Quality of Care for Children With Medical Complexity: An Analysis of Continuity of Care as a Potential Quality Indicator

Abstract

ObjectiveTo examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination. MethodsWe measured ED utilization and primary care continuity with the Bice-Boxerman continuity of care index for 1477 CMC using administrative data from Minnesota and Washington state Medicaid agencies. For a subset of 186 of these CMC a caregiver survey was used to measure care coordination quality (using items adapted from the Consumer Assessment of Healthcare Providers and System Adult Health Plan Survey) and family impact (using items adapted from the National Survey of Children with Special Health Care Needs). Multivariable regression was used to examine the relationship between continuity, entered as a continuous variable ranging from 0 to 1, and the outcomes. ResultsThe median continuity was 0.27 (interquartile range [IQR], 0.12–0.48) in the administrative data cohort and 0.27 (IQR, 0.14–0.43) in the survey cohort. Compared with children with a continuity score of 0, children with a score of 1 had lower odds of having ≥1 ED visit (odds ratio, 0.65; 95% confidence interval [CI], 0.46–0.93; P = .017) and their caregivers reported higher scores for the measure of receipt of care coordination (β = 35.2 on a 0–100 scale; 95% CI, 11.5–58.9; P = .004). There was no association between continuity and family impact. ConclusionsContinuity of care holds promise as a quality measure for CMC because of its association with lower ED utilization and more frequent receipt of care coordination.