Interpersonal Continuity Of Care Research Articles

Using Interpersonal Continuity of Care in Home Health Physical Therapy to Reduce Hospital Readmissions

This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient’s admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤ .001, AME = −4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions.

Interpersonal Continuity of Care and Its Effect on Health Care Utilizations and Expenditures for Diabetes: An Experience From a Fragmented Health System.

We aimed to quantify continuity of care (COC) and investigate its association with health care utilizations and expenditure among patients with diabetes. This was an observational retrospective cohort study using administrative claims database of Iranian Health Insurance Organization for East Azerbaijan Province, Iran. Standard indices of COC were calculated for each patient, and their associations with utilization outcomes were determined by applying general linear regression models. A total of 32 263 patients were included (mean age: 60.9 ± 14.5 years; 64% females). Higher levels of COC were associated with a reduced number and spending of all health care service categories.

Interpersonal continuity of primary care of veterans with diabetes: a cohort study using electronic health record data

BackgroundContinuity of care is a cornerstone of primary care and is important for patients with chronic diseases such as diabetes. The study objective was to examine patient, provider and contextual factors associated with interpersonal continuity of care (ICoC) among Veteran’s Health Administration (VHA) primary care patients with diabetes.MethodsThis patient-level cohort study (N = 656,368) used electronic health record data of adult, pharmaceutically treated patients (96.5% male) with diabetes at national VHA primary care clinics in 2012 and 2013. Each patient was assigned a “home” VHA facility as the primary care clinic most frequently visited, and a primary care provider (PCP) within that home clinic who was most often seen. Patient demographic, medical and social complexity variables, provider type, and clinic contextual variables were utilized. We examined the association of ICoC, measured as maintaining the same PCP across both years, with all variables simultaneously using logistic regression fit with generalized estimating equations.ResultsAmong VHA patients with diabetes, 22.3% switched providers between 2012 and 2013. Twelve patient, two provider and two contextual factors were associated with ICoC. Patient characteristics associated with disruptions in ICoC included demographic factors, medical complexity, and social challenges (example: homeless at any time during the year OR = 0.79, CI = 0.75–0.83). However, disruption in ICoC was most likely experienced by patients whose providers left the clinic (OR = 0.09, CI = 0.07–0.11). One contextual factor impacting ICoC included NP regulation (most restrictive NP regulation (OR = 0.79 CI = 0.69–0.97; reference least restrictive regulation).ConclusionsICoC is an important mechanism for the delivery of quality primary care to patients with diabetes. By identifying patient, provider, and contextual factors that impact ICoC, this project can inform the development of interventions to improve continuity of chronic illness care.

The association of longitudinal and interpersonal continuity of care with emergency department use, hospitalization, and mortality among Medicare beneficiaries.

BackgroundContinuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit) relates to improved health outcomes and service use.MethodsWe linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period.ResultsPatient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality.ConclusionOur results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality.

D2-5: Interpersonal Continuity of Care and Utilization Among Multimorbid Seniors in an Integrated Healthcare System

Background/Aims Greater continuity of care (CoC) is associated with lower hospital utilization. This has not been fully explored in integrated care delivery systems with high informational continuity.

How outcomes are achieved through patient portals: a realist review

To examine how patient portals contribute to health service delivery and patient outcomes. The specific aims were to examine how outcomes are produced, and how variations in outcomes can be explained. We used a realist review method, which aims to describe how 'an intervention works, for whom, and in what circumstances' by analyzing patterns between context, mechanism, and outcomes. We reviewed 32 evaluation studies of patient portals published since 2003. The reviewed evaluations indicate that as a complement to existing health services, patient portals can lead to improvements in clinical outcomes, patient behavior, and experiences. Four different mechanisms are reported to yield the reported outcome improvements. These are patient insight into personal health information, activation of information, interpersonal continuity of care, and service convenience. The vast majority of evaluations were conducted in integrated health service networks in the USA, and we detected no substantial variation in outcomes across these networks. Patient portals may impact clinical outcomes and health service delivery through multiple mechanisms. Given the relative uniformity of evaluation contexts, we were not able to detect patterns in how patient portals work in different contexts. Nonetheless, it appears from the overwhelming proportion of patient portal evaluations coming from integrated health service networks, that these networks provide more fertile contexts for patient portals to be effective. To improve the understanding of how patient portals work, future evaluations of patient portals should capture information about mechanisms and context that influence their outcomes.

Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in general practice

The ageing population and increasing prevalence of chronic illness have contributed to the need for significant primary care reform, including increased use of multidisciplinary care and task substitution. This cross-sectional study explores conditions under which older patients would accept having health professionals other than their general practitioner (GP) involved in their care for chronic disease management (CDM). Ten practices were randomly sampled from a contiguous major city and inner regional area. Questionnaires were distributed to consecutive patients aged 60 years and over in each practice. Agency theory was used to inform analyses. Statistical analysis was undertaken using Wald's test, growth modelling and linear regression, controlling for the clustered design. The response rate was 53% (n=272). Most respondents (79%) had at least one chronic health condition. Respondents were more comfortable with GP than with practice nurse management in the CDM scenario (Wald's test=105.49, P<0.001). Comfort with practice nurse CDM was positively associated with increased contact with their GP at the time of the visit (β=0.41, P<0.001), negatively associated with the number of the respondent's chronic conditions (β=-0.13, P=0.030) and not associated with the frequency of other health professional visits. Agency theory suggests that patients employ continuity of care to optimise factors important in CDM: information symmetry and goal alignment. Our findings are consistent with the theory and lend support to ensuring that interpersonal continuity of care is not lost in health care reform. Further research exploring patients' acceptance of differing systems of care is required.

Do English patients want continuity of care, and do they receive it?

Interpersonal continuity of care is valued by patients, but there is concern that it has declined in recent years. To determine how often patients express preference for seeing a particular GP and the extent to which that preference is met. Analysis of data from the 2009/2010 English GP Patient Survey. A stratified random sample of adult patients registered with 8362 general practices in England (response rate 39%, yielding 2,169,718 responses). Weighted estimates were calculated of preference for and success in seeing a particular GP. Multilevel logistic regression was used to identify characteristics associated with these two outcomes. Excluding practices with one GP, 62% of patients expressed a preference for seeing a particular GP. Of these patients, 72% were successful in seeing their preferred GP most of the time. Certain patient groups were associated with more preference for and success in seeing a particular GP. These were older patients (preference odds ratio [OR] = 1.7, success OR = 1.8), those with chronic medical conditions (preference OR = 1.9, success OR = 1.3), those with chronic psychological conditions (preference OR = 1.6, success OR = 1.3), and those recently requesting only non-urgent versus urgent appointments (preference OR = 1.4, success OR = 1.6). Patient groups that had more frequent preference but less success in seeing a preferred GP were females (preference OR = 1.5, success OR = 0.9), patients in larger practices (preference OR = 1.3, success OR = 0.5), and those belonging to non-white ethnic groups. The majority of patients value interpersonal continuity, yet a large minority of patients and specific patient groups are not regularly able to see the GP they prefer.

Patients' perceptions of safety if interpersonal continuity of care were to be disrupted.

To determine if patients vary in perceptions of safety if interpersonal continuity were to be disrupted. If so, which characteristics are associated with feeling unsafe? The extent to which patients' preference for continuity with a personal physician is due to perceptions of safety is unclear. Observational study (Wisconsin Longitudinal Study Graduate and Sibling Survey). A total of 6827 respondents (most aged 63-66 years) who completed the 2003-06 survey round. Age, gender, marital status, education, health insurance type, illnesses, medications, length of relationship with provider and place, personality type, decision-making preference and trust in physician deliberation. Safety perception when visiting another doctor or clinic if own doctor were not available. Twelve percent of respondents felt unsafe. After adjustment, as compared to those who felt safe, those who felt unsafe were more likely to be women (Odds ratio=1.65, 95% confidence interval=1.35-2.01), have more chronic conditions (1.27, 1.08-1.50) and have a longer relationship with a usual provider: 5-9 years (1.53, 1.11-2.10) 10-14 years (1.41, 1.02-1.95) and 15 or more years (1.62, 1.20-2.17) compared to 0-4 years. Those who preferred active participation in decision making and had trust in their physician were less likely to feel safe (1.63, 1.10-2.41). Certain older adults perceive being unsafe if not seeing their usual physician. Further research should investigate reasons for perceptions of safety if continuity were disrupted and any implications for care.

Fatores associados à continuidade interpessoal na atenção à saúde: estudo de base populacional

This study focused on the prevalence of interpersonal continuity of care and its determinants. A cross-sectional population-based study was conducted with 3,133 individuals 20 years or older in Pelotas, Rio Grande do Sul State, Brazil. Multivariate analysis used Poisson regression, with the first level representing socioeconomic and demographic variables and the proximal level including health care and health needs variables. Prevalence of interpersonal continuity of care was 43.7% (95%CI: 42.0-45.5). Female gender, higher age, higher income, consultation during the previous year, report of chronic disease, and consultation outside the public health system showed higher interpersonal continuity of care. Among individuals that consulted in public primary health care services, female gender, age, and the Family Health Program were associated with interpersonal continuity of care. Some vulnerable groups (low-income and users of the public health system) showed low prevalence of the outcome.

Interpersonal continuity of care and care outcomes: a critical review.

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. A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to find 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. Forty-one research articles reporting the results of 40 studies were identified 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 significantly improved and only 2 were significantly 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 significantly lower cost or utilization for 35 of 41 cost variables in association with interpersonal continuity. Although the available literature reflects persistent methodologic problems, it is likely that a significant association exists between interpersonal continuity and improved preventive care and reduced hospitalization. Future research in this area should address more specific and measurable outcomes and more direct costs and should seek to define and measure interpersonal continuity more explicitly.

Interpersonal continuity of care and patient satisfaction: a critical review.

We wanted to review the medical literature regarding the relationship between interpersonal continuity of care and patient satisfaction and suggest future strategies for research on this topic. A search of the MEDLINE database from 1966 through April 2002 was conducted to find articles focusing on interpersonal continuity of patient care. The resulting articles were screened to select those focusing on the relationship between interpersonal continuity in the doctor-patient relationship and patient satisfaction. These articles were systematically reviewed and analyzed for study method, measurement technique, and the quality of evidence. Thirty articles were found that addressed the relationship between interpersonal continuity and patient satisfaction with medical care. Twenty-two of these articles were reports of original research. Nineteen of the 22, including 4 clinical trials, reported significantly higher satisfaction when interpersonal continuity was present. Although the available literature reflects persistent methodologic problems, a consistent and significant positive relationship exists between interpersonal continuity of care and patient satisfaction. Future research in this area should address whether the same is true for all patients or only for those who seek ongoing relationships with physicians in primary care.