Background/Aims Greater continuity of care (CoC) is associated with lower hospital utilization. This has not been fully explored in integrated care delivery systems with high informational continuity.

Methods We determined associations between hospital utilization and: the Modified, Modified Continuity Index (MMCI), the Continuity of Care Index (COCI), and patient-reported care integration, in 2 retrospective cohorts of persons age 65+ with 3+ chronic conditions. A primary cohort (N = 806) reported care integration as measured by the Ambulatory Care Experiences Survey (ACES) in addition to administratively-measured CoC data; a secondary cohort (N = 11,394) had CoC data only. CoC and outcomes were measured over a 2-year period. Outcomes included: 1+ inpatient admissions (total and preventable), observation stays, and treat-and-release ED visits. Associations were evaluated with Wilcoxon Rank Sum tests.

Results Cohorts had similar age, gender, and morbidity. Median (5%,95%) scores for ACES domains were all 90 (50,100). CoC measures had different distributions, but were highly correlated: Median MMCI scores for primary and secondary cohorts were 0.54 (0.23, 0.80) and 0.55 (0.26, 0.84) respectively; COCI scores for primary and secondary cohorts were 0.17 (0.05, 0.53) and 0.20 (0.05, 0.65). In the primary cohort, ACES domains were not associated with having an inpatient admission, preventable admission, or observation stay; those with 1+ ED visit reported slightly lower team coordination; and no associations were observed between CoC measures and outcomes. In the secondary cohort, higher mean MMCI scores were associated with slightly greater utilization for all outcomes, whereas higher mean COCI scores were associated with slightly lower utilization.

Conclusions Differences in CoC among those with and without hospital use were statistically but not clinically significant. For multimorbid patients in a highly integrated system, the value of interpersonal continuity is unlikely to be demonstrated by a reduction in hospital utilization, which may be more a function of informational continuity.