Abstract
Objectives
1) To assess continuity of care (CoC) within primary-care practices for children with
asthma and autism spectrum disorder (ASD) compared to children without chronic conditions,
and 2) to determine patient and clinical-care factors associated with CoC.
Methods
Retrospective cohort study of electronic health records from office visits of children
<9 years, seen ≥4 times between 2015 and 2019 in 10 practices of a community-based
primary health care network in California. Three cohorts were constructed: 1) Asthma:
≥2 visits with asthma visit diagnoses; 2) ASD: same method; 3) Controls: no chronic
conditions. CoC, using Usual Provider of Care measure (range > 0–1), was calculated
for 1) all visits (overall) and 2) well-care visits. Fractional regression models
examined CoC adjusting for patient age, medical insurance, practice affiliation, and
number of visits.
Results
Of 30,678 children, 1875 (6.1%) were classified with Asthma, 294 (1.0%) with ASD,
and 15,465 (50.4%) as Controls. Overall CoC was lower for Asthma (Mean = 0.58, SD
0.21) and ASD (M = 0.57, SD = 0.20) than Controls (M = 0.66, SD = 0.21); differences
in well-care CoC were minimal. In regression models, lower overall CoC was found for
Asthma (aOR = 0.90, 95% CI, 0.85–0.94). Lower overall and well-care CoC were associated
with public insurance (aOR = 0.77, CI, 0.74–0.81; aOR = 0.64, CI, 0.59–0.69).
Conclusion
After accounting for patient and clinical-care factors, children with asthma, but
not with ASD, in this primary-care network had significantly lower CoC compared to
children without chronic conditions. Public insurance was the most prominent patient
factor associated with low CoC, emphasizing the need to address disparities in CoC.
Keywords
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Article info
Publication history
Published online: July 17, 2022
Accepted:
July 2,
2022
Received:
February 10,
2022
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
