Clinical Question: Does better continuity of care of infants affect the rate of emergency department use?

Setting: Population-based

Study Design: Cohort (prospective)

Synopsis: Previous research suggests that patterns of emergency department use are established during the first year of life. Investigators evaluated the association between emergency department use and continuity of care in 181 children from a group of pediatric practices who were continuously enrolled in a health maintenance organization that provided commercial and Medicaid (27 percent) coverage.

The investigators calculated a continuity-of-care score from well-child visits during the first seven months of life. Emergency department use was measured for the subsequent 12 months. Of all recorded visits, 11.2 percent of all sick visits and 7.7 percent of all visits occurred in the emergency department. Higher continuity-of-care scores were associated with a lower number of emergency department visits per child and a lower percentage of all health care visits occurring in the emergency department (Spearman rank correlation coeffficient = – 0.214 and –0.215).

Bottom Line: Better continuity of care of infants during the first six months of life is associated with lower emergency department use in the following 12 months. One theory is that the physician-parent bond, if established early, decreases emergency department use. (Level of Evidence: 2b)