Community health centers maintained care continuity during COVID-19 pandemic

As the COVID-19 pandemic upended virtually every aspect of people's lives, one critical question loomed large for millions of low-income and underserved healthcare patients: Would they still be able to see their own doctor?

Researchers at Case Western Reserve University and the OCHIN nonprofit consultancy conducted a comprehensive, nationwide study of community-based health centers-the frontline primary care providers serving millions of America's most vulnerable patients. The goal: to assess how consistently patients were able to see their primary care provider before, during and after the COVID-19 pandemic.

The study, published in Annals of Family Medicine, tracked on average 354,000 patients treated at 186 community health centers yearly from 2019 to 2023. The researchers found that the centers maintained consistently high levels of continuous care throughout the five-year study. 

For these patients, a community health center is not just a convenience-it is their only option. Knowing that these centers maintained consistent, high-quality care throughout one of the most turbulent periods in modern healthcare history is deeply meaningful for the communities they serve.

Our findings reveal a remarkable story of resilience despite the unprecedented disruption of the COVID-19 pandemic, which forced healthcare systems across the country to cancel appointments, shift to telehealth and operate under severe staffing constraints."

Kurt C. Stange, Distinguished University Professor and the Dorothy Jones Weatherhead Professor of Medicine, Case Western Reserve School of Medicine

The methodology

The researchers gauged continuity using the Usual Provider of Care (UPC) index, which measures how consistently patients were able to be treated by their primary care provider rather than a different clinician at each visit. A score of 1.0 represents perfect continuity-meaning a patient saw the same provider for every visit.

The median UPC score was 1.0 each year-the highest possible level-even during the height of the pandemic. The average UPC varied from a low of 0.822 in 2020 to a high of 0.831 in 2021-so it was consistently high. 

But the study also identified some flaws.

"When we dug deeper into the 2023 data, we found that not all patients experienced the same level of care continuity," Stange said. "Significant gaps emerged along racial, ethnic, economic and demographic lines."

Patients less likely to see their own doctor consistently:

• Patients with multiple chronic conditions faced greater difficulty seeing the same provider consistently.

• Hispanic patients faced lower care continuity among both adults and children.

• Black and African American patients faced lower care continuity among adults.

• Low-income patients-those living below 138% of the federal poverty level- were less likely to achieve consistent care.

• Telehealth users-both adults and children-were less likely to achieve consistent care.

• Patients at large clinics faced lower continuity than those at smaller practices.

"The differences identified in this study occurred even in these community health centers focused on caring for historically underserved populations," Stange said. "These disparities are targets for systematic intervention-specific, identifiable gaps that healthcare systems, policymakers and community health centers can address so that everyone can have the advantages of being cared for by a clinician who knows them."