The association between continuity of care in the community and health outcomes: a population-based study

Jacob Dreiher,Doron S Comaneshter,Erez Battat,Haim Bitterman,Arnon D Cohen,Yael Rosenbluth

doi:10.1186/2045-4015-1-21

Abstract

BackgroundThe study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization.MethodsThe study included a random sample of enrollees from Clalit Health Services 19 years-of-age or older who visited their primary care clinic at least three times in 2009. Indices of continuity of care were computed, including the Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity (SECON). Quality measures of preventive medicine and healthcare services utilization and their costs were assessed as outcomes.Results1,713 randomly sampled patients were included in the study (mean age: 48.9 ± 19.2, 42% males). Continuity of care indices were: UPC: 0.75; MMCI: 0.81; COC: 0.67; SECON: 0.70. After controlling for patient characteristics in a multivariate analysis, a statistically significant association was found between higher values of UPC, COC, and SECON and a decrease in the number and cost of ED visits. Higher MMCI values were associated with a greater number and higher costs of medical consultation visits. Continuity of care indices were associated with BMI measurements, and inversely associated with blood pressure measurements. No association was found with other quality indicators, e.g., screening tests for cancer.ConclusionsSeveral continuity of care indices were associated with decreased number and costs of ED visits. There were both positive and negative associations of continuity of care indices with different aspects of healthcare utilization. The relatively small effects of continuity might be due to the consistently high levels of continuity in Clalit Health Services.

Highlights

The study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization
Some of the major principles on which Clalit has based its network of primary care clinics are the central role of the primary care provider in assuring high quality medical care for all members and the importance of a supplying a continuous source of primary care
Patients treated at a group-practice clinic were excluded, because in such clinics more than one physician is the regular source of care for the patient and the individual physician that participated in the clinical encounter could not be identified

Summary

Introduction

The study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization. Continuity of Care is defined as consistent, “seamless” treatment over time involving various healthcare providers and settings. This paper explores the extent and impact of continuity of care in Clalit Health Services ("Clalit”), the largest healthcare provider organization in Israel. Clalit operates both primary care clinics and hospitals, and provides all aspects of primary, secondary, and tertiary care to nearly 4 million enrollees (over 50% of the country’s population). The primary care physician is assumed to be the main pivot of the healthcare system.

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