Clinic continuity and the cost of chronic disease

Design

Retrospective population-level cross-sectional study

Population

About 70,000 matched patients with chronic disease in Alberta

Primary outcome

Health-service use costs by clinic continuity level

Effect

Lower acute-care costs with high continuity (UPC 80–100%) at all complexity levels

A population study in the BJGP (1 October) examined about 70,000 matched patients with chronic disease in Alberta, Canada, comparing acute-care costs across practices with low, moderate and high continuity — the share of visits made to the patient's usual clinic.

Higher clinic continuity was associated with lower acute-care costs at every level of complexity, with the largest gains in the most complex patients. The authors estimate that moving everyone to high-continuity care could theoretically save hundreds of millions over three years.

The finding extends the familiar benefits of seeing the same doctor to seeing the same clinic team, which matters as practices move to shared models.

• Patients with chronic disease cost less when most of their care stays in one clinic
• The gain was largest for the most complex patients
• Team continuity, not only personal continuity, appears to matter
• Protect continuity for multimorbid patients when designing appointment systems

Why it matters

It gives practices running shared lists evidence that clinic-level continuity still pays off.

Don't overread it

The savings are modelled from cross-sectional associations, not from moving patients between clinics.

The statistics, in plain English

The savings figure is a projection: it assumes the cost differences between high- and low-continuity clinics are caused by continuity, which a cross-sectional study cannot prove.

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