The association between continuity of care in the community and health outcomes: a population-based study

Abstract

BackgroundThe study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization.MethodsThe study included a random sample of enrollees from Clalit Health Services 19 years-of-age or older who visited their primary care clinic at least three times in 2009. Indices of continuity of care were computed, including the Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity (SECON). Quality measures of preventive medicine and healthcare services utilization and their costs were assessed as outcomes.Results1,713 randomly sampled patients were included in the study (mean age: 48.9 ± 19.2, 42% males). Continuity of care indices were: UPC: 0.75; MMCI: 0.81; COC: 0.67; SECON: 0.70. After controlling for patient characteristics in a multivariate analysis, a statistically significant association was found between higher values of UPC, COC, and SECON and a decrease in the number and cost of ED visits. Higher MMCI values were associated with a greater number and higher costs of medical consultation visits. Continuity of care indices were associated with BMI measurements, and inversely associated with blood pressure measurements. No association was found with other quality indicators, e.g., screening tests for cancer.ConclusionsSeveral continuity of care indices were associated with decreased number and costs of ED visits. There were both positive and negative associations of continuity of care indices with different aspects of healthcare utilization. The relatively small effects of continuity might be due to the consistently high levels of continuity in Clalit Health Services.

Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

“…The association was stronger for inpatient care utilization and costs than for outpatient care costs, 17 suggesting that the main benefit of continuity of care was to reduce emergency department visits 19,21,22,28,35,53 and hospitalizations, 17,27,28,35 the most costly elements of health care. In addition, the reduction in cardiovascular complications seen in our study should also contribute to reduced resource utilization and health care costs.…”

“…We studied a 3% random sample (n = 1,162,234) of KNHI enrollees who were aged at least 20 15,19,27,35,39 and time frame 18,29 on the basis of our literature review, considering that (1) it would be difficult to construct stable measures of continuity for patients with fewer visits 15,27 ; (2) semiannual visits are the desirable minimum for the management of the target conditions; and (3) a 2-year window may ensure longitudinal continuity. 29 After excluding 974 subjects who died during the first 2 years after their first visit, a total of 47,433 subjects were included in our study (Figure 1).…”

“…Continuity of care was measured with 3 commonly used indices 19,41 : most frequent provider continuity (MFPC), 42 modified, modified continuity index (MMCI), 27,43 and continuity-of-care index (COC) 44 (Sup- 27 and COC integrates both aspects into a single metric. The primary outcome of the study was all-cause mortality.…”

“…[7][8][9] As a consequence, there is substantial interest in understanding the role of continuity of care in determining health care outcomes and costs. 10 Continuity of care has been associated with better quality of care 11,12 and with improved patient adherence and self-management, 11,[13][14][15] improved outcomes, 15,16 and lower health care utilization and costs, [17][18][19][20][21][22] but the evidence is inconsistent. [23][24][25][26] Furthermore, previous studies have often been affected by methodological limitations, 2 including unrepresentative samples,study has found that continuity of care with a primary care physician was associated with lower mortality.…”

Relational Continuity or Rapid Accessibility in Primary Care?

“…11 In addition to affecting patient satisfaction, trust, and confidence, relational continuity has also been shown to impact frequency and cost of some types of patient visits. For example, it has been shown to decrease frequency and cost of emergency department visits, 12 although rapid accessibility has also been found to decrease frequency of emergency department visits, particularly among patients from rural areas. 13 Increased rapid accessibility has also been shown to increase patient satisfaction ratings, particularly among patients contacting for nonurgent needs, such as routine questions.…”