Effective Use of Comprehensive Pediatric Care

Alpert, Joel J.; Heagarty, Margaret C.; Robertson, Leon S.; Kosa, John; Haggerty, Robert J.

doi:10.1001/archpedi.1968.02100020533014

Cited by 47 publications

(7 citation statements)

References 2 publications

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“…21,37,45,57,58 In 7 of the studies, including 6 of the 7 clinical trials, patients were assigned either to a clinic designed to deliver clinician continuity or to a clinic with no physician continuity. [22][23][24][25][26]29,40,70 Unfortunately, the quality of evidence in these studies is compromised, because in only 1 study was continuity actually measured in either study group. 33 Supplemental Table 3 (http://www.annfammed.org/ cgi/content/full/3/2/159/DC1) summarizes the 20 studies examining the association between interpersonal continuity and the cost of health care.…”

Section: Resultsmentioning

confidence: 99%

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Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Saultz

Lochner

2005

The Annals of Family Medicine

492

389

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PURPOSE We wanted to undertake a critical review of the medical literature regarding the relationships between interpersonal continuity of care and the outcomes and cost of health care.METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to fi nd original English language articles focusing on interpersonal continuity of patient care. The articles were then screened to select those articles focusing on the relationship between interpersonal continuity and the outcome or cost of care. These articles were systematically reviewed and analyzed by both authors for study method, measurement technique, and quality of evidence.RESULTS Forty-one research articles reporting the results of 40 studies were identifi ed that addressed the relationship between interpersonal continuity and care outcome. A total of 81 separate care outcomes were reported in these articles. Fifty-one outcomes were signifi cantly improved and only 2 were signifi cantly worse in association with interpersonal continuity. Twenty-two articles reported the results of 20 studies of the relationship between interpersonal continuity and cost. These studies reported signifi cantly lower cost or utilization for 35 of 41 cost variables in association with interpersonal continuity.CONCLUSIONS Although the available literature refl ects persistent methodologic problems, it is likely that a signifi cant association exists between interpersonal continuity and improved preventive care and reduced hospitalization. Future research in this area should address more specifi c and measurable outcomes and more direct costs and should seek to defi ne and measure interpersonal continuity more explicitly. Ann Fam Med INTRODUCTIONC ontinuity of care traditionally is considered one of the core principles of family medicine, 1,2 and it is a core element of the Institute of Medicine defi nition of primary care. 3 Recently there has been a resurgence of interest in this subject, and the Annals of Family Medicine has devoted a theme issue to the topic. 4 This resurgence has occurred in part because of the growing sophistication of research in family medicine and because of changes in American health care that many believe have undermined continuity in the relationship between physicians and their patients.5-11 A central question facing the future of family medicine is the degree to which we will provide personal health care based on the individual doctor-patient relationship, or whether we will seek to provide a medical home for patients based on an interdisciplinary team with less emphasis on personal care. 12Continuity has proved to be a diffi cult variable to defi ne and measure. Several previous reviews of this subject have noted major limitations to its research foundation because of inconsistent defi nitions and complex methodologic challenges. [13][14][15][16][17][18] In early 2002, we undertook a comprehensive review of the medical literature to examine one aspect of continuity 160INTERPERSONAL CONTINUITY AND...

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Section: Resultsmentioning

confidence: 99%

“…One of the cohort studies examined interpersonal continuity as the dependent variable in a managed care environment and found a signifi cant association between more restrictive utilization and increased continuity of care. References 21,22,24,26,32,38,40,43,45,49,50, 56. † References 22,24,26,29,[43][44][45][46]50,52,55, 60.…”

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confidence: 99%

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Saultz

Lochner

2005

The Annals of Family Medicine

492

389

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“…A mid-1960s experiment that offered primary care to a group of poor families found that free comprehensive services increased physician use and reduced hospitalizations, and an evaluation of a Medicaid managed care program in Maryland found that the number of primary care visits was inversely associated with avoidable hospitalizations. 14,25 Neither of these studies examined specifically the concept of adherence to guidelines for pediatric care.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries

2001

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A series of well-child visits maintained during the first 2 years of life has a positive effect on health outcomes as indicated by a decrease in avoidable hospitalizations among poor and near-poor children, regardless of race, level of poverty, or health status. National efforts to improve the quality of child health services for young children should focus on increasing compliance with periodic preventive care for young children in addition to improving immunization levels.

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“…One of the best known examples is a study of the introduction of &dquo;comprehensive family-focused pediatric&dquo; care at the children § Hospital Medical Center in Boston in the mid-1960s (Alpert et al 1968;Alpert et al 1970;Heagarty et al 1970). The initial article (Alpert et al 1968) noted, &dquo;The absence of a single physician to provide both preventive and curative services precludes the development of any relationship between doctor and patient.&dquo; The studies reported improvements in performance-more well visits, less sick visits, less hospitalization, more patient satisfaction, and better patient knowledge about when to use. The reason given for the reduced hospital use was: &dquo;It seems likely that physicians with a stable relationship with their patients are more comfortable in treating illnesses on an outpatient basis when the indication for hospitalization is not certain.…”

Section: Effect Of Managing Physicianmentioning

confidence: 99%

“…The reason given for the reduced hospital use was: &dquo;It seems likely that physicians with a stable relationship with their patients are more comfortable in treating illnesses on an outpatient basis when the indication for hospitalization is not certain. Their knowledge of the family adds to their control of the situation&dquo; (Alpert et al 1968). This conclusion seems reasonable; note its similarity to the Breslau and Haug statement presented earlier.…”

Section: Effect Of Managing Physicianmentioning

confidence: 99%

Patient-Provider Concordance: A Review and Conceptualization

Penchansky

1986

Medical Care Review

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The existence and character of the relationship between a patient and provider are probably key variables determining the performance of the medical care system. Prior analyses of this relationship have addressed it as three largely distinct areas: the patient having a usual source, a personal physician, or a central source; the concept of managing physician, primary physician or gatekeeper; and,-the patientphysician interpersonal or therapeutic relationship.If the relationship between provider and patient is important, then there is a need to answer the questions: Are there factors that influence the existence or strength of the relationship and, if so, what are they? How do the existence and strength of the relationship influence choice of source, use, quality, compliance, efficiency, and satisfaction? Will the addition of a measure (or measures) of the existence and characteristics of the patient-provider relationship improve our ability to explain the functioning of the health 'care system? How can the relationship between patient and system or provider be characterized in ways useful for research and policy analysis? This article has four major objectives: to establish the importance of usual source (personal physician or managing physician) to health at UQ Library on June 18, 2015 mcr.sagepub.com Downloaded from

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Effective Use of Comprehensive Pediatric Care

Cited by 47 publications

References 2 publications

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries

Patient-Provider Concordance: A Review and Conceptualization

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