Patient-Reported Care Coordination: Associations With Primary Care Continuity and Specialty Care Use

David T. Liss; Jessica Chubak; Melissa L. Anderson; Kathleen W. Saunders; Leah Tuzzio; Robert J. Reid

doi:10.1370/afm.1278

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We need new tools!
Samuel W, Warburton, MD

Published on: 01 August 2011
Other possible explanations
Susan Lin

Published on: 22 July 2011

Published on: (1 August 2011)
Page navigation anchor for We need new tools!
We need new tools!
Samuel W, Warburton, MD, Durham, NC, USA
Can continuity be reduced to a mathematical calculation based on the number of primary care visits and the number of clinicians seen by the patient? The Bice-Boxerman measure was developed in or before 1977 in the pre-information era. To fully evaluate continuity we would also need to track the various 'touches' that occur between the primary and the practice care team with the patient and the family. What about the pho...
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Can continuity be reduced to a mathematical calculation based on the number of primary care visits and the number of clinicians seen by the patient? The Bice-Boxerman measure was developed in or before 1977 in the pre-information era. To fully evaluate continuity we would also need to track the various 'touches' that occur between the primary and the practice care team with the patient and the family. What about the phone calls, and the email messages which are often more numerous than visits by a significant multiple? While the Medicare patients may not be electronically connected to their primary, the family often is very well connected. In the case of high utilizers of speciality services, the family as well as the patient is a focus of care and coordination. We clearly need new tools to study continuity in the 21st century. Continuity is more than face-to-face visits with a clinician.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (22 July 2011)
Page navigation anchor for Other possible explanations
Other possible explanations
Susan Lin, New York, NY
Other Contributors:
This study did not find the association of primary care continuity with patient self-reported care coordination among patients with higher use of specialist care. The reasons for the absence of this association were convincingly discussed by the authors. We would like to add alternative interpretations of this study finding.
First, the study finding may also suggest that when patients use more specialist car...
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This study did not find the association of primary care continuity with patient self-reported care coordination among patients with higher use of specialist care. The reasons for the absence of this association were convincingly discussed by the authors. We would like to add alternative interpretations of this study finding.
First, the study finding may also suggest that when patients use more specialist care their perceived care coordination depends less on visit based continuity but more on interpersonal relationship and informational continuity between the patients and their health care providers. While visit based continuity scale has been more frequently used, more research is needed to develop valid tools to measure other important dimensions of care continuity in primary care practice 1, 2.
Secondly, as some of the Medicare patients with higher use of specialist care in this study may have used specialists such as cardiologists for their primary care, their continuity with or the care coordination by a primary care provider may have become less needed. However, with the overwhelming evidence on the benefits of primary care to health care system 3, it is expected the overall outcomes of these patients with less involvement of primary care providers in their on-going care can be compromised.
Finally, given the study finding on the lack of association between the perceived care coordination and visit based care continuity among patients with higher use of specialist care, future research is needed to examine among Medicare patients with higher demand for specialist care how the implementation of Patient Centered Medical Home (PCMH) designed to address fragmented care can improve the perceived experience of care coordination in primary care practice.
References:
1. Saultz JW. Defining and measuring interpersonal continuity of care. Ann Fam Med. Sep-Oct 2003;1(3):134-143.
2. Jee SH, Cabana MD. Indices for continuity of care: a systematic review of the literature. Med Care Res Rev. Apr 2006;63(2):158-188.
3. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457-502.
Competing interests: None declared
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Competing Interests: None declared.