Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

The lack of strong evidence about the influence of outpatient continuity of care on outcomes such as mortality and morbidity of some chronic diseases means that Dr. Shin's and his research team's devotion of time to this interesting research subject belongs among the worldwide milestones in FM practice.

The authors used a sophisticated statistical model (multi-events survival analysis including the Cox model and HR) with the relevant cohort population to find strong evidence for the impact of continuity of care on outcomes in the research question.

A strong aspect of Korean health insurance, which covers 97% of the population (universal coverage), is also a limitation of this research as mentioned by the authors: the findings may not apply to health care systems that lack universal coverage, high level of access to care, and free choice of physician.

Although the authors use quantitative indices for measuring the continuity of care, such as MFPC, MMCI and COC, those confirm only the visit of patients and do not include measurement of the patient-doctor relationship (trust and responsibility) or satisfaction of patients -- pivotal aspects of continuity of care.

Besides those, John W. Saultz's paper [1] defined continuity of care as a hierarchy of 3 dimensions: informational, longitudinal, and interpersonal continuity (interpersonal continuity being of particular interest for primary care), which helps us classify the impact of this research as belonging to the contribution of a longitudinal dimension.

The other 2 dimensions mentioned in the hierarchy above, plus geographic continuity, family continuity, and interdisciplinary or team-based continuity, will be the subjects of future research. I appreciate the strong evidence for continuity of care from the Korean group.

1. John W. Saultz. Defining and Measuring Interpersonal Continuity of Care. Ann Fam Med. 2003;1:134-143. DOI: 10:1370/afm.23

Competing interests: None declared