OBJECTIVES : To examine the association of continuity of care with long-term outcomes in African American, Hispanic, and white Medicare beneficiaries with localized prostate cancer.

METHODS : In this retrospective cohort design study we used Surveillance, Epidemiological, and End Results (SEER)-Medicare database. Fee-for-service Medicare patients aged ≥66, diagnosed with localized prostate cancer between 2000 and 2003 were extracted from SEER-Medicare. Physician specialty data was obtained from American Medical Association. Continuity of care measures were Continuity of Care Index (COCI), and Usual Provider Care Index (UPCI) for oncology visits and primary care visits in acute survivorship phase (two-year post-diagnosis). Outcomes were Emergency room visits, hospitalizations, cost, and mortality (all-cause and prostate cancer-specific) over a follow-up of up to thirteen years. We used Cox model and Fine-Gray competing risk analysis for survival, log-link Generalized Linear Model for cost, and Poisson models for count data, weighted by propensity score.

RESULTS : Cohort consisted of 67,011 localized prostate cancer patients who had at least two outpatient visits during acute survivorship phase. High overall COCI during acute survivorship care was associated with mortality benefit for all racial and ethnic groups. Mortality reduction was largest for African American, compared to white and Hispanic patients (28% vs. 11% and 23%, respectively). Higher overall COCI was associated with lower cost for all groups. Primary care continuity had wider benefits than that of oncology continuity. We observed similar results for UPCI, a measure of density of continuity of care.

CONCLUSIONS : Higher continuity of care during acute survivorship phase can improve long-term outcomes in localized prostate cancer patients across racial and ethnic groups. Care during acute survivorship phase must promote continuity, especially for patients who may see multiple providers. Future research can analyze the mechanisms through which continuity of care affects outcomes and improves quality of care.