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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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Process of care. For preventive services, 5 cross-sectional studies found that increased SCOC improved receipt of preventive services (Table 1). (24,28-30,32,33,35)

Two cross-sectional studies examined the association between SCOC and patient-provider communication. (25,27) One study found that increased SCOC improved communication and patient perception regarding the ability to influence treatment. (27) One study on epilepsy care found greater patient ease in talking to the physician. (25)

One RCT found no differences in scheduled or unscheduled clinic visits, specialty referrals, or receipt of preventive care procedures such as blood pressure measurement, weight assessment, or assessment of smoking status (P>.05). (38)

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* DISCUSSION

Increased SCOC has not had any negative effects on quality of care. Indeed, in many cases, increased SCOC heightens patient satisfaction, decreases hospitalizations and emergency department visits, and improves receipt of preventive services. The positive effect of SCOC on health care use has been well documented for patients with chronic conditions. Although our search strategy and exclusion criteria differed from a previous review by Dietrich et al, we report similar conclusions regarding SCOC and patient satisfaction. (16)

We observed that the association between SCOC and quality of care appears most consistent for patients with chronic conditions, and we think there are several reasons for this relationship. Improved care should evolve throughout the course of a long-term relationship. The time frame of most studies in our analysis was limited, with the longest being only 2 years. It is possible that the benefits of SCOC do not become manifest until a much longer time period or after many visits with the same primary care provider.

However, patients with chronic disease are more likely to use outpatient, emergency department, and hospital services than are otherwise healthy persons. The increased number of outpatient visits by a patient with chronic disease may establish SCOC more quickly in a relationship, compared with patients who have fewer outpatient visits in general. The increased frequency of emergency department use and hospitalizations for patients with chronic disease may also magnify the effects and benefits of SCOC. As a result, it may be easier to detect the positive effects of SCOC for patients with chronic disease. Finally, low SCOC may simply be a marker for other factors (associated with the patient or health care system) that are linked to decreased quality of care or increased costs.

Limitations

Because this review included only published articles, it is susceptible to publication bias. (40) We included only studies that looked at the effect of SCOC on quality of care, and excluded studies that considered SCOC as part of a larger intervention. It is not clear if this under- or overestimates the effect of SCOC. However, by including only such studies, we are underreporting the overall evidence base of the effect of SCOC on quality of care.

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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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