title: Is greater continuity of care associated with less emergency department utilization?
abstract: 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.
authors: Division of General Pediatrics, University of Washington, Seattle 98103, USA.
authors: D A
authors: DA
authors: Christakis
authors: J A
authors: JA
authors: Wright
authors: T D
authors: TD
authors: Koepsell
authors: S
authors: S
authors: Emerson
authors: F A
authors: FA
authors: Connell
mesh_terms: 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