Maintaining Continuity in Service: An Empirical Examination of Primary Care Physicians
41 Pages Posted: 8 Jan 2018 Last revised: 11 Oct 2018
Date Written: September 30, 2018
In many service operations, customers have repeated interactions with service providers. This creates several important questions for service design. First, how important is it to maintain the continuity of service for individuals? Second, since maintaining continuity is costly and at times perhaps operationally impractical, should certain customer types, such as those with complex needs, be prioritized for continuity? Third, is it possible to have too much continuity? These questions are particularly important in healthcare services where patients with chronic conditions visit primary care offices repeatedly, with important health implications. We use a detailed and comprehensive dataset from the Veterans Health Administration, the largest integrated healthcare delivery system in the United States that permits us to control for potential sources of heterogeneity. We analyze over 300,000 patients that suffer from diabetes, a chronic disease whose successful management requires care continuity, as well as kidney disease, a major complication of diabetes, over an eleven-year period. We use an empirical approach to quantify the relationship between care continuity and three important health outcomes: inpatient visits, length of stay, and readmission rate. We conduct extensive robustness checks and sensitivity analysis, including use of instrumental variables method to validate our findings. We find that continuity of care is related to improvements in all three health outcomes. Moreover, we find that the gains are not linearly improving in continuity, but rather, the relationship is U-shaped whereby outcomes improve and then decline in increasing care continuity, suggesting that there may be value in having multiple providers. Additionally, we find that care continuity is even more important for patients suffering from more complex conditions. Finally, we find that continuity of care leads to a more efficient provision of resources, as measured by diagnostic tests ordered. Our results are of interest to both of interest to practitioners and policymakers as that can help design appropriate policies for staffing and work allocation.
Keywords: Continuity of Care, Healthcare Operations, Empirical Operations
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