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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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Benefits of SCOC may occur if a patient develops a consistent relationship with a specific clinic or practice site. Since we limited our analysis to the provider-level, our results might not reflect the benefits of SCOC in broader contexts.

Although SCOC has many positive effects on quality of care, absolute or complete SCOC may not necessarily be ideal. There may be tradeoffs between SCOC and patient access to care. One study suggested that in certain scenarios (ie, "minor problems"), convenience was more important than SCOC; however for chronic issues, SCOC was more valued. (39) Although this analysis suggests that SCOC is associated with improved quality of care, it is beyond the scope of this study to suggest the ideal level of SCOC in relation to other factors such as access. The published studies in this analysis were not designed to address these issues.

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Finally, patient satisfaction may not be an appropriate measure for quality in this particular analysis. Patients who are dissatisfied with care may be more likely to change physicians and thus have less continuity. However, in this analysis we examined quality-of-care endpoints separately from other endpoints.

Implications and future research

Based on our study criteria, our analysis suggests an association between SCOC and patient satisfaction, as well as improved process of care and patient outcomes.

Other areas remain to be investigated. We found few studies, for example, that examined the impact of SCOC on cost of care. Programs that attempt to maximize SCOC may require significant administrative resources and costs (ie, to improve scheduling or provider availability). In an era of limited resources, promoting increased investment in this area may necessitate a demonstration of the long-term financial effects of SCOC and the absence of any unintended consequences (eg, delays in diagnosis). Although there are specific expenditures associated with promoting SCOC, such changes should theoretically lower health care costs overall by decreasing avoidable hospitalizations or emergency department visits.

Future research should investigate which populations benefit most from SCOC. A significant portion of the evidence for the positive effects of SCOC on quality of care includes patients with chronic disease, such as asthma and diabetes. Programs or clinics with limited resources to promote SCOC may be able to maximize impact by focusing on such populations.

ACKNOWLEDGEMENTS

Presented in part at the Pediatric Academic Societies Annual Meeting, Seattle, Wash. May 6, 2003. Support (SHJ) provided by the National Institute of Child Health and Human Development T32 HD07534-03. The authors would like to thank Ms. Lucy M. Schiller and Ms. Kathryn L. Wheeler for their assistance in data collection, as well Ms. Kathryn Slish for her editorial assistance.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to report.

REFERENCES

(1.) Starfield B. Primary Care: Concept, Evaluation and Policy. New York, NY: Oxford University Press; 1998.

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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