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As three students interested in healthcare delivery, we were interested in the development and validation of your physician-level continuity of care (CoC) measure. We agree that CoC is a central primary care tenet with clear benefits such as reduced hospitalization rates, lower mortality, and reduced costs for patients with chronic conditions or residents of long-term care facilities. As such, it is important to have an accurate measurement for healthcare systems to gauge primary care physician-level CoC.
After reading your paper, two main points came to mind. Firstly, we were curious about your perspective on the evolving definition of CoC. Particularly, what elements of CoC may not be included in your measure? You mentioned the inability to account for CoC in team-based healthcare systems. However, we are curious about other variables that could fine-tune and expand upon the CoC s measure in the future. For example, how will physician-level CoC scoring differ based on geographical location and scope of practice? Another question we had was whether the CoC scoring methodology places the onus of CoC on the physician rather than the health system overall (including patients, nurses, nurse practitioners, etc.)? With the American Board of Family Medicines’ development of an incentive system for improving CoC scores, how might physician burnout/burden be affected and addressed?
In the limitations section, you mention the potential expansion of your sample. How might your CoC scoring method be limited by the absence of Medicaid or uninsured patients and/or patients with fewer than two visits? We are curious as to whether you are interested in pursuing a subsequent study with a smaller sample size that explores specific areas of healthcare in greater detail that encapsulates a larger range of diverse patients.