Background: The rise of managed care has lent added saliency to the role of continuity of the relationship between patients and primary care providers.

Objective: To determine whether improved continuity of care is associated with decreased emergency room use in children.

Methods: This was a retrospective project using four years('93-'97) of Medicaid managed care data on children followed at the outpatient teaching clinic at Children's Hospital and Medical Center. Patients visiting the clinic were seen by both residents and attendings. Continuity of care was quantified seperately for residents and attendings using a previously established index developed by Bice and Boxerman. A multivariate, Poisson regression model was used to assess the association between continuity of care and the rate of ER utilization both for all children and for a sub-group of children with asthma while controlling for age, sex, enrollment period, and total outpatient visits.

Results: 943 patients were included in the analysis. Mean age was 7.4 years. 53% were male. 15% had asthma. 38% had at least one ER visit during the study period. For all children, increased resident continuity was not associated with a significant reduction in ER use [Rate Ratio.85 (95% C.I.62-1.14)]. Increased attending continuity however was [Rate Ratio.45 (95% C.I..34-.62)]. For children with asthma, resident continuity again appeared not to be predictive of ER use [Rate Ratio 1.5 (95% C.I..8-2.84)] while attending continuity was very protective [Rate Ratio.19 (.09-.38)].

Conclusion: For children followed in an outpatient teaching hospital, increased attending continuity may diminish ER use. Research in other settings is needed to determine the extent to which these findings can be generalized.