Is greater continuity of care associated with less emergency department utilization?
BACKGROUND
The benefits of continuity of care (COC) have not been firmly established for pediatric patients.


OBJECTIVE
To assess whether greater COC is associated with lower emergency department (ED) utilization.


METHODS
Outpatient teaching clinic at Children's Hospital and Regional Medical Center, Seattle, WA.


METHODS
All 785 Medicaid managed care children ages 0 to 19 years followed at Children's Hospital and Regional Medical Center between 1993 to 1997 who had at least four outpatient visits.


METHODS
Retrospective claims-based analysis. COC was quantified based on the number of different care providers in relation to the number of clinic visits.


RESULTS
Attending COC was significantly greater than resident COC. In a multiple event survival analysis, compared with those patients in the lowest tertile of attending COC, those in the middle tertile had 30% lower ED utilization (hazard ratio 0.70 [0.53-0.93]) and those in the highest tertile had 35% lower ED use (hazard ratio 0.65 [0.50-0.80]). Resident COC was not significantly associated with ED use.


CONCLUSIONS
Greater COC with attending physicians in outpatient teaching clinics is associated with lower ED utilization.
Christakis
D A
DA
Division of General Pediatrics, University of Washington, Seattle 98103, USA.
Wright
J A
JA
Koepsell
T D
TD
Emerson
S
S
Connell
F A
FA
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital; D010044:Outpatient Clinics, Hospital; D010372:Pediatrics / Q000193:education; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D014861:Washington