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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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Six of the methods used formulas to account for different combinations of factors, such as number of visits, dispersion of providers, and number of visits to a particular provider (see Appendix, available online at www.jfponline.com). There were 8 different methods to determine SCOC based on survey responses, ranging from single item questions (24,32) to a 23-item perception of continuity scale. (22)

Associations between SCOC and quality or cost of care

Overall, we found no studies documenting any negative effects of increased SCOC on quality or care. Due to the heterogeneity of methods to calculate SCOC and endpoints, we were unable to combine results.

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Costs. Two cross-sectional studies examined factors associated with cost of care (Table 1). Increased SCOC measured by the usual provider continuity (UPC) index correlated with increased provider or MC0 cost of care (P<.05); however, the results were not significant when SCOC was measured using other indicies. (22) Another study found that increased SCOC was associated with decreased total annual health care expenditures. (23)

Satisfaction. Although we could not pool results of studies due to heterogeneity, there is a consistent association between SCOC and patient satisfaction, based on the results of 4 studies (Table 1).

Three cross-sectional studies in different settings (21,22,31) found a positive association between increased SCOC and patient satisfaction. However, all 3 studies used subjective methods to determine SCOC. One study that used quantitative 2methods to measure SCOC (ie, COC index, UPC scale) did not find a statistically significant association with patient satisfaction. (22) One RCT found no effect on satisfaction with patient-provider interaction overall (P>.05). (38)

Patient outcomes. The effect of SCOC seems consistent across studies for patients with chronic conditions who were hospitalized or visited emergency departments (Table 1).

In one RCT, the continuity group had fewer hospital days (5.7 vs. 9.1, P=.02); fewer intensive care days (0.4 vs. 1.4, P=.01); shorter hospital length of stay (15.5 vs. 25.5, P=.008); and lower percentages of emergent hospitalization (20% vs 39%, P=.002) compared with the discontinuity group. Of note, the subjects were all elderly men, of whom 47% had cardiovascular disease and 18% had respiratory disease. (38)

In 2 cross-sectional and 4 cohort studies, SCOC led to decreased hospitalizations and emergency department use, and to some improvements in preventive health behavior. Half of the studies focused on patients with chronic conditions (asthma or diabetes). (33,34,37) Medicaid claims data analyses suggest that higher SCOC is associated with decreased likelihood of making single and multiple emergency department visits, hospitalizations overall, and hospitalizations for chronic conditions. (26,36) However, higher SCOC did not decrease the risk of hospitalization for acute ambulatory care sensitive conditions (eg, gastroenteritis). (36)

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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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