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

Walraven, Carl van; Oake, Natalie; Jennings, Alison; Forster, Alan J.

doi:10.1111/j.1365-2753.2009.01235.x

Cited by 486 publications

(440 citation statements)

References 37 publications

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“…23 Hence, we used insurance premiums as an indicator to represent patients' socioeconomic status. 39 In addition, despite measuring COC before health care outcomes, as suggested by a previous study, 53 the problem of temporal ambiguity between COC and health care outcomes might not be completely avoided. We recommend that this issue should be further investigated in the future.…”

Section: Discussionmentioning

confidence: 99%

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

Kao¹,

Wu²

2017

J Am Board Fam Med

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Background: Continuity of care (COC) is positively associated with health care outcomes. However, the effect of COC on the reduction of asthma-related emergency department (ED) visits among older asthmatic patients is not clearly understood.Methods: We conducted a retrospective cohort study using the Taiwan Results: Among a total of 3395 subjects, the overall mean COC was 0.73, and 48.5% of subjects had perfect COC (COCI ‫؍‬ 1). After controlling for covariables, in the group of patients with low COC, the risk of having an asthma-related ED visit was higher compared with those with perfect COC (Adjusted HR, 2.11; 95% CI, 1.37؊3.25).Conclusions

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Section: Discussionmentioning

confidence: 99%

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

Kao¹,

Wu²

2017

J Am Board Fam Med

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“…In the outpatient setting, greater continuity has been associated with better hypertensive control, lower risk of hospitalization, fewer emergency department visits, higher patient satisfaction, and higher physician satisfaction. [1][2][3][4] Achieving continuity is difficult in the inpatient setting, where care must be provided continuously. Fletcher et al showed that between 1996 and 2006, Medicare patients experienced declining levels of physician continuity during their hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

Turner

Hansen²,

Hinami³

et al. 2014

J GEN INTERN MED

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BACKGROUND: Achieving patient-physician continuity is difficult in the inpatient setting, where care must be provided continuously. Little is known about the impact of hospital physician discontinuity on outcomes. OBJECTIVE: To determine the association between hospital physician continuity and percentage change in median cost of hospitalization, 30-day readmission, and patient satisfaction with physician communication. DESIGN: Retrospective observational study using various multivariable models to adjust for patient characteristics. PARTICIPANTS: Patients admitted to a non-teaching hospitalist service in a large, academic, urban hospital between 6 July 2008 and 31 December 2011. MAIN MEASURES: We used two measures of continuity: the Number of Physicians Index (NPI), and the Usual Provider of Continuity (UPC) index. The NPI is the total number of unique physicians caring for a patient, while the UPC is calculated as the largest number of patient encounters with a single physician, divided by the total number of encounters. Outcome measures were percentage change in median cost of hospitalization, 30-day readmissions, and top box responses to satisfaction with physician communication. KEY RESULTS: Our analyses included data from 18,375 hospitalizations. Lower continuity was associated with modest increases in costs (range 0.9-12.6 % of median), with three of the four models used achieving statistical significance. Lower continuity was associated with lower odds of readmission (OR=0.95-0.98 across models), although only one of the models achieved statistical significance. Satisfaction with physician communication was lower, with less continuity across all models, but results were not statistically significant. CONCLUSIONS: Hospital physician discontinuity appears to be associated with modestly increased hospital costs. Hospital physicians may revise plans as they take over patient care responsibility from their colleagues.KEY WORDS: continuity of care; health care costs; health services research; hospital medicine.

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“…31 There is evidence that increased continuity is associated with improved outcomes and satisfaction. 35,36 Although continuity may be important to all health service users, it is thought to be particularly important for those with complex health needs such as dementia, long-term conditions, multimorbidity and frailty. 37,38 Dementia is a long-term condition characterised by progressive deterioration and dependency.…”

Section: Continuity Of Carementioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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

Abstract: 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.

Cited by 486 publications

References 37 publications

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

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