Can Continuity of Care Be Improved? Results From a Randomized Pilot Study

Context.—Although continuity of care is an important component of primary care, few mechanisms for improving it have been studied.

Objective.—To determine if automated reminders to providers and patient schedulers can improve continuity of care in a practice.

Design.—Prospective randomized controlled trial.

Setting and Population.—Four hundred and nine patients in the lowest tertile of continuity of care in a university-affiliated clinic with a computerized information system were randomized to 1 of 4 groups: 1) control (no reminder), 2) provider alert, 3) scheduler alert, or 4) provider and scheduler alert.

Main Outcome Measures.—Continuity of care as measured by a previously described dispersion index that ranges from 0 to 1.

Results.—Initial continuity of care was .134 (standard deviation, .07). In a linear regression model, 9 months after implementation of the system, both the provider-prompt group (.027 [.006, .05]) and the provider and scheduler group (.024 [.001, .054]) were associated with increased continuity compared with the control group

Conclusions.—Prompting providers for patients with poor continuity of care may improve it.

KEY WORDS:  continuity of care , pediatrics , randomized controlled trial