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Key DFM Personnel

Nancy Pandhi, MD, MPH – Principal Investigator
Zaher Karp, MPH – Project Coordinator


National Institutes of Health (NIH)


This research examines whether continuity of care with a physician has a beneficial effect on the health of older adults and achieves cost savings over and above continuity with a site. We examine if these effects are enhanced for those traditionally considered vulnerable (e.g. women, widows, those with lower socioeconomic status, limited education, limited insurance, more chronic conditions, or perceived worse health status). Next, we develop a resource-based model of vulnerability and determine whether this approach adds significant value to understanding continuity’s effect on outcomes. Finally, we examine different aspects of continuity and patient’s preference for these aspects of continuity in relationship to health outcomes.


1) To determine if continuity of care with an individual physician has an effect over and above continuity with a site on health care, health outcomes and costs for older adults

  • Does continuity with a physician have a differential effect for subgroups of patients traditionally considered vulnerable (e.g., poor, chronically ill)?

2) To characterize vulnerability using a resource-based framework and then determine if this approach improves our understanding of how continuity with a physician and site affects older adults’ health outcomes.

3) To determine the effect of distinct aspects of continuity of care with a physician (e.g. trust) and site on older adults’ health care and health outcomes


This research uses data from the Wisconsin Longitudinal Survey, a long-term cohort study of a random sample of 10,317 men and women who graduated from Wisconsin high schools in 1957 and 7,638 of their randomly selected brothers and sisters. Sixty-eight percent of WLS graduates and siblings currently reside in Wisconsin, with the rest spread out across the United States. Graduates currently range in age from 64 to 70, and the siblings range in age from 36 to 89. Survey data were collected from the original graduates or their parents in 1957, 1964, 1975 and 1992 and a selected sibling in 1977 and 1993. In 2003-2006, data from graduates, the spouses and widows of the graduates, and a selected sibling was collected via mail and telephone. Additional data is being collected from graduates, starting in 2009. For cost analyses, we will use data from siblings of Medicare age interviewed in 2005-06 who gave us verbal permission during the telephone survey to have their 2004-6 Medicare Claims and Enrollment data linked to their survey responses (N= 843).