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Address correspondence to: John H. Wasson, MD, (170), Veterans Administration Hospital, White River Junction, VT 05001. nurse practitioners, and four physician assistants) at a rural Veterans Administration General Medical Clinic (VAGMC) provided medical care to the study patients during the study period 1979-1982. To be included in the study, a patient had to be a man aged 55 years or older, and his one-way mileage from home to the VAGMC had to be 90 miles or less. Patients

In Reply.— We share the curiosity expressed by Drs Flynn and Kiel about how provider continuity accounts for significant differences in duration of hospitalization in our study. However, we do not share their concern that the finding was an artifact caused by some unrecognized difference in the two large groups of prospectively randomized patients that made up our study population. Table 2, which demonstrated comparability of patients prior to the analysisperiod of the study, was shortened prior to publication. An appended Table 2 is published in this letter. In a separate manuscript, currently in preparation, we demonstrate that broad descriptions that profile patient health status forecast subsequent use of service better than disease diagnoses. Table 2 demonstrated that health status measures, as well as diagnoses, were comparable in both groups prior to the analysis period of the study.

P6 an outpatient repeatedly sees the same practitioner, is his care influenced? This double-blind randomized trial examines the effects of outpatient health care provider continuity on the process and outcome of the medical care for 776 men aged 55 years and older. Participants were randomized to two different groups of provider care: provider discontinuity and provider continuity. The outcome of the continuity group was significantly different from that of the discontinuity group. During an 18-month period, patients who had been randomized to the continuity group had fewer emergent admissions (20% v 39%) and a shorter average length of stay (15.5 v 25.5 days). These patients also perceived that the providers were more knowledgeable, thorough, and interested in patient education. We conclude that continuity of outpatient provider care for men aged 55 years and older results in more patient satisfaction, shorter hospitalizations, and fewer emergent hospital admissions.