Clark Elizabeth C, Saultz John, Buckley David I, Rdesinski Rebecca, Goldberg Bruce, Gill James M
Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 1 Worlds Fair Drive, Somerset, NJ 08773, USA.
J Am Board Fam Med. 2008 Sep-Oct;21(5):385-91. doi: 10.3122/jabfm.2008.05.070040.
Continuity of care is a fundamental component of family medicine that has been shown to improve health care quality. Family continuity, when different family members are seen by the same clinician or practice, has not been well studied.
We performed a retrospective cohort study of Medicaid enrollees in Oregon using administrative data. Infants were determined to have family continuity if they received well-baby care at the same clinic as that in which their mothers received prenatal care.
Of the 1591 infants identified for participation in this study, 749 (47.1%) had family continuity. Infants had a mean of 4.55 well-child visits, 1.23 emergency department visits, and 0.17 hospitalizations in the first 13 months of life. Multivariate analyses found that infants with family continuity had increased numbers of well-child visits (relative risk, 1.05; P = .041), increased numbers of emergency department visits (relative risk, 1.36; P < .0001), and no difference in the number of hospitalizations (relative risk, 0.85; P = .282) when compared with infants without family continuity.
Family continuity, when measured at the clinic level, is associated with a variable effect on infant health service use. This finding suggests that clinic-level continuity is not sufficient for achieving all the benefits of continuity.
连续性医疗是家庭医学的一个基本组成部分，已被证明能提高医疗质量。当不同家庭成员由同一位临床医生或医疗机构诊治时的家庭连续性，尚未得到充分研究。
我们利用行政数据对俄勒冈州医疗补助计划的参保者进行了一项回顾性队列研究。如果婴儿与其母亲在同一家诊所接受产前护理和婴儿健康护理，那么就判定该婴儿具有家庭连续性。
在确定参与本研究的1591名婴儿中，749名（47.1%）具有家庭连续性。婴儿在出生后的前13个月平均进行了4.55次儿童健康检查、1.23次急诊就诊和0.17次住院治疗。多变量分析发现，与没有家庭连续性的婴儿相比，具有家庭连续性的婴儿儿童健康检查次数增加（相对风险为1.05；P = 0.041），急诊就诊次数增加（相对风险为1.36；P < 0.0001），住院次数没有差异（相对风险为0.85；P = 0.282）。
在诊所层面衡量时，家庭连续性对婴儿医疗服务利用的影响存在差异。这一发现表明，诊所层面的连续性不足以实现连续性的所有益处。
