Focusing continuity of care on sicker patients can save millions of dollars annually

Research shows higher continuity of care, meaning a care team cooperatively involved in ongoing healthcare, is better for health outcomes, but can there be too much of a good thing? New research in the INFORMS journal Manufacturing & Service Operations Management finds the answer is "yes."

Continuity of care is related to improvements in inpatient visits, length of stay, and readmission rates, but the data show outcomes improve and then decline in increasing continuity of care, suggesting that there may be value in having multiple providers.

The study, "Maintaining Continuity in Service: An Empirical Examination of Primary Care Physicians," conducted by Vishal Ahuja of Southern Methodist University, Carlos Alvarez of Texas Tech University, and Bradley Staats of University of North Carolina at Chapel Hill looked at 300,000 patients from the Veterans Health Administration over an 11-year period. They focused on patients who suffer from diabetes or kidney disease, a major complication of diabetes.

Through the researchers' work and prior literature, the consensus is that continuity of care creates an opportunity for learning—with repeated interactions, the service provider gains important knowledge about the patient's situation. These exchanges may improve the efficiency of subsequent interactions, yielding both productivity and quality benefits, but the relationship may not be so straightforward.

"Variety may also prove beneficial. With too many repeated interactions, it is possible that a service provider may grow complacent and miss information. A new provider may provide a fresh look at an existing problem," said Ahuja, a professor in the Cox School of Business at SMU.

The data proved continuity of care is especially important for patients suffering from more serious conditions because it provides even more operational value for those complex patients, which results in a greater opportunity for improvement from continuity.

"At the highest levels of continuity of care, the outcomes grow worse. It is possible to have too much of a good thing. So, focusing continuity on sicker patients can result in saving millions of dollars annually," continued Ahuja. "It is necessary to understand where continuity matters most and where perhaps it is less vital."