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

Israel Journal of Health Policy Research - Tập 1 - Trang 1-12 - 2012
Jacob Dreiher1,2, Doron S Comaneshter1, Yael Rosenbluth1, Erez Battat1, Haim Bitterman1,3, Arnon D Cohen1,2
1Chief Physician’s Office, Clalit Health Services, Tel Aviv, Israel
2Siaal Research Center, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
3The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

Tóm tắt

The 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. The 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. 1,713 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. Several 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.

Tài liệu tham khảo

Campbell H, Hotchkiss R, Bradshaw N, Porteous M: Integrated care pathways. BMJ. 1998, 316: 133-137. 10.1136/bmj.316.7125.133.

Donaldson MS: Continuity of care: a re-conceptualization. Med Care Res Rev. 2001, 58: 255-290. 10.1177/107755870105800301.

Reid RJ, Haggerty JL, McKendry R: Defusing the confusion - Concepts and Measures of Continuity of Healthcare. 2002, Ottawa, ON: Canadian Health Services Research Foundation

Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. BMJ. 2003, 327: 1219-1221. 10.1136/bmj.327.7425.1219.

Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC: Continuity of primary care: to whom does it matter and when?. Ann Fam Med. 2003, 1: 149-155. 10.1370/afm.63.

van Servellen G, Fongwa M, Mockus DE: Continuity of care and quality care outcomes for people experiencing chronic conditions: A literature review. Nursing Health Sci. 2006, 8: 185-195. 10.1111/j.1442-2018.2006.00278.x.

Gulliford M, Naithani S, Morgan M: What is 'continuity of care'?. J Health Services Res Policy. 2006, 11: 248-250. 10.1258/135581906778476490.

Salisbury C, Montgomery AA, Simons L, Sampson F, Edwards S, Baxter H, Goodall S, Smith H, Lattimer V, Pickin DM: Impact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study. Br J Gen Practice. 2007, 57: 608-614.

Saultz JW: Defining and measuring interpersonal continuity of care. Ann Fam Med. 2003, 1: 134-143. 10.1370/afm.23.

Flocke SA, Miller WL, Crabtree BF: Relationships between physician practice style, patient satisfaction, and attributes of primary care. J Fam Practice. 2002, 51: 835-840.

Saultz JW, Albedaiwi W: Interpersonal continuity of care & patient satisfaction: a critical review. Ann Fam Med. 2004, 2: 445-451. 10.1370/afm.91.

Saultz JW, Lochner J: Interpersonal continuity of care and care outcomes: a critical review. Ann Family Med. 2005, 3: 159-166. 10.1370/afm.285.

Atlas SJ, Grant RW, Ferris TG, Chang Y, Barry MJ: Patient-physician connectedness and quality of primary care. Ann Intern Med. 2009, 150: 325-335.

Inkelas M, Schuster MA, Olson LM, Park CH, Halfon N: Continuity of primary care clinician in early childhood. Pediatrics. 2004, 113: 1917-1925.

Guthrie B, Wyke S: Does continuity in general practice really matter?. BMJ. 2000, 321: 734-736. 10.1136/bmj.321.7263.734.

Mainous AG, Baker R, Love MM, Gray DP, Gill JM: Continuity of care and trust in one's physician: evidence from primary care in the United States and the United Kingdom. Family Med. 2001, 33: 22-27.

De Maeseneer JM, De Prins L, Gosset C, Heyerick J: Provider continuity in family medicine: does it make a difference for total health care costs?. Ann Fam Med. 2003, 1: 144-148. 10.1370/afm.75.

Guthrie B, Wyke S: Personal continuity and access in UK general practice: a qualitative study of general practitioners' and patients' perceptions of when and how they matter. BMC Fam Practice. 2006, 7: 11-10.1186/1471-2296-7-11.

Sharma G, Fletcher KE, Zhang D, Kuo YF, Freeman JL, Goodwin JS: Continuity of outpatient and inpatient care by primary care physicians for hospitalized older adults. JAMA. 2009, 301: 1671-1680. 10.1001/jama.2009.517.

Salisbury C, Sampson F, Ridd M, Montgomery AA: How should continuity of care in primary health care be assessed?. Br J Gen Practice. 2009, 59: 134-141.

Phan K, Brown SR: Decreased continuity in a residency clinic: a consequence of Open Access scheduling. Fam Med. 2009, 41: 46-50.

Gill JM, Mainous AG: The role of provider continuity in preventing hospitalizations. Arch Fam Med. 1998, 7: 352-357. 10.1001/archfami.7.4.352.

Koopman RJ, Mainous AG, Baker R, Gill JM, Gilbert GE: Continuity of care and recognition of diabetes, hypertension and hypercholesterolemia. Arch Intern Med. 2003, 163: 1357-1361. 10.1001/archinte.163.11.1357.

Guthrie B, Saultz JW, Freeman GK, Haggerty JL: Continuity of care matters. BMJ. 2008, 337: a867-10.1136/bmj.a867.

Cabana MD, Jee SH: Does continuity of care improve patient outcomes?. J Fam Practice. 2004, 53: 974-980.

Gill JM, Mainous AG: The role of provider continuity in preventing hospitalizations. Arch Fam Med. 1998, 7: 352-357. 10.1001/archfami.7.4.352.

Steinwachs DM: Measuring provider continuity in ambulatory care: an assessment of alternative approaches. Med Care. 1979, 17: 551-565. 10.1097/00005650-197906000-00001.

Bice TW, Boxerman SB: A quantitative measure of continuity of care. Med Care. 1977, 15: 347-349. 10.1097/00005650-197704000-00010.

Eriksson EA, Mattsson LG: Quantitative measurement of continuity of care. Measures in use and an alternative approach. Med Care. 1983, 21: 858-875. 10.1097/00005650-198309000-00003.

Given CW, Branson M, Zemach R: Evaluation and application of continuity measures in primary care settings. J Community Health. 1985, 10: 22-41. 10.1007/BF01321357.

Spooner SA: Incorporating temporal and clinical reasoning in a new measure of continuity of care. Proc Ann Symp Computer Appl Med Care. 1994, 716-721.

Ribka JP: Building systems to measure continuity of care. Nursing Case Manage. 1998, 3: 151-154.

Hussein A, Carriere KC: A measure of continuity of care based on the multiplicative intensity model. Stat Med. 2002, 21: 457-465. 10.1002/sim.1030.

Jee SH, Cabana MD: Indices for continuity of care: a systematic review of the literature. Med Care Res Rev. 2006, 63: 158-188. 10.1177/1077558705285294.

Wu Y, Takkenberg JJ, Grunkemeier GL: Measuring follow-up completeness. Ann Thorac Surg. 2008, 85: 1155-1157. 10.1016/j.athoracsur.2007.12.012.

Rose D, Sweeney A, Leese M, Clement S, Jones IR, Burns T, Catty J, Wykes T: Developing a user-generated measure of continuity of care: brief report. Acta Psychiatric Scand. 2009, 119: 320-324. 10.1111/j.1600-0447.2008.01296.x.

Vanvoorhis CW, Morgan BL: Statistical rules of thumb: What we don't want to forget about sample sizes. Psi Chi J Undergrad Res. 2001, 6: 139-141.

Rennert G, Peterburg Y: Prevalence of selected chronic diseases in Israel. Isr Med Assoc J. 2001, 3: 404-408.

Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40: 373-383. 10.1016/0021-9681(87)90171-8.

Manor O, Shmueli A, Ben-Yehuda A, Paltiel O, Calderon R, Yaffe D: The National Program for Quality Indicators in the Community in Israel, 2007-2009. 2011, Ministry of Health, Israel

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Israel Journal of Health Policy Research

Tập 1

1-12

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