Continuity of care and cardiovascular risk factor management: does care by a single clinician add to informational continuity provided by electronic medical records?
BACKGROUND: Electronic medical records allow information sharing among multiple clinicians treating the same patient, enabling informational continuity between visits. OBJECTIVE: To assess the contribution of continuity of care (COC) with a single clinician to short-term outcomes in a setting in which electronic medical records are used. STUDY DESIGN: Retrospective cohort study. METHODS: Between January 1, 2003, and October 1, 2004, we identified 3718 patients assessed for lipid and blood pressure control and a subgroup of 1448 patients with diabetes mellitus assessed for glycemic control in the primary care clinics of a large Department of Veterans Affairs healthcare facility. Continuity of care was defined as having been seen by the same clinician (physician or nurse practitioner) in the year before testing. Analytic techniques accounting for clustering of patients by providers yielded robust estimators for the association between continuity with a single clinician and control of these cardiovascular disease risk factors. RESULTS: Patients with complete COC were more likely to be men with few medical problems and visits during the study period. Controlling for these differences, we detected no association between COC and patient attainment of recommended goals for cardiovascular disease risk factor control (P < .05 for all). CONCLUSION: Continuity of care with a single clinician contributes little to cardiovascular risk factor management in a setting in which electronic medical records provide enhanced informational continuity, although its value may be greater in the management and outcomes of established diseases that require coordination of care and ongoing collaboration between clinician and patient.