Continuity of Care by Primary Care Provider in Young Children with Chronic Conditions

Abstract

AbstractObjectives(1) To assess continuity of care by primary-care provider (CoC), an established quality indicator, in children with asthma, autism spectrum disorder (ASD), and no chronic conditions, and (2) to determine patient factors that influenced CoC.MethodsRetrospective cohort study of electronic health records from all office visits of children under 9 years, seen ≥4 times between 2015 and 2019 in 10 practices of a community-based primary healthcare network in California. Three cohorts were constructed: (1)Asthma: ≥2 visits with asthma visit diagnoses; (2)ASD: same method; (3)Controls: no chronic conditions. CoC, using the Usual Provider of Care measure (range >0-1), was calculated for (1)total visits and (2)well-care visits only. Fractional regression models examined CoC adjusting for patient age, medical insurance, practice affiliation, and number of visits.ResultsOf 30,678 eligible children, 1875 (6.1%) were classified as Asthma, 294 (1.0%) as ASD, and 15,465 (50.4%) as Controls. Asthma and ASD had lower total CoC than Controls (Mean=0.58, SD 0.21, M=0.57, SD 0.20, M=0.66, SD 0.21). Differences among well-care CoC were smaller (Asthma M=0.80, ASD M=0.78, Controls M=0.82). In regression models, lower total CoC was found for Asthma (aOR 0.90, 95% CI 0.85-0.94). Lower total and well-care CoC were associated with public insurance (aOR 0.77, CI 0.74-0.81; aOR 0.64, CI 0.59-0.69).ConclusionChildren with asthma in this primary-care network had lower CoC compared to children without chronic conditions. Public insurance was the most prominent patient factor associated with low CoC. Quality initiatives should address disparities in CoC for children with chronic conditions.Table of Contents SummaryContinuity of care by primary care provider is an established quality indicator. We compared continuity in young children with asthma, autism, and no chronic conditions.What’s Known on This SubjectContinuity of care has emerged as an important component of care in the patient-centered medical home, especially for children with chronic medical conditions. However, it has been minimally studied across chronic conditions, especially in neurodevelopmental disorders.What This Study AddsChildren with asthma, but not those with autism spectrum disorder, had lower continuity of care compared to children without chronic conditions. Public insurance was associated with lower care continuity for children with and without chronic conditions, highlighting important sociodemographic disparities.Contributors’ Statement PageDr. Bannett conceptualized and designed the study, defined and coordinated data extraction, carried out the data analyses, drafted the manuscript, and reviewed and revised the manuscript.Ms. Gardner participated in study design, extensively reformatted the data for analysis, performed statistical data analysis, and critically reviewed and revised the manuscript.Dr. Feldman participated in study design, supervised data analysis and critically reviewed and revised the manuscript.Drs. Huffman and Sanders supervised the conceptualization and design of the study, supervised data analysis, and critically reviewed and revised the manuscript.All authors approved the final manuscript as submitted and are responsible for all aspects of the work.