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. Setting.: Outpatient teaching clinic at Children's Hospital and Regional Medical Center, Seattle, WA. Patients.: 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. Conclusion.: Greater COC with attending physicians in outpatient teaching clinics is associated with lower ED utilization.