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Is greater continuity of care associated with less emergency department utilization?
D A Christakis1, J A Wright, T D Koepsell
1Division of General Pediatrics, University of Washington, Seattle 98103, USA.
Insights
Continuity of care (COC) with attending physicians in pediatric clinics is linked to reduced emergency department (ED) visits. Higher COC correlates with fewer ED utilizations, benefiting patient care and resource management.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Continuity of Care
Background:
- The benefits of continuity of care (COC) for pediatric patients remain incompletely defined.
- Establishing a strong link between COC and healthcare utilization is crucial for optimizing pediatric health services.
Purpose of the Study:
- To investigate the association between greater continuity of care (COC) and reduced emergency department (ED) utilization in pediatric patients.
- To quantify the impact of attending physician versus resident physician continuity on ED visits.
Main Methods:
- Retrospective claims-based analysis of 785 Medicaid managed care children (ages 0-19) with at least four outpatient visits.
- Continuity of care (COC) was measured by the ratio of care providers to clinic visits.
- Survival analysis was employed to assess the relationship between COC tertiles and ED utilization.
Main Results:
- Higher continuity of care (COC) with attending physicians was significantly associated with lower emergency department (ED) utilization.
- Patients in the middle and highest tertiles of attending COC had 30% and 35% lower ED utilization, respectively.
- Continuity of care (COC) with resident physicians did not show a significant association with ED utilization.
Conclusions:
- Enhanced continuity of care (COC) with attending physicians in pediatric outpatient teaching clinics is demonstrably linked to decreased emergency department (ED) use.
- These findings suggest that fostering stronger patient-attending physician relationships can lead to more efficient healthcare resource allocation by reducing unnecessary ED visits.
Background:
The benefits of continuity of care (COC) have not been firmly established for pediatric patients.
Objective:
To assess whether greater COC is associated with lower emergency department (ED) utilization.
Setting:
Outpatient teaching clinic at Children's Hospital and Regional Medical Center, Seattle, WA.
Patients:
All 785 Medicaid managed care children ages 0 to 19 years followed at Children's Hospital and Regional Medical Center between 1993 to 1997 who had at least four outpatient visits.
Methods:
Retrospective claims-based analysis. COC was quantified based on the number of different care providers in relation to the number of clinic visits.
Results:
Attending COC was significantly greater than resident COC. In a multiple event survival analysis, compared with those patients in the lowest tertile of attending COC, those in the middle tertile had 30% lower ED utilization (hazard ratio 0.70 [0.53-0.93]) and those in the highest tertile had 35% lower ED use (hazard ratio 0.65 [0.50-0.80]). Resident COC was not significantly associated with ED use.
Conclusion:
Greater COC with attending physicians in outpatient teaching clinics is associated with lower ED utilization.