{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:12:40Z","timestamp":1782263560105,"version":"3.54.5"},"reference-count":61,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,2,9]],"date-time":"2020-02-09T00:00:00Z","timestamp":1581206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify patient social risk factors associated with Continuity of Care (COC) index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources\/Study Setting<\/jats:title><jats:p>Medicare Current Beneficiary Survey (MCBS), the Dartmouth Institute, and Area Resource File for 2006\u20102013.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We use regression methods to assess the effect of patient social risk factors on COC after adjusting for medical complexity. In secondary analyses, we assess the effect of social risk factors on annual utilization of physicians and specialists for evaluation and management (E&amp;M).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection\/Extraction Methods<\/jats:title><jats:p>We retrospectively identified 59\u00a0499 patient years for Medicare beneficiaries with one year of enrollment and three or more E&amp;M visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>After adjustment for medical complexity, individual\u2010level social risk factors such as lack of education, low income, and living alone are all associated with better patient COC (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05). Similarly, area\u2010level social risk factors such as living in areas that are nonurban or high poverty, as well as in areas with low specialist or high primary care physician supply, are all associated with better patient COC (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05). We found the opposite pattern of associations between these same risk factors and annual patient utilization of physicians and specialists (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Medicare patients with multiple social risk factors have consistently better COC; these same social risk factors are associated with reduced patient\u2010realized access to specialist physician care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13272","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T04:09:25Z","timestamp":1581307765000},"page":"445-456","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Patient social risk factors and continuity of care for Medicare beneficiaries"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7760-203X","authenticated-orcid":false,"given":"Kenton J.","family":"Johnston","sequence":"first","affiliation":[{"name":"Department of Health Management and Policy and Center for Outcomes Research College for Public Health and Social Justice Saint Louis University St. Louis Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Mittler","sequence":"additional","affiliation":[{"name":"Department of Health Administration College of Health Professions Virginia Commonwealth University Richmond Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"Hockenberry","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Rollins School of Public Health Emory University Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000246"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.10059"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.245"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glp188"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.1340"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1739"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13841"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-710"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-11-43"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12600"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2009.01235.x"},{"key":"e_1_2_9_13_1","volume-title":"Merit\u2010Based Incentive Payment System (MIPS): Total Per Capita Costs for All Attributed Beneficiaries","author":"Centers for Medicare and Medicaid Services","year":"2018"},{"key":"e_1_2_9_14_1","volume-title":"Accountable Care Organization 2018 Quality Measures. 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