Continuity of Care by Primary Care Provider in Young Children with Chronic Conditions

Abstract

Objectives: (1) To assess continuity of care by primary-care provider (CoC), an established quality indicator, in children with asthma, autism spectrum disorder (ASD), and no chronic conditions, and (2) to determine patient factors that influenced CoC. Methods: Retrospective cohort study of electronic health records from all office visits of children under 9 years, seen >4 times between 2015 and 2019 in 10 practices of a community-based primary healthcare network in California. Three cohorts were constructed: (1)Asthma: >2 visits with asthma visit diagnoses; (2)ASD: same method; (3)Controls: no chronic conditions. CoC, using the Usual Provider of Care measure (range >0-1), was calculated for (1)total visits and (2)well care visits only. Fractional regression models examined CoC adjusting for patient age, medical insurance, practice affiliation, and number of visits. Results: Of 30,678 eligible children, 1875 (6.1%) were classified as Asthma, 294 (1.0%) as ASD, and 15,465 (50.4%) as Controls. Asthma and ASD had lower total CoC than Controls (Mean=0.58, SD 0.21, M=0.57, SD 0.20, M=0.66, SD 0.21). Differences among well CoC were smaller (Asthma M=0.80, ASD M=0.78, Controls M=0.82). In regression models, lower total CoC was found for Asthma (aOR 0.90, 95% CI 0.85-0.94). Lower total and well CoC were associated with public insurance (aOR 0.77, CI 0.74-0.81; aOR 0.64, CI 0.59-0.69). Conclusion: Children with asthma in this primary-care network had lower CoC compared to children without chronic conditions. Public insurance was the most prominent patient factor associated with low CoC. Quality initiatives should address disparities in CoC for children with chronic conditions.