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Association of Lower Continuity of Care With Greater Risk of Emergency Department Use and Hospitalization in Children
Abstract
Context.: The benefits of continuity of pediatric care remain controversial. Objective.: To determine whether there is an association between having a continuous relationship with a primary care pediatric provider and decreased risk of emergency department (ED) visitation and hospitalization. Design.: Retrospective cohort study. Setting and Population.: We used claims data from 46 097 pediatric patients enrolled at Group Health Cooperative, a large staff-model health maintenance organization, between January 1, 1993, and December 31, 1998, for our analysis. To be eligible, patients had to have been continuously enrolled for at least a 2-year period or since birth and to have made at least 4 visits to one of the Group Health Cooperative clinics. Main Exposure Variable.: A continuity of care (COC) index that quantifies the degree to which a patient has experienced continuous care with a provider. Main Outcome Measures.: ED utilization and hospitalization. Results.: Compared with children with the highest COC, children with medium continuity were more likely to have visited the ED (hazard ratio [HR]: 1.28 [1.20–1.36]) and more likely to be hospitalized (HR: 1.22 [1.09–1.38]). Children with the lowest COC were even more likely to have visited the ED (HR: 1.58 [1.49–1.66]) and to be hospitalized (HR: 1.54 [1.33–1.75]). These risks were even greater for children on Medicaid and those with asthma. Conclusions.: Lower continuity of primary care is associated with higher risk of ED utilization and hospitalization. Efforts to improve and maintain continuity may be warranted.
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Citations
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Cited by
The association between continuity of care and outcomes: a systematic and critical review
Van Walraven, C., Oake, N., Jennings, A., & Forster, A. J. (2010) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2009.01235.x · Cited by 644
A Review of the Evidence for the Medical Home for Children With Special Health Care Needs
Homer, C. J., Klatka, K., Romm, D., Kuhlthau, K., Bloom, S., Newacheck, P., Van Cleave, J., & Perrin, J. M. (2008) · Pediatrics · doi:10.1542/peds.2007-3762 · Cited by 373
Continuity of Primary Care: To Whom Does It Matter and When?
Nutting, P. A. (2003) · The Annals of Family Medicine · doi:10.1370/afm.63 · Cited by 316
Pearson, S.-A., Moxey, A., Robertson, J., Hains, I., Williamson, M., Reeve, J., & Newby, D. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-154 · Cited by 193
Quality of Primary Care and Subsequent Pediatric Emergency Department Utilization
Brousseau, D. C., Hoffmann, R. G., Nattinger, A. B., Flores, G., Zhang, Y., & Gorelick, M. (2007) · Pediatrics · doi:10.1542/peds.2006-3518 · Cited by 145
Metadata
- Authors
- Christakis, D. A., Mell, L., Koepsell, T. D., Zimmerman, F. J., & Connell, F. A.
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2001-03-01
- Volume
- 107
- Issue
- 3
- Pages
- 524-529
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2065107858
- Cited by
- 409
- References
- 1
- FWCI
- 55.93
- Type
- journal article
- Language
- en
- Open access
- closed
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