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The association between continuity of care and outcomes: a systematic and critical review
Carl van Walraven1, Natalie Oake, Alison Jennings
1Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. carlv@ohri.ca
Background:
Numerous studies have tried to determine the association between continuity and outcomes. Studies doing so must actually measure continuity. If continuity and outcomes are measured concurrently, their association can only be determined with time-dependent methods.
Objective:
To identify and summarize all methodologically studies that measure the association between continuity of care and patient outcomes.
Methods:
We searched MEDLINE database (1950-2008) and hand-searched to identify studies that tried to associate continuity and outcomes. English studies were included if they: actually measured continuity; determined the association of continuity with patient outcomes; and properly accounted for the relative timing of continuity and outcome measures.
Results:
A total of 139 English language studies tried to measure the association between continuity and outcomes but only 18 studies (12.9%) met methodological criteria. All but two studies measured provider continuity and used health utilization or patient satisfaction as the outcome. Eight of nine high-quality studies found a significant association between increased continuity and decreased health utilization including hospitalization and emergency visits. Five of seven studies found improved patient satisfaction with increased continuity.
Conclusions:
These studies validate the belief that increased provider continuity is associated with improved patient outcomes and satisfaction. Further research is required to determine whether information or management continuity improves outcomes.
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