Recent changes in health care delivery may reduce continuity with the patient’s primary care provider (PCP). Little is known about the association between continuity and quality of communication during ongoing efforts to redesign primary care in the Veterans Administration (VA).
To evaluate the association between longitudinal continuity of care (COC) with the same PCP and ratings of patient–provider communication during the Patient Aligned Care Team (PACT) initiative.
Four thousand three hundred ninety-three VA outpatients who were assigned to a PCP, had at least three primary care visits to physicians or physician extenders during Fiscal Years 2009 and 2010 (combined), and who completed the Survey of Healthcare Experiences of Patients (SHEP) following a primary care visit in Fiscal Year (FY)2011.
Usual Provider of Continuity (UPC), Modified Modified Continuity Index (MMCI), and duration of PCP care were calculated for each primary care patient. UPC and MMCI values were categorized as follows: 1.0 (perfect), 0.75–0.99 (high), 0.50–0.74 (intermediate), and < 0.50 (low). Quality of communication was measured using the four-item Consumer Assessment of Healthcare Providers and Systems-Health Plan program (CAHPS-HP) communication subscale and a two-item measure of shared decision-making (SDM). Excellent care was defined using an “all-or-none” scoring strategy (i.e., when all items within a scale were rated “always”).
UPC and MMCI continuity remained high (0.81) during the early phase of PACT implementation. In multivariable models, low MMCI continuity was associated with decreased odds of excellent communication (OR = 0.74, 95 % CI = 0.58–0.95) and SDM (OR = 0.70, 95 % CI = 0.49, 0.99). Abbreviated duration of PCP care (< 1 year) was also associated with decreased odds of excellent communication (OR = 0.35, 95 % CI = 0.18, 0.71).
Reduced PCP continuity may significantly decrease the quality of patient–provider communication in VA primary care. By improving longitudinal continuity with the assigned PCP, while redesigning team-based roles, the PACT initiative has the potential to improve patient–provider communication.
Institute of Medicine. Primary Care: America’s Health in a New Era. Washington, DC: National Academy Press; 1996.
Weyrauch KF. Does continuity of care increase HMO patients’ satisfaction with physician performance? J Am Board Fam Pract. 1996;9:31–36. PubMed
Cabana MD, Jee SH. Does continuity of care improve patient outcomes? J Fam Pract. 2004;53(12):974–980. PubMed
Pandhi N, Saultz JW. Patients’ perceptions of interpersonal continuity of care. J Am Board Fam Pract. 2006;19(4):390–397. CrossRef
Gabel LL, Lucas JB, Westbury RC. Why do patients continue to see the same physician? Fam Pract Res J. 1993;13:133–147. PubMed
Epstein RM, Fiscella K, Lesser CS, Stange KC. Why the nation needs a policy push on patient-centered health care. Health Aff. 2010;29(8):1489–1495. CrossRef
Klein S. The Veterans Health Administration: Implementing Patient-Centered Medical Homes in the Nation’s Largest Integrated Delivery System. Washington, DC: The Commonwealth Fund; 2011.
Solimeo S, Hein M, Paez M, Ono S, Lampman M, Stewart G. Medical homes require more than an EMR and aligned incentives. Am J Manag Care. 2013;19(2):132–140. PubMed
Dillman DA. Internet, Mail, and Mixed-Mode Surveys: The Tailored Design Method. 3rd ed. Hoboken: Wiley; 2009.
Love MM, Mainous AG III. Commitment to a regular physician: how long will patients wait to see their own physician for acute illness? J Fam Pract. 1999;48(3):202–207. PubMed
Holmboe ES, Arnold GK, Weng W, Lipner R. Current yardsticks may be inadequate for measuring quality improvements from the medical home. Health Aff. 2010;29(5):859–866. CrossRef
Epstein RM, Street RL. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Bethesda: National Cancer Institute; 2007.
Safran DG, Montgomery JE, Chang H, Murphy J, Rogers WH. Switching doctors: predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract. 2001;50(2):130–136. PubMed
Love MM, Mainous AG 3rd, Talbert JC, Hager GL. Continuity of care and the physician-patient relationship: the importance of continuity for adult patients with asthma. J Fam Pract. 2000;49(11):998–1004. PubMed
Nunnally J. Psychometric Theory. New York: McGraw Hill; 1978.
Flocke SA. Measuring attributes of primary care: development of a new instrument. J Fam Pract. 1997;45(1):64–74. PubMed
Phan K, Brown S. Decreased continuity in a residency clinic: a consequence of open access scheduling. Fam Med. 2009;41(1):46–50. PubMed
Levinson W, Lesser CS, Epstein AM. Developing physician communications skills for patient-centered care. Health Aff. 2010;29(7):1310–1317. CrossRef
- Does Improved Continuity of Primary Care Affect Clinician–Patient Communication in VA?
MD, MSc David A. Katz
MS Kim McCoy
PhD Mary Vaughan Sarrazin
- Springer US
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