Higher continuity lowers emergency use and admissions
Among older adults receiving long-term home-based primary care, having at least 75% of contacts with the assigned family doctor or nurse was linked to fewer urgent services and hospital admissions.
*Cohort study; Level 2b (OCEBM).

Citation

Herranz C, González-de Paz L, Borrás-Santos A, et al. Effect of Continuity of Care on Emergency Care and Hospital Admissions Among Patients Receiving Home-Based Care: A Population-Based Cohort Study. Annals of Family Medicine. 2026;24:17-24. https://doi.org/10.1370/afm.240637

Background

Continuity of care (an ongoing relationship with the same clinician) has been tied to fewer hospital and emergency visits, but evidence is limited for very frail patients receiving permanent home-based care and for nursing continuity.

Patients

1,207 adults receiving permanent home-based primary care in 3 urban centers in Barcelona, Spain (mean age 88.5 years; 71.5% women).

Intervention

Higher continuity with the assigned family doctor or assigned primary care nurse (measured as the share of contacts with that clinician; key threshold tested: ≥75%).

Control

Lower continuity (<50%; and 50% to <75% in some analyses).

Outcome

(Primary) Home ambulance use, emergency department visits, and hospital admissions.

Follow-up Period

365 days.

Results

Outcome (primary) Assigned family doctor continuity ≥75% vs <50% (hazard ratio, 95% confidence interval) Assigned nurse continuity ≥75% vs <50% (hazard ratio, 95% confidence interval)
Home ambulance use 0.69 (0.58 to 0.83) 0.69 (0.54 to 0.88)
Emergency department visit 0.61 (0.50 to 0.75) NS
Hospital admission 0.65 (0.52 to 0.82) 0.62 (0.46 to 0.83)
NS = not significant.
Models adjusted for age, sex, illness burden, and daily-activity dependence.
A data-driven threshold of ≥75% continuity with the assigned family doctor showed modest prediction of admission risk.

Limitations

Observational design; possible reverse causality near end of life; only 3 centers; reasons for visits/admissions not analyzed.

Funding

Funding not reported; authors declared no conflicts of interest.

Clinical Application

For home-based primary care, prioritize scheduling so ≥3 of 4 contacts stay with the assigned doctor and nurse to help reduce urgent use and admissions.