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.

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.