The association between continuity of care and outcomes: a systematic and critical review
Abstract
Background Numerous studies have tried to determine the association between continuity and outcomes. Studies doing so must actually measure continuity. If continuity and outcomes are measured concurrently, their association can only be determined with time‐dependent methods. Objective To identify and summarize all methodologically studies that measure the association between continuity of care and patient outcomes. Methods We searched MEDLINE database (1950–2008) and hand‐searched to identify studies that tried to associate continuity and outcomes. English studies were included if they: actually measured continuity; determined the association of continuity with patient outcomes; and properly accounted for the relative timing of continuity and outcome measures. Results A total of 139 English language studies tried to measure the association between continuity and outcomes but only 18 studies (12.9%) met methodological criteria. All but two studies measured provider continuity and used health utilization or patient satisfaction as the outcome. Eight of nine high‐quality studies found a significant association between increased continuity and decreased health utilization including hospitalization and emergency visits. Five of seven studies found improved patient satisfaction with increased continuity. Conclusions These studies validate the belief that increased provider continuity is associated with improved patient outcomes and satisfaction. Further research is required to determine whether information or management continuity improves outcomes.
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Increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality.
“In addition, increased continuity of care, particularly with a family physician, is associated with decreased hospitalizations, fewer emergency visits, more preventive care, improved patient satisfaction, safer prescribing, lower rates of major adverse events and reduced mortality [11–17].”
Relational continuity may be more difficult to improve than information or management continuity.
“Previous work suggests that relational continuity may be more difficult to improve than information or management continuity [11]”
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- Authors
- Van Walraven, C., Oake, N., Jennings, A., & Forster, A. J.
- Affiliations
- Ottawa Hospital Research Institute (CA)
- University of Ottawa (CA)
- Venue
- Journal of Evaluation in Clinical Practice
- Publisher
- Wiley
- Published
- 2010-06-11
- Volume
- 16
- Issue
- 5
- Pages
- 947-956
- ISSN
- 1356-1294 (ISSN-L)
- 1365-2753
- OpenAlex
- W1559305369
- Cited by
- 644
- References
- 45
- Citations by year
- 2026: 30 · 2025: 44 · 2024: 68 · 2023: 51 · 2022: 47 · 2021: 74 · 2020: 55 · 2019: 43 · 2018: 44 · 2017: 47 · 2016: 36 · 2015: 25 · 2014: 24 · 2013: 30 · 2012: 11
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Evaluation in Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- continuity of care, provider continuity, patient outcomes, health care utilization, hospitalization, emergency department visits, patient satisfaction, information continuity, management continuity, time-dependent analysis
- MeSH terms
- Adult, Aged, Continuity of Patient Care, Female, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Young Adult
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