Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1123-1125 (doi:10.1542/peds.2007-1471)
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COMMENTARY

Continuity, the Medical Home, and Retail-Based Clinics

Stephen Berman, MD

Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado; Pediatrics, Consulting Editor for Health Policy

Abbreviations: AAP, American Academy of Pediatrics

The first 20% of the full text of this article appears below.

The emergence and rapid spread of walk-in clinics staffed with nurse clinicians in retail stores and shopping malls challenges both medical and nonmedical communities to consider the relative priorities of continuity and the medical home compared with convenience and cost. Continuity of care has 3 dimensions: time, accessibility, and setting. The time dimension refers to having the same pediatrician (or clinician team) care for a child over a considerable period of time, optimally for many years, so that the pediatrician can develop a long-lasting relationship with the child and his or her family. Having continuous care allows for deeper understanding of the past as well as present issues that impact the child's development, health, and well-being. The accessibility dimension refers to ensuring that the family will be able to contact the pediatrician or a member of the coverage team 24 hours a day, 7 days a week, and be able to get needed care promptly in an appropriate medical setting. The setting dimension refers to coordinating care across multiple settings including the hospital, physician outpatient office, school, home health care agency, and, if necessary, hospice program. Continuity of care is important for both pediatric primary and subspecialty care. In several situations a subspecialty pediatrician, such as an oncologist, may provide continuous care and assume the care-coordination responsibilities.

For more than 3 decades pediatric residency training programs have attempted to "teach continuity" through the establishment of continuity clinics in which residents care for a panel of patients. Because most residents only attend these clinics 1 or 2 half-days per week, continuity over time tends to be limited to scheduled preventive care and chronic care visits. However, even this limited amount of continuity . . . [Full Text of this Article]

Address correspondence to Stephen Berman, MD, Children's Hospital, 1056 E 19th Ave, B032, Denver, CO 80218. E-mail: berman.stephen@tchden.org