The association between continuity of care and outcomes: a systematic and critical review.

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.

[1]  Carl van Walraven,et al.  Time-dependent bias was common in survival analyses published in leading clinical journals. , 2004, Journal of clinical epidemiology.

[2]  C. Adair,et al.  History and measurement of continuity of care in mental health services and evidence of its role in outcomes. , 2003, Psychiatric services.

[3]  T. Bodenheimer.  Coordinating care--a perilous journey through the health care system. , 2008, The New England journal of medicine.

[4]  K C Stange,et al.  The impact of insurance type and forced discontinuity on the delivery of primary care. , 1997, The Journal of family practice.

[5]  Peter C. Austin,et al.  Effect of discharge summary availability during post-discharge visits on hospital readmission , 2002, Journal of General Internal Medicine.

[6]  B Starfield,et al.  Coordination of Care and Its Relationship to Continuity and Medical Records , 1977, Medical care.

[7]  A G Mainous,et al.  The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician? , 1998, American journal of public health.

[8]  J H Wasson,et al.  Continuity of outpatient medical care in elderly men. A randomized trial. , 1984, JAMA.

[9]  D. Baker,et al.  Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. , 2007, JAMA.

[10]  Flynn Sp.  Continuity of care during pregnancy: the effect of provider continuity on outcome. , 1985 .

[11]  E. Skinner,et al.  Provider Continuity and Outcomes of Care for Persons with Schizophrenia , 2000 .

[12]  Dimitri A Christakis,et al.  Continuity of care is associated with well-coordinated care. , 2003, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[13]  Scott Emerson,et al.  Is Greater Continuity of Care Associated With Less Emergency Department Utilization? , 1999, Pediatrics.

[14]  Ngaire Kerse,et al.  Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation , 2004, The Annals of Family Medicine.

[15]  Denis Pereira Gray,et al.  Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors , 2003, Scandinavian journal of primary health care.

[16]  J. Iglehart.  No place like home--testing a new model of care delivery. , 2008, The New England journal of medicine.

[17]  V. D. Hsu,et al.  Validation of a method for identifying nursing home admissions using administrative claims , 2007, BMC Health Services Research.

[18]  P. Austin,et al.  Quantifying the impact of survivor treatment bias in observational studies. , 2006, Journal of evaluation in clinical practice.

[19]  E. Fisher.  Building a medical neighborhood for the medical home. , 2008, The New England journal of medicine.

[20]  A. Stiell,et al.  Prevalence of information gaps in the emergency department and the effect on patient outcomes. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[21]  Muhammad Mamdani,et al.  Continuity of care and patient outcomes after hospital discharge , 2004, Journal of General Internal Medicine.

[22]  David Aron,et al.  Continuity of care and cardiovascular risk factor management: does care by a single clinician add to informational continuity provided by electronic medical records? , 2005, The American journal of managed care.

[23]  M. Weinberger,et al.  Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. , 1996, The New England journal of medicine.

[24]  S. Flocke.  Measuring attributes of primary care: development of a new instrument. , 1997, The Journal of family practice.

[25]  Sung-joon Min,et al.  The care transitions intervention: results of a randomized controlled trial. , 2006, Archives of internal medicine.

[26]  Stephen A. Martin,et al.  A Reengineered Hospital Discharge Program to Decrease Rehospitalization , 2009, Annals of Internal Medicine.

[27]  M. Lauer,et al.  A propensity analysis of cigarette smoking and mortality with consideration of the effects of alcohol. , 2001, The American journal of cardiology.

[28]  A. Forster,et al.  Frequency of adverse events in patients with poor anticoagulation: a meta-analysis , 2007, Canadian Medical Association Journal.

[29]  Michael S. Barr.  The need to test the patient-centered medical home. , 2008, JAMA.

[30]  E. Kuhn,et al.  Association between infant continuity of care and pediatric emergency department utilization. , 2004, Pediatrics.

[31]  Michael D Cabana,et al.  Does continuity of care improve patient outcomes? , 2004, The Journal of family practice.

[32]  Paul Beattie,et al.  Longitudinal continuity of care is associated with high patient satisfaction with physical therapy. , 2005, Physical therapy.

[33]  M. Renfrew,et al.  Continuity of carer: what matters to women? A review of the evidence. , 2000, Midwifery.

[34]  J. Saultz,et al.  Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review , 2004, The Annals of Family Medicine.

[35]  T. Koepsell,et al.  Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. , 2001, Pediatrics.

[36]  Jennifer Schore,et al.  Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. , 2009, JAMA.

[37]  A. Mainous,et al.  The role of provider continuity in preventing hospitalizations. , 1998, Archives of family medicine.

[38]  J. Saultz,et al.  Interpersonal Continuity of Care and Care Outcomes: A Critical Review , 2005, The Annals of Family Medicine.

[39]  D. Hoover,et al.  Survivor Treatment Selection Bias in Observational Studies: Examples from the AIDS Literature , 1996, Annals of Internal Medicine.