Defining and Measuring Interpersonal Continuity of Care

Saultz, John

doi:10.1370/afm.23

Cited by 442 publications

(553 citation statements)

References 83 publications

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“…[45][46][47][48] Continuity also has various components, including informational continuity (the availability of a patient's health information at the point of care), continuity with the same practice over time, and interpersonal continuity with the same clinician over time. 4,5,49,50 These last two aspects are the concepts most often referenced in primary care research; they have been associated with lower hospitalization rates, [51][52][53][54][55][56] lower complication rates for patients with chronic conditions, 55 fewer emergency room visits, 57,58 lower total costs 53 and lower episodebased costs for chronic conditions. 54,55,59,60 Greater site and interpersonal continuity are also associated with increased use of preventive services and guideline-concordant care.…”

Section: Primary Care Features and Associations With Patient Outcomesmentioning

confidence: 99%

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

et al. 2015

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Primary care plays a central role in the provision of health care, and is an organizing feature for health care delivery systems in most Western industrialized democracies. For a variety of reasons, however, the practice of primary care has been in decline in the U.S. This paper reviews key primary care concepts and their definitions, notes the increasingly complex interplay between primary care and the broader health care system, and offers research priorities to support future measurement, delivery and understanding of the role of primary care features on health care costs and quality.

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Section: Primary Care Features and Associations With Patient Outcomesmentioning

confidence: 99%

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

et al. 2015

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“…We used two measures of continuity: the Number of Physicians Index (NPI), and the Usual Provider of Continuity (UPC) index. 7,8 The NPI, in this context, is the total number of unique authors of H&Ps and/or progress notes for a patient. The UPC is calculated as the largest number of notes written by a single physician divided by the total number of notes written for a patient.…”

Section: Predictor Variablesmentioning

confidence: 99%

The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

Turner

Hansen²,

Hinami³

et al. 2014

J GEN INTERN MED

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BACKGROUND: Achieving patient-physician continuity is difficult in the inpatient setting, where care must be provided continuously. Little is known about the impact of hospital physician discontinuity on outcomes. OBJECTIVE: To determine the association between hospital physician continuity and percentage change in median cost of hospitalization, 30-day readmission, and patient satisfaction with physician communication. DESIGN: Retrospective observational study using various multivariable models to adjust for patient characteristics. PARTICIPANTS: Patients admitted to a non-teaching hospitalist service in a large, academic, urban hospital between 6 July 2008 and 31 December 2011. MAIN MEASURES: We used two measures of continuity: the Number of Physicians Index (NPI), and the Usual Provider of Continuity (UPC) index. The NPI is the total number of unique physicians caring for a patient, while the UPC is calculated as the largest number of patient encounters with a single physician, divided by the total number of encounters. Outcome measures were percentage change in median cost of hospitalization, 30-day readmissions, and top box responses to satisfaction with physician communication. KEY RESULTS: Our analyses included data from 18,375 hospitalizations. Lower continuity was associated with modest increases in costs (range 0.9-12.6 % of median), with three of the four models used achieving statistical significance. Lower continuity was associated with lower odds of readmission (OR=0.95-0.98 across models), although only one of the models achieved statistical significance. Satisfaction with physician communication was lower, with less continuity across all models, but results were not statistically significant. CONCLUSIONS: Hospital physician discontinuity appears to be associated with modestly increased hospital costs. Hospital physicians may revise plans as they take over patient care responsibility from their colleagues.KEY WORDS: continuity of care; health care costs; health services research; hospital medicine.

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“…Precisely in this context, clinicians point out a neglected distinction between provision of care (by clinicians) and receipt of care (by patients), 62 and the patient's noncompliance with or lack of adherence to recommended treatments is a plausible (albeit one-sided) explanation for the disconnect between provision and receipt of care. Researchers have found that continuity of care, allowing clinicians to establish and develop ongoing interactions that promote familiarity with their patients, is a fundamental dimension of quality care, 63,64 particularly for vulnerable patient populations. 65 Our investigation concurs with these findings; a clinician's interactional familiarity with a patient enables clinicians to deliver more effective and efficient person-focused care.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Clinicians’ Recognition and Management of Depression: A Model of Depression Care in Real-World Primary Care Practice

2013

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BACKGROUND: Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered. OBJECTIVE: This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions. DESIGN: Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n=24, 2 h each), two surveys per clinician, and investigators' field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data. PARTICIPANTS: Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners. KEY RESULTS: A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians' interactions with patients, practice, and the local community. A clinician's interactional familiarity ("familiarity capital") was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression. CONCLUSIONS: The clinician's ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

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Defining and Measuring Interpersonal Continuity of Care

Abstract: Future inquiry in family medicine should focus on better understanding the interpersonal dimension of continuity of care.

Cited by 442 publications

References 83 publications

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

Primary Care Clinicians’ Recognition and Management of Depression: A Model of Depression Care in Real-World Primary Care Practice

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