Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e399-e406 (doi:10.1542/peds.2007-1497)
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ARTICLE

Effects of Continuity of Care in Infancy on Receipt of Lead, Anemia, and Tuberculosis Screening

Ana I. Flores, BSa, Warren B. Bilker, PhDb and Evaline A. Alessandrini, MD, MSCEa,b

a Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
b Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania

OBJECTIVES. The goals were (1) to examine the influence of continuity of care on delivery of lead, anemia, and tuberculosis screening in a cohort of Medicaid-enrolled children, (2) to determine whether well-child care continuity had a greater effect than continuity for all ambulatory visits, and (3) to investigate which aspects of continuity were most associated with receipt of these screening services.

METHODS. A prospective birth cohort of 1564 Medicaid-enrolled infants was studied. Continuity of care scores for the first 6 months of life were calculated for total ambulatory visits and well-child care visits. Outcomes of interest were performance of ≥1 screening for lead toxicity, anemia, and tuberculosis during the first 24 months of life.

RESULTS. For total ambulatory visits, children with complete continuity of care (the same practitioner seen for every visit) were more than twice as likely to receive lead screening, compared with children who saw a different practitioner for every visit, irrespective of the measurement technique used. Similarly, children with complete continuity were 1.5 to 2 times more likely to have been screened for tuberculosis. Continuity showed a lesser, but still significant, effect on anemia screening. Well-child care visit continuity of care had less impact on screening performance than did total visit continuity of care.

CONCLUSIONS. In this study, greater continuity of care in infancy was associated with increased likelihood of receiving screening for lead toxicity, anemia, and tuberculosis in the first 24 months of life. The dimension of continuity of care that was most influential in this population was dispersion of visits among different practitioners.

Key Words: continuity of care • Medicaid • screening • early childhood • urban

Abbreviations: COC—continuity of care • WCC—well-child care • UPC—usual provider of care • B&B—Bice and Boxerman • SECON—sequence continuity • CI—confidence interval • IQR—interquartile range • OR—odds ratio

Accepted Jul 20, 2007.