Staying With the Same Practice for More Than Five Years Is Associated With Up to 21 Percent Fewer Urgent Hospitalizations, a New Study Finds

A peer-reviewed study of more than 100,000 patients just put numbers on something DPC advocates have been saying for years: the longer a patient stays with the same practice, the less likely they are to end up in the hospital.

Researchers in the Netherlands tracked 100,450 patients across 48 general practices and found that patients registered with their practice for more than five years had 9 to 21 percent lower odds of urgent hospital admission compared with patients who had been registered for five years or fewer. The same long-term patients also had 17 to 28 percent lower hospital costs.

The study, “Association of General Practice Continuity With Hospital Admissions and Costs: A Retrospective Study,” was published in the Annals of Family Medicine in June 2026 and highlighted in a July 1 press release from the journal’s editorial team. The lead authors are Marije T. te Winkel, MD, and Otto R. Maarsingh, MD, PhD, of Amsterdam UMC.

This is not a DPC study. But it isolates the variable — duration of care within the same practice — that DPC is structurally designed to maximize.

What the Study Measured

The researchers split continuity into two distinct categories.

The first is duration continuity: how long a patient has been registered with the same practice. The second is density continuity: how concentrated a patient’s visits are with a single physician within that practice.

Both matter, but they matter differently.

Duration continuity — long-term registration — was associated with both fewer hospitalizations and lower costs. Patients registered for more than five years had 9 to 21 percent lower odds of urgent admission and 17 to 28 percent lower hospital costs compared with those registered for five years or fewer.

Density continuity — consistently seeing the same doctor — was associated with 6 to 7 percent lower hospital costs. But it was not independently associated with fewer urgent hospital admissions.

That distinction is worth sitting with. The protective effect on hospitalization risk came from the relationship with the practice itself — the nurses who know a patient’s chart, the referral pathways the office has already worked out, the medication history that is actually complete. Not solely from seeing the same face at the same appointment.

Why DPC Is Built for This

The te Winkel study used Dutch general practice data. Dutch GPs care for roughly 2,300 to 2,500 patients. The Netherlands has a different insurance structure than the United States. These numbers do not translate directly.

But the principle translates.

DPC practices are designed around sustained, ongoing relationships between physician and patient. The 2026 State of Direct Primary Care Report from the DPC Alliance, published last week, found that 89.3 percent of DPC practices are single-physician, single-location operations. When a patient joins a DPC practice, they register with one doctor and stay there.

Average DPC panel sizes run roughly 400 to 600 patients, compared with 2,000 or more in traditional insurance-based primary care. A physician who knows 500 patients instead of 2,000 has more context per patient. A patient who has been with that physician for four or five years has had their preventive care, their chronic conditions, their hospitalizations, and their pharmacy history tracked in one place, with one person.

That is duration continuity built into the membership structure. And in solo DPC practices, patients accumulate both types simultaneously — years with the practice and years with the same physician.

If the te Winkel study is right, that accumulating relationship predicts something meaningful: whether a patient ends up in an emergency department at 2 a.m. with a condition that should have been caught months earlier.

A Note on the Evidence Landscape

The DPC movement has accumulated outcome data in several forms — patient satisfaction surveys, employer case studies, and clinical findings like last week’s pediatric DPC study showing 69 percent of families avoided the ER by texting their physician. What it has had less of is controlled, peer-reviewed research that specifically isolates the mechanism behind those outcomes.

The Hint Health 2026 Direct Primary Care Trends Report documented that employers now fund the majority of active DPC memberships, in part because employer case studies have shown reduced ER visits and hospitalizations. Those findings are real. But a controlled retrospective cohort of 100,000 patients asking “does time registered with the same practice predict fewer hospitalizations?” is a different kind of evidence.

The te Winkel study provides the peer-reviewed infrastructure for an argument DPC doctors have been making from intuition and individual case experience for years.

What This Means

The DPC Summit opens today in New Orleans, where roughly 400 physicians will spend four days working through the clinical and operational details of practicing outside the insurance billing system.

Many of those doctors you might talk to can describe a patient whose hospitalization they prevented because they knew the patient’s complete picture, were reachable on a Tuesday night, and had the chart in front of them. The te Winkel study gives those stories a peer-reviewed frame.

Patients who stay registered with the same practice for more than five years have up to 21 percent lower odds of an urgent hospitalization. DPC’s membership model — long-term registration, small panel, same physician — is one of the few primary care structures in the United States specifically designed to keep patients inside that relationship.

The study does not prove that DPC reduces hospitalizations. What it does is confirm the specific mechanism DPC is built around: the accumulating relationship, year over year, that turns primary care from a series of isolated transactions into something protective.

That is worth naming at a summit.