Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Abstract

PURPOSE We wanted to undertake a critical review of the medical literature regarding the relationships between interpersonal continuity of care and the outcomes and cost of health care.METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to fi nd original English language articles focusing on interpersonal continuity of patient care. The articles were then screened to select those articles focusing on the relationship between interpersonal continuity and the outcome or cost of care. These articles were systematically reviewed and analyzed by both authors for study method, measurement technique, and quality of evidence.RESULTS Forty-one research articles reporting the results of 40 studies were identifi ed that addressed the relationship between interpersonal continuity and care outcome. A total of 81 separate care outcomes were reported in these articles. Fifty-one outcomes were signifi cantly improved and only 2 were signifi cantly worse in association with interpersonal continuity. Twenty-two articles reported the results of 20 studies of the relationship between interpersonal continuity and cost. These studies reported signifi cantly lower cost or utilization for 35 of 41 cost variables in association with interpersonal continuity.CONCLUSIONS Although the available literature refl ects persistent methodologic problems, it is likely that a signifi cant association exists between interpersonal continuity and improved preventive care and reduced hospitalization. Future research in this area should address more specifi c and measurable outcomes and more direct costs and should seek to defi ne and measure interpersonal continuity more explicitly. Ann Fam Med INTRODUCTIONC ontinuity of care traditionally is considered one of the core principles of family medicine, 1,2 and it is a core element of the Institute of Medicine defi nition of primary care. 3 Recently there has been a resurgence of interest in this subject, and the Annals of Family Medicine has devoted a theme issue to the topic. 4 This resurgence has occurred in part because of the growing sophistication of research in family medicine and because of changes in American health care that many believe have undermined continuity in the relationship between physicians and their patients.5-11 A central question facing the future of family medicine is the degree to which we will provide personal health care based on the individual doctor-patient relationship, or whether we will seek to provide a medical home for patients based on an interdisciplinary team with less emphasis on personal care. 12Continuity has proved to be a diffi cult variable to defi ne and measure. Several previous reviews of this subject have noted major limitations to its research foundation because of inconsistent defi nitions and complex methodologic challenges. [13][14][15][16][17][18] In early 2002, we undertook a comprehensive review of the medical literature to examine one aspect of continuity 160INTERPERSONAL CONTINUITY AND...

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Medical Student Education

“…3 Multiple studies point to the benefits of continuity of patient care, including improved delivery of preventive services, decreased emergency room use, fewer emergent hospital admissions and shorter hospital stays, and better management of chronic diseases. [4][5][6][7][8] Continuity of care also increases patient satisfaction. 9,10 These findings may in part be due to management of illness in a context of trust and respect between physician and patient.…”