Associate Professor of Medicine and Pediatrics Cohen Children's Medical Center New Hyde Park, New York, United States
Background: Primary care serves as the foundation of medical care for children and young adults with complex chronic conditions (CCCs). In some populations such as pediatric asthma patients, children with medical complexity, and older adults, higher continuity of care has been shown to reduce Emergency Department (ED) utilization. However, continuity of care (COC) is rarely evaluated across the age spectrum. Objective: To calculate continuity of care in the primary care setting for children and young adults with CCCs and to determine how continuity of care in the outpatient setting affects ED utilization among children and adults with CCCs. Design/Methods: A retrospective cohort study was conducted. Data were collected from the electronic health record for all children and young adults (ages 2 to 26 years old) with at least 1 CCC seen across more than 35 primary care practices in a clinically integrated health network from 2015 to 2019. Patients were included if they had 4 or more outpatient primary care visits within a specified 2-year period. The predictor was COC as measured by the Continuity of Care Index (COCI). The COCI values range from 0 to 1 with 0 reflecting the lowest level of continuity, with a different provider seen at every visit and 1 indicating the highest level of continuity where all visits are with the same provider. Demographic information was collected. Logistic regression was used to assess the impact of COCI on ED use after adjusting for age, race/ethnicity, asthma diagnosis, number of visits to any sub-specialist (i.e. cardiologist, etc.) during the 2-year period, insurance and prior ED use. Results: A total of 1,856 patients met eligibility criteria. Patients had a mean ± SD age of 14.9 ±5.8 years. Most patients identified as non-Hispanic or Latino (75.9%; n=1,387) and 50.7% were female (n=942). The mean ± SD COCI was 0.45 ± 0.31. Results failed to provide evidence that COC was significantly associated with future ED utilization (p=0.12) after adjusting for potential confounders. However, the odds of having an ED visit were lower for those who identified as non-Hispanic (OR=0.66 (95% CI: 0.44-0.99) or had commercial insurance (OR=0.66 (95% CI: 0.50-0.89) compared to Hispanic or public insurance, respectively. A greater number of sub-specialist visits increased the odds of an ED visit (OR=1.05 (95% CI: 1.02-1.08)).
Conclusion(s): In children and young adults with CCCs, we did not find an association between continuity of care and ED utilization. However, in this group, other factors such as ethnicity and insurance status may help identify high-risk populations for ED utilization.
