LAUSR

BACKGROUND Continuity of care may be associated with health care outcomes and costs. The objective of the current study was to characterize the impact of continuity of care on perioperative outcomes, as well as on cost of care, among Medicare beneficiaries undergoing hepatopancreatic resection. METHODS Patients with a minimum of 4 outpatient visits in the year before hepatopancreatic surgery were identified in the Medicare claims data. The Bice-Boxerman index was used to calculate continuity of care. The association of continuity of care and expenditures was assessed using a multivariable gamma regression with a log link. RESULTS Among 25,698 Medicare beneficiaries who underwent a hepatopancreatic surgical procedure (hepatectomy: n = 10,679, 41.6%, pancreatectomy: n = 15,019, 58.4%), median patient age was 72 years (interquartile range: 68-77). Overall continuity of care was poor as the median continuity of care was 0.17 (0.10-0.29). Median total surgical costs were higher among patients in the lowest continuity-of-care quartile (continuity of care1st quartile: $25,500 [interquartile range, $18,100-$41,800]) compared with patients in the highest continuity-of-care quartile (continuity of care4th quartile: $22,700 [interquartile range, $17,100-$38,400]). Among patients undergoing hepatic resection, an increase in continuity of care of 0.2 was associated with decreased costs of 5.1% (95% confidence interval: -6.3% to -3.8%) compared with a decrease of 2.5% (95% confidence interval: -3.7% to -1.2%) among pancreatic resection patients. CONCLUSION Continuity of care in the year before surgery was associated with total cost of surgery-including the cost of the index hospitalization and the total 90-day postdischarge costs. Relative to patients with a continuity of care = 0, indicating complete fragmentation of a patient's outpatient health care, patients with a continuity of care = 0.60 had 12.1% lower total surgical costs.