CMO Brief: Continuity of Care

Awhile back, I wrote about hospitalists truly being PCPs in the hospital by improving long-term continuity of care in the hospital setting.  Let’s explore that a little bit more.

While there is not much data on long-term continuity of care in the inpatient setting, there is a fair bit of it in the outpatient setting.  While it may not be directly transferable, one could argue that given it’s the same kinds of doctors and the same kind of patients, we may still be able to draw some conclusions about inpatient continuity.

When speaking about breaks in continuity from one admission to the next, hospitalists often say that while it may be a different hospitalist caring for the patient each time, it’s the same team, and this provides appropriate levels of continuity.

However, on the outpatient side, Mainous III and Gill, looked at the effect of physician continuity on hospitalization rate.  They showed that maintaining continuity with the same doctor led to lower hospitalization rates.  Being with a different doctor increased hospitalization rates, regardless of whether the patient was at the same site, or a different one.  So, a break in continuity with the primary doctor, even if being seen by the same primary care team, was no better than being at a different site with a different doctor when it came to rates of hospitalization.

The relationship with the individual doctor was the most critical part of achieving the benefit of decreased hospitalization.

When we think about hospitalists then, it may be that being cared for by the same hospitalist team will not provide the same benefits to the patient as being cared for by the same hospitalist.

Next time, we’ll talk about both patient and provider satisfaction, and how it correlates with continuity of care.