Continuity, regularity linked to ambulatory use in Shanghai cohort

A retrospective cohort study of 10,122 patients with hypertension or diabetes at a community healthcare center in Shanghai found that continuity and regularity of primary care were associated with different patterns of ambulatory care utilization. Greater continuity was associated with more emergency department visits and a higher probability of follow-up for chronic diseases, whereas greater regularity was associated with fewer emergency department visits and a lower probability of such follow-up. Neither measure was associated with outpatient expenditure at general secondary and tertiary hospitals.

Researchers analyzed electronic health records collected in 2017 and 2018 at the T community healthcare center. They assessed continuity between patients and their general practitioners with three measures: the Continuity of Care Index, Usual Provider of Care and Sequential Continuity of Care Index. Principal component analysis was then used to integrate these indicators into a single continuity-of-care index, designated iCOCGP. A modified regularity index, or RI, represented a second dimension of primary-care quality. The cohort was restricted to patients with hypertension or diabetes receiving care at one urban community healthcare center, limiting the study’s geographic and clinical scope.

The three continuity measures had median values of 0.47 for Usual Provider of Care, 0.25 for the Continuity of Care Index and 0.57 for the Sequential Continuity of Care Index. The median modified regularity index was 0.29. Different statistical models were used to examine associations between the integrated continuity index, the regularity index and utilization of ambulatory services. The outcomes considered included outpatient visits and expenditure at general secondary and tertiary hospitals, emergency department visits and follow-up for chronic diseases.

Regularity was associated with greater use of outpatient services at general secondary and tertiary hospitals. For every 1% increase in the regularity index, the reported probability of such visits increased by 1.1%, with a 95% confidence interval of 0.3% to 1.9%. The integrated continuity index and regularity index were not associated with outpatient expenditure at those hospitals. Thus, the analysis distinguished between the probability of visiting higher-level outpatient facilities and expenditure associated with that use.

The emergency department and chronic-disease follow-up results showed different associations for continuity and regularity. Each 1% increase in the integrated continuity index was associated with a 0.4% increase in emergency department visits (95% CI: 0.2% to 0.7%) and a 2.9% increase in the probability of follow-up for chronic diseases (95% CI: 2.5% to 3.3%). By contrast, each 1% increase in the regularity index was associated with a 0.6% decrease in emergency department visits (95% CI: 0.1% to 1.2%) and a 1.4% decrease in the probability of chronic-disease follow-up (95% CI: 0.6% to 2.1%). These are model-based associations, not evidence that changes in either measure would cause the corresponding utilization patterns.

The study provides evidence that continuity and regularity can be separately related to service use within the same primary-care population. The authors concluded that both should be considered in future research examining primary care and general-practitioner services. The retrospective design, two-year data window, single-center setting and focus on two chronic conditions constrain generalization and make it difficult to determine the causal direction of the relationships. The findings therefore support treating continuity and regularity as distinct variables in future analyses of healthcare utilization rather than demonstrating a clinical effect of changing either one.

Subject of Research: Associations of primary-care continuity and regularity with ambulatory care utilization among patients with chronic conditions in Shanghai

Article Title: The continuity and regularity of primary care were associated with ambulatory care utilization: evidence from community healthcare centers in China

Article References: Wang, J., Gu, H., Liu, W., Yin, S., & Jiang, H. (2026). The continuity and regularity of primary care were associated with ambulatory care utilization: evidence from community healthcare centers in China. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15553-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15553-4

Keywords: primary care, care continuity, care regularity, ambulatory care, chronic disease follow-up, emergency department visits, community healthcare, hypertension, diabetes, electronic health records, continuity, regularity