during 2019-2023. We used age-stratified multilevel logit analyses to assess patient, clinic, and visit characteristics associated with the perfect UPC index of 1 in 2023.

Among an annual average of 353,608 patients seen in an average of 186 CHCs, the median UPC index was 1 in each year, with the mean index varying from a low of 0.822 in 2020 to a high of 0.831 in 2021. In the 2023 sample, logit analyses adjusted for clustering of patients within clinics found that among adults, the likelihood of achieving a UPC index of 1 was higher for patients who were middle-aged or older and had an income greater than 138% of the federal poverty level or an unknown income, whereas it was lower for patients who were of Hispanic ethnicity, were of Black/African American race, had multimorbidity, had a telehealth visit, and received care at large clinics. Among children, the likelihood of achieving a UPC of 1 was lower for those who were of Hispanic ethnicity, had a telehealth visit, and received care at large clinics.

In a large national sample of patients seen at CHCs, continuity of primary care within CHCs remained high before, during, and after the COVID-19 pandemic, and was associated with practice and patient characteristics that provide targets for systemic intervention. Although health care systems explore different approaches to balance continuity with easy access, CHCs continue to value and deliver high-continuity care.