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  1. Is greater continuity of care associated with less emergency department utilization ?

    Article - En anglais

    Background

    The benefits of continuity of care (COC) have not been firmly established for pediatric patients.

    Objective

    To assess whether greater COC is associated with lower emergency department (ED) utilization.

    Setting

    Outpatient teaching clinic at Children's Hospital and Regional Medical Center, Seattle, WA.

    Patients

    All 785 Medicaid managed care children ages 0 to 19 years followed at Children's Hospital and Regional Medical Center between 1993 to 1997 who had at least four outpatient visits.

    Methods

    Retrospective claims-based analysis.

    COC was quantified based on the number of different care providers in relation to the number of clinic visits.

    Results

    Attending COC was significantly greater than resident COC.

    In a multiple event survival analysis, compared with those patients in the lowest tertile of attending COC, those in the middle tertile had 30% lower ED utilization (hazard ratio 0.70 [0.53-0.93]) and those in the highest tertile had 35% lower ED use (hazard ratio 0.65 [0.50-0.80]). Resident COC was not significantly associated with ED use.

    Conclusion

    Greater COC with attending physicians in outpatient teaching clinics is associated with lower ED utilization.

    Mots-clés Pascal : Etats Unis, Amérique du Nord, Amérique, Epidémiologie, Enfant, Homme, Evaluation, Bénéfice, Soin, Continu, Utilisation, Service urgence, Soin intégré, Soin santé primaire

    Mots-clés Pascal anglais : United States, North America, America, Epidemiology, Child, Human, Evaluation, Profit, Care, Continuous, Use, Emergency department, Managed care, Primary health care

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0212315

    Code Inist : 002B30A01A2. Création : 16/11/1999.