- Design
- retrospective population-level cross-sectional study with matching, three years
- Population
- about 70,000 matched patients with chronic disease from a 500,000-patient Alberta cohort
- Primary outcome
- health service utilisation costs by level of clinic continuity
- Effect
- high clinic continuity associated with lower acute care costs, projected at up to £898 million over three years across 195,000 patients
Roughly 70,000 matched patients with chronic disease, drawn from a cohort of 500,000 in Alberta, were grouped by how concentrated their primary care was at a single clinic, using an adapted Usual Provider of Care index, and their acute care costs compared over three years.
Higher clinic continuity was associated with lower acute care costs at every level of complexity, and the per-patient difference was largest in the most medically complex patients. Scaled up, the authors estimate that moving all 195,000 patients below the high-continuity band into it could be associated with savings of up to £898 million over three years.
That headline figure is a modelled extrapolation from a cross-sectional association, and it should be read as an order of magnitude rather than a budget line. Sicker patients also move around the system more, which generates both fragmentation and cost, and matching cannot fully separate the two. What is worth carrying is the unit of measurement: this is clinic continuity, not doctor continuity - the measure a shared practice or a team-based model can actually act on. In Indian practice, where a single physician may be the whole clinic, the equivalent lever is whether the patient's record follows them, and whether they can get back to the same place rather than the same person.
- Continuity here is measured at clinic level, which is what a team-based practice can influence.
- The largest per-patient association was among the most medically complex patients.
- Book complex patients back to the same clinic rather than the next available slot elsewhere.
- Where one doctor is the clinic, continuity of the record is the practical equivalent.
- The headline saving is a modelled extrapolation, not an observed saving.
Why it matters
It gives a practice manager an argument for continuity in the currency that actually decides rotas and booking systems.
Don't overread it
A cross-sectional association with a modelled projection on top - it cannot show that increasing continuity would produce these savings.
The statistics, in plain English
This is cross-sectional, so continuity and cost were measured together and neither can be shown to cause the other. The likeliest confounder is severity: patients who are deteriorating attend more places and cost more, which produces this association without continuity doing anything. The £898 million figure compounds that uncertainty by extrapolating an observed association to a population that was never moved.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for family medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free