Quantifying organization of care in a complex healthcare environment

Abstract

In 1948, W. Eugene Smith published "Country Doctor" in Life Magizine. 1 This landmark photo essay highlighted continuity of care in rural America by showing Dr Ceriani delivering babies, examining children, performing emergency surgery, and caring for the dying in Kremmling, Colorado. However, a half century of medical progress has brought us to a world filled with robotic surgery, MRI machines, DNA tests, electronic medical records, and handheld ultrasound devices that Dr Ceriani would barely recognize. Medical care has become more fragmented and specialized with an emphasis on convenience and care teams. 2-4 Despite these amazing medical advances, patients with chronic diseases still desire a relationship with their physician. 5-7 The Institute of Medicine defines continuity of care to be longitudinal care coupled with effective and timely communication of health information. 8 Continuity of care has been associated with lower mortality, fewer hospitalizations, fewer ED visits, improved preventative services, lower costs, decreased healthcare utilization, and improved patient satisfaction. 9-11 However, there is little agreement on an accepted measure of continuity of care. 12,13 Continuity of care measures have traditionally been classified into five categories that measure density of visits, dispersion of visits, sequence of visits, duration of relationships, and subjective patient

Continuity of Care: A Primer for Family Medicine Residencies

“…Demonstrated benefit may depend heavily on the exact measure of continuity chosen and the unique underlying medical practice characteristics of the population studied. 14 Continuity of care is generally associated with better patient satisfaction. In one systematic review, subjective measures of continuity were associated with greater patient satisfaction, but various objective measures of longitudinal continuity were not reliably associated with greater patient satisfaction.…”

“…3 Visit entropy has been proposed as a measure of managerial continuity in team-based care environments because it is able to detect and quantify organized visit patterns produced by team-based care. 6,14 Perhaps the most widely accepted and well-known measure of continuity, defined in 1975 by Breslau and Reeb, is usual provider continuity (UPC). 45 It is expressed as the proportion of visits with the patient's primary (or most frequent) clinician divided by the total number of visits over a period of time, typically one year.…”

Clinician Care Team Composition and Health Care Utilization

“…We did not control for continuity or organization of care, which has been shown to have an effect on many aspects of care including management of chronic disease, ED visits, and hospital readmissions. [31][32][33][34] There was variability of time on the floor among the teams, with urban practices having more time away from patient care for academic pursuits. This variability may affect utilization and needs further study.…”

Want improved quality? Improve your systems

“…Quality of care is related to continuity of care, 18‐20 however, in the emerging environment of interdisciplinary care personal provider continuity is much harder to achieve. Garrison and Dilger 21 demonstrate that focusing on continuity within a care team results in quality of care improvement as care is better organized and coordinated leading to better health outcomes and reduced costs.…”