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Does continuity of care improve patient outcomes?

Journal of Family Practice, Dec, 2004 by Michael D. Cabana, Sandra H. Jee

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Finally, the method had to (iv) account for the possibility of more than one provider during the observed time period. We did not include studies that used "duration of time that the patient has seen the provider" as a measure of SCOC. Theoretically, any number of other providers could have seen the patient during this time and affected the SCOC.

Two investigators (MDC, SHJ) independently reviewed the full text to exclude articles not fulfilling criteria. Differences were resolved by informal consensus. We calculated a kappa score to measure the degree of agreement in the selection process.

Data extraction and analysis

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We abstracted study design, location, population, method to calculate SCOC, and the association of SCOC with a study endpoint. We grouped articles in relation to endpoint measured. Simple counts and descriptive statistics of the articles were calculated. If 2 articles used data from the same study, we used the more recent article.

* RESULTS

Search yield

We found 5087 candidate titles in our original search. We excluded 4891 titles after examination of the bibliographic citation, which left 196 articles. After examining the full text of these remaining articles, 18 fulfilled our criteria (Table 1, available online at www.jfponline.com). The kappa to measure the preconsensus inter-rater reliability for article selection was 0.93.

Study designs

Of the 18 articles in the final analysis, 12 (67%) were cross-sectional studies, (21-32) five (28%) were cohort studies, (33-37) and one (6%) was an RCT. (38) In the RCT, subjects were elderly men enrolled in a Veteran's Administration outpatient clinic. Subjects randomized to the "discontinuity" group had a 33% chance of being scheduled with a different provider at each visit and were also scheduled with a different provider if they had seen the same provider for the previous 2 visits. Subjects in the "continuity" group were scheduled to see the same provider routinely. (38)

Study populations, providers, and settings

Fifteen of the 18 studies (83%) were conducted in the United States. Ten studies (56%) focused on specific groups of patients: those insured by Medicaid (n=4), adults with diabetes (n=2), multiethnic women, elderly men, adults with seizure disorder, children with chronic diseases, and children and adults with asthma (n=1 each).

Health care providers in these studies included different primary care specialties, such as family medicine (n=4), pediatrics (n=4), general practice (n=2), internal medicine (n=1), and mixed primary care physicians (n=5). One study included pediatric subspecialists. In 5, the SCOC was described for the patient's "regular physician."

Methods used to measure SCOC

Table 2 (available online at www.jfponline.com) displays the different methods and data sources used to determine SCOC. Data sources included medical records (n=3), medical claims data (n=5), and surveys (n=10). One study calculated SCOC separately using both medical records and a patient survey. (22)

Health Care Industry

Does continuity of care improve patient outcomes?

Journal of Family Practice, Dec, 2004 by Michael D. Cabana, Sandra H. Jee

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