Breslau N, Haug M R
J Health Soc Behav. 1976 Dec;17(4):339-52.
The effects of the reorganization of a medical practice on continuity of care were investigated in a case study of a changing pediatric practice. Continuity, which has often been conceptualized as one indicator of quality of care, was measured by an index of which the numerator was the number of visits with own pediatrician and the denominator was the total number of pediatric visits for the year. Increased number of pediatricians and incorporation of the practice into an academic setting resulted in a decline of continuity of care accompanied by a rise in the number of doctor visits for acute illness care. Patient satisfaction, although related in some of its aspects to continuity, was by and large unaffected by the change. The consequences of changes in practice size and goal complexity for interpersonal aspects of patient care and quality of care are discussed.
在一项关于不断变化的儿科诊疗实践的案例研究中，调查了医疗实践重组对医疗连续性的影响。连续性常被视为医疗质量的一个指标，通过一个指数来衡量，该指数的分子是看自己儿科医生的就诊次数，分母是当年儿科就诊的总次数。儿科医生数量的增加以及该诊疗实践并入学术环境导致了医疗连续性的下降，同时急性病护理的就诊次数增加。患者满意度虽然在某些方面与连续性相关，但总体上不受这种变化的影响。文中讨论了实践规模和目标复杂性的变化对患者护理人际方面和医疗质量的影响。
