The Relationships Among Dimensions of Health Services in Two Provider Systems: A Causal Model Approach

Sm, Shortell; Wc, Richardson; Lp, LoGerfo; Diehr, Paula; Weaver, B; Ke, Green

doi:10.2307/2955378

Cited by 75 publications

(26 citation statements)

References 12 publications

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“…Although the patients were less likely to see their own physicians after the move, overall satisfaction did not change signifi cantly. The remaining 2 cohort studies by Shortell et al 42 and Smith 46 both found a signifi cant association between improved continuity and patient satisfaction. Shortell et al measured continuity in an unusual way by simply counting the number of clinicians seen.…”

Section: Resultsmentioning

confidence: 99%

“…Cohort studies have addressed the relationship between continuity and patient satisfaction among patients with hypertension in Seattle, 42 obstetric patients in the United States, 52 pediatric patients in an academic practice in Cleveland, 53 and patients in a VA internal medicine clinic. 46 All of these studies rated or measured the continuity of care and attempted to correlate the scores with patient satisfaction.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Saultz¹

2004

The Annals of Family Medicine

377

305

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PURPOSE We wanted to review the medical literature regarding the relationship between interpersonal continuity of care and patient satisfaction and suggest future strategies for research on this topic.METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted to fi nd articles focusing on interpersonal continuity of patient care. The resulting articles were screened to select those focusing on the relationship between interpersonal continuity in the doctor-patient relationship and patient satisfaction. These articles were systematically reviewed and analyzed for study method, measurement technique, and the quality of evidence.RESULTS Thirty articles were found that addressed the relationship between interpersonal continuity and patient satisfaction with medical care. Twenty-two of these articles were reports of original research. Nineteen of the 22, including 4 clinical trials, reported signifi cantly higher satisfaction when interpersonal continuity was present.CONCLUSIONS Although the available literature refl ects persistent methodologic problems, a consistent and signifi cant positive relationship exists between interpersonal continuity of care and patient satisfaction. Future research in this area should address whether the same is true for all patients or only for those who seek ongoing relationships with physicians in primary care. INTRODUCTIONC ontinuity of care is considered to be a core principle of family medicine 1,2 and primary care, 3 but conclusive proof regarding its value has eluded primary care and health policy researchers. The fi rst step in establishing this proof requires a specifi c defi nition of the most important elements of continuity. Previous authors have addressed different aspects of continuity and have proposed defi nitions with multiple dimensions. 1,[4][5][6][7][8][9][10] Recently, 3 of these dimensions were organized into a hierarchy ranging from the availability of accurate information from one health care encounter to another (informational continuity), through a pattern of health care utilization at a particular site of care (longitudinal continuity), to a personal doctor-patient relationship characterized by loyalty and trust (interpersonal continuity).11 For family physicians the concept of interpersonal continuity holds particular importance. 12 Interpersonal continuity refers to a special type of longitudinal continuity in which an ongoing personal relationship between the patient and clinician is characterized by personal trust and responsibility.11 Changes in the American health care system during the past decade have made it increasingly diffi cult to establish such long-term trusting relationships between physicians and patients. [13][14][15][16][17][18][19] Some authors have questioned whether a personal model of care is feasible, as health plans increasingly have required provider changes for economic reasons. 20 As these changes occur, health policy planners are looking for evidence supporting the value of interpersonal continuity...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Saultz¹

2004

The Annals of Family Medicine

377

305

View full text Add to dashboard Cite

show abstract

“…It may be, as some research suggests, that use causes the feeling of having an affiliation with a PCP not vice versa [74,75]. However, variables that might influence the affiliation with a PCP, for example, greater health care needs/or greater use of health services because of ill-health, are partially controlled for by health status adjustment.…”

Section: Strengths and Limitations Of Studymentioning

confidence: 99%

Affiliation with a primary care provider in New Zealand: Who is, who isn’t

Jatrana

Crampton

2009

Health Policy

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“…A ccess to care often is defined as the degree to which individuals are able to obtain needed health care. [1][2][3][4][5][6][7][8] The inability to obtain needed health care is used to indicate unmet needs for care. 9 A small and growing literature describes the prevalence and correlates of unmet need for health care among children.…”

mentioning

confidence: 99%

Access to Care for Children of Migratory Agricultural Workers: Factors Associated With Unmet Need for Medical Care

Weathers

Minkovitz²,

O’Campo³

et al. 2004

Pediatrics

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ABSTRACT. Objective. To assess the correlates of unmet need for medical care among migrant children.Design and Setting. A cross-sectional household survey used multistage sampling to identify migrant families in eastern North Carolina.Participants. Three hundred adult caretakers of 1 (per household) randomly selected child <13 years old.Results. Fifty-three percent of the children had an unmet medical need. The most common reasons for unmet medical need were lack of transportation (80%) and lack of knowledge of where to go for care (20%). Unmet medical need was associated inversely with less than very good health (odds ratio Conclusions. Medical-access barriers among migrant children are largely nonfinancial. Preschool-aged migrant children disproportionately experience unmet medical need. Decreasing forgone care among migrant children will likely require a combination of individual, health-system, and labor-policy modifications. Pediatrics 2004;113:e276 -e282. URL: http://www.pediatrics.org/cgi/ content/full/113/4/e276; transients, migrants, health services needs and demand, health-services accessibility, Hispanic Americans, child.[ABBREVIATIONS. OR, odds ratio; WIC, Women, Infants, and Children; CI, confidence interval. A ccess to care often is defined as the degree to which individuals are able to obtain needed health care. [1][2][3][4][5][6][7][8] The inability to obtain needed health care is used to indicate unmet needs for care. 9 A small and growing literature describes the prevalence and correlates of unmet need for health care among children. 9 -19 The prevalence of any unmet need for care among US children Ͻ18 years old is 7.3% 9 and varies by the type of care. For example, the proportion of children reported to experience an unmet need for medical care is 1.6%, whereas 5.3% of children are reported to experience unmet need for dental care. 9 Among all children, unmet need for care is consistently associated with poverty and a lack of insurance. 9 -12,14,15,17-19 Adjusted associations with unmet need for care among US children include 1) school age, 2) living in a single-parent household, 3) less than very good health status (including beddays or activity limitation), and 3) lack of a usual source of care. 9 Few studies examine the prevalence and correlates of unmet health needs among children categorized as ethnic/racial minorities. Although these studies reveal trends, several inconsistencies are evident. As compared with white (non-Latino) children, the prevalence of unmet health needs is generally higher among African American and Latino children. 9,20 -24 Moreover, Latino children have increased unadjusted odds of unmet need (odds ratio [OR]: 1.31; P Ͻ .01). 9 After multivariable control, the association between unmet need and ethnic/racial category became insignificant, 21,22,25 exhibited an inverse association, 9 or persisted among Latino females, as compared with males. 21 Similarly, the prevalence of unmet mental health needs is higher among African American, Latino, and Asian/Pacific Isla...

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The Relationships Among Dimensions of Health Services in Two Provider Systems: A Causal Model Approach

Cited by 75 publications

References 12 publications

Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Affiliation with a primary care provider in New Zealand: Who is, who isn’t

Access to Care for Children of Migratory Agricultural Workers: Factors Associated With Unmet Need for Medical Care

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