Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Jul;29 Suppl 2(Suppl 2):S682-8.
doi: 10.1007/s11606-013-2633-8.

Does improved continuity of primary care affect clinician-patient communication in VA?

David A Katz  1 , Kim McCoy, Mary Vaughan Sarrazin
Affiliations
Randomized Controlled Trial

Does improved continuity of primary care affect clinician-patient communication in VA?

David A Katz et al. J Gen Intern Med. 2014 Jul.

Abstract

Background: 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).

Objective: 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.

Design: Cross-sectional survey.

Participants: 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.

Main measures: 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").

Key results: 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).

Conclusions: 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.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Derivation of analysis sample.
Figure 2
Figure 2
Relationship between CAHPS-HP communication scores and PCP ratings.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Stange KC, Nutting PA, Miller WL, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601–612. doi: 10.1007/s11606-010-1291-3. - DOI - PMC - PubMed
    1. Institute of Medicine . Primary Care: America’s Health in a New Era. Washington, DC: National Academy Press; 1996.
    1. Wasson JH, Sauvigne AE, Mogielnicki P, et al. Continuity of outpatient medical care in elderly men: a randomized trial. JAMA. 1984;252(17):2413–2417. doi: 10.1001/jama.1984.03350170015011. - DOI - PubMed
    1. Mainous AG, III, Gill JM. The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician? Am J Public Health. 1998;88:1539–1541. doi: 10.2105/AJPH.88.10.1539. - DOI - PMC - PubMed
    1. Gill JM, Mainous AG, III, Nsereko M. The effect of continuity of care on emergency department use. Arch Fam Med. 2000;9:333–338. doi: 10.1001/archfami.9.4.333. - DOI - PubMed

Publication types