Researchers develop tool to measure continuity of care for patients

Relying on 60 years of qualitative studies, researchers have developed an instrument to measure the continuity of care from a patient perspective. They described the tool and its development in the September/October issue of Annals of Family Medicine.

“Primary care requires a generic instrument, applicable to a broad range of health conditions and patients in an ambulatory setting,” wrote lead author Jeanne L. Haggerty, PhD, of McGill University in Montreal. “Some subscales measure coordination in primary care, but these focus on the primary care physician and do not capture the patient’s continuity experience at the system level.”

To develop an instrument, researchers conducted meta-summary of 33 qualitative studies published between 1950 and 2007 of the patient experience when multiple providers deliver care over time. They pulled common themes from these studies and matched them to existing instruments to identify potential measures and measurement gaps. Based on this work, researchers developed a questionnaire with 84 items.

The questionnaire was administered to 376 patients recruited from the waiting rooms of six primary care clinics, three from poorly integrated and three from highly integrated health networks. It was returned to researchers by 300 patients. Researchers refined the instrument, mostly to account for clinical language not easily understood by patients and because some items addressed events that patients’ weren’t able to observe. The refined questionnaire was readministered six months later and returned by 256 of the 300 initially surveyed.

The refined instrument contained 37 items that measured nine dimensions of continuity. “Though the instrument builds on previous measures of continuity of care, this measure advances by integrating different types of continuity and refinements that emerge from qualitative studies and a variety of health conditions,” Haggerty and her colleagues wrote.

“The ultimate test of this tool will be to show whether improving continuity translates into better quality of care and health outcomes,” they concluded. “This instrument represents an important addition to tools that assess care from the patient’s perspective, addressing dimensions of information transfer, care plan and monitoring, support for self-management and teamwork focused on coordination.”