Organizational correlates of continuity of care: a pendulum swing between differentiation and integration

Introduction: Continuity of care is among the foundations of primary care and has long been identified as a critical determinant of healthcare outcomes. This article aims to assess through an empirical study the relationships between distinct organizational features (namely, the use of clinical pathways and clinical databases, and the centralization of healthcare setting or provider) and types of patient-perceived continuity of care. Methods: A multilevel regression model was performed, analyzing survey data on patient-perceived continuity of care and on the organization of care for three specific chronic conditions (chronic obstructive pulmonary disease, diabetes and late-stage cancer). A total of 497 healthcare professional responses (79% response rate) and 323 patient responses (69%) were collected in 13 Italian Local Health Authorities. Results: Clinical pathways have a statistical significant and positive effect on relational continuity (p-value ≤ 0.01), while centralization of care in one professional improves the perceived quality of the relationship from a longitudinal perspective. A small, but statistical significant, improvement in continuity of care was detected when services are taken out of the hospital. No statistical significant effect of the use of clinical databases by professionals was found. Conclusions: Although largely neglected, organizational features can impact the continuity of care experienced by patients. The higher prevalence of chronic conditions should push modern health systems for more extensive attention towards organizational strategies aimed at enhancing continuity of care.