In many service operations, customers have repeated interactions with service providers. This creates two 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, operationally impractical for both the organization (due to potentially lower utilization) and providers (due to high effort required), should certain customer types, such as those with complex needs, be prioritized for continuity? These questions are particularly important in healthcare services where patients with chronic conditions visit primary care offices repeatedly. Therefore, we explore these questions in the context of diabetes, a chronic disease.
We use a detailed and comprehensive dataset from the Veterans Health Administration, the largest integrated healthcare delivery system in the United States, which permits us to control for potential sources of heterogeneity. We analyze over 300,000 patients over an eleven-year period that suffer from diabetes, a chronic disease whose successful management requires continuity of care, as well as kidney disease, a major complication of diabetes. We use an empirical approach to quantify the relationship between continuity of care and three important health outcomes: inpatient visits, length of stay, and readmission rate. We conduct extensive robustness checks and sensitivity analyses 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 curvilinear whereby outcomes improve and then decline in increasing continuity of care, suggesting that there may be value in having multiple providers. Additionally, we find that continuity of care is even more important for patients suffering from more complex conditions. Identifying the amount of continuity of care to provide and which individuals to prioritize are both of interest to practitioners and policymakers as that can help in designing appropriate policies for staffing and work allocation.
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