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PEDIATRICS Vol. 103 No. 4 April 1999, pp. 738-742

Is Greater Continuity of Care Associated With Less Emergency Department Utilization?

Received May 11, 1998; accepted Aug 31, 1998.

Dimitri A. Christakis*, Jeffrey A. Wright*, Thomas D. KoepsellDagger , §, parallel , Scott Emerson, and Frederick A. Connellparallel

From the * Division of General Pediatrics, University of Washington, the Dagger  Robert Wood Johnson Clinical Scholars Program; and the Departments of § Epidemiology, parallel  Health Services, and  Biostatistics, University of Washington, Seattle, Washington.

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.  Key words:  continuity of patient care, pediatrics, ambulatory care, resident education.




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