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Annals of Family Medicine 4:548-555 (2006)
© 2006 Annals of Family Medicine, Inc.
doi: 10.1370/afm.578
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Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure

Martin C. Gulliford, FRCP, Smriti Naithani, MSc and Myfanwy Morgan, PhD

Division of Health and Social Care, Research, King’s College, London, UK

CORRESPONDING AUTHOR: Martin Gulliford, FRCP, Department of Public Health Sciences, Capital House, 42 Weston St, London SE1 3QD, UK, martin.gulliford{at}kcl.ac.uk

PURPOSE Continuity is an important attribute of health care, but appropriate measures are not currently available. We developed an experience-based measure of continuity of care in type 2 diabetes.

METHODS A 19-item measure of experienced continuity of care for diabetes mellitus (ECC-DM) was developed from qualitative patient interview data with 4 continuity subdomains: longitudinal, flexible, relational, and team and cross-boundary continuity. The measure was implemented in a survey of 193 patients with type 2 diabetes from 19 family practices. Associations of ECC-DM scores with clinician organizational characteristics were estimated.

RESULTS Potential ECC-DM scores ranged from 0 to 100 with an observed mean of 62.1 (SD 16.0). The average inter-item correlation was 0.343 and Cronbach’s {alpha} was 0.908. Factor analysis found 4 factors that were generally consistent with the proposed subdomains. Patients’ mean scores varied significantly between practices (P = .001), ranging from 46 to 78 at different family practices. Experienced continuity was lower for patients receiving only hospital clinic care than for those receiving some diabetes care from their family practice (difference 13.7; 95% confidence interval [CI], 8.2–19.2; P <.001). Patients had higher ECC-DM scores if their family practice had a designated lead doctor for diabetes (difference 8.2; 95% CI, 2.7–13.6; P = .003).

CONCLUSIONS The results provide evidence for the reliability, construct validity, and criterion validity of the experienced continuity-of-care measure. The measure may be used in research and monitoring to evaluate patient-centered outcomes of diabetes care. Patients’ experiences of continuity of care vary between health care organizations and are influenced by the organizational arrangements for care.

Key Words: Diabetes mellitus • continuity of patient care • family practice • patient care management • patient experience • patient views




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TRACK Comments:

Read all TRACK Comments

Measuring continuity of care
John W Saultz
Annals of Family Medicine, 8 Dec 2006 [Full text]
A new continuity measure: remarks on content and utility
Henk J Schers, et al.
Annals of Family Medicine, 8 Dec 2006 [Full text]
The new continuity measure is grounded in patients’ experiences
Martin C Gulliford, et al.
Annals of Family Medicine, 22 Dec 2006 [Full text]
What is continuity?
Barbara Starfield
Annals of Family Medicine, 19 Jan 2007 [Full text]
Continuity of care
Martin C Gulliford, et al.
Annals of Family Medicine, 24 Jan 2007 [Full text]

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