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Review ArticleReviews

Defining and Measuring Interpersonal Continuity of Care

John W. Saultz
The Annals of Family Medicine September 2003, 1 (3) 134-143; DOI: https://doi.org/10.1370/afm.23
John W. Saultz
MD
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    Table 1.

    Continuity of Care Research Themes

    No.Research ThemePapers Reviewed No.Reference Citations
    1What is the best conceptual definition of continuity?1710,13-28
    2What is the best way to measure continuity of care?1713,14,20-22,29-40
    3Are patients who receive interpersonal continuity more satisfied with their care?3112,14,16,33,41-67
    4What patient characteristics correlate with choosing an interpersonal continuity model?2036,44,46,48,49,51,52,58,62,68-78
    5Is health care better in any measurable way when delivered in interpersonal continuity?545,6,13,14,17,25,35,36,42,45,53-56,60,61,64,66-68,74,79-110
    6Are physicians more satisfied with practice when an interpersonal continuity model is followed?1214,16,42,52,53,55,61,62,67,111-113
    7Is health care less expensive when delivered in interpersonal continuity?2042,53,54,57,61,66,80,72,84,88,90-92,108,114-119
    8Can interpersonal continuity be improved by organizing a practice in a particular way?2212,17,33,46,52-55,59,63,69,76,94,120-128
    9Why do patients leave the care of a physician with whom they have interpersonal continuity?134-6,58,69,71,73,126,129-133
    10What do primary care physicians value regarding continuity of care?2110,13,16,17,23,26,27,33,52,61,62,77,85,112,122,134-139
    11What do patients value regarding continuity of care?1816,17,33,44,46,49,51,52,59,60,62,65,69,70,104,131,136,140
    12Does geographic continuity matter to patients?1028,41,70,79,80,135,141-144
    13How are changes in the health care system affecting continuity?164-6,9-12,61,76,114,120,133,141,142,144,145
    • View popup
    Table 2.

    References Addressing Theme 2: What Is the Best Way to Measure Continuity of Care?

    ReferencePrimary Research Question
    Bice & Boxerman, 197730How can continuity of care best be measured?
    Ejlertsson & Berg, 198434How do the quantitative measures of continuity compare with one another?
    Eriksson & Mattsson 198320How can continuity of care be defined and measured?
    Given,198540How consistent are three measures of continuity?
    Godkin & Rice,198437How can continuity of care be measured?
    Hansen,197513How can continuity of care best be measured?
    Magill & Senf,198731How can continuity of care best be measured in a residency?
    Murata,199329How can family continuity be measured?
    Patten & Friberg, 198032How can continuity of care best be measured in a residency program?
    Pereira Gray,197933How can personal patient lists assure ongoing personal care in a group practice?
    Rogers & Curtis,198021How can continuity of care best be defined?
    Roos et al, 198036Is objectively measured continuity of care associated with any measurable improvement in outcome quality?
    Shortell,197622How can continuity of care best be defined and measured?
    Smedby et al,198639Do various methods of measuring continuity correlate with one another?
    Starfield et al,197635What can be done to improve coordination as measured by recognition of patient information?
    Steinwachs,197938Do various methods of measuring continuity of care correlate with one another?
    Wall,198114How can continuity of care best be defined and studied?
    • View popup
    Table 3.

    Hierarchical Definition of Continuity of Care

    Level of ContinuityDescription
    1. InformationalAn organized collection of medical and social information about each patient is readily available to any health care professional caring for the patient. A systemic process also allows accessing and communicating about this information among those involved in the care
    2. LongitudinalIn addition to informational continuity, each patient has a “medical home” where the patient receives most health care, which allows the care to occur in an accessible and familiar environment from an organized team of providers. This team assumes responsibility for coordinating the quality of care, including preventive services
    3. InterpersonalIn addition to longitudinal continuity, an ongoing relationship exists between each patient and a personal physician. The patient knows the physician by name and has come to trust the physician on a personal basis. The patient uses this physician for basic health services and depends on the physician to assume personal responsibility for the patient’s overall health care. When the personal physician is not available, a coverage arrangement assures that longitudinal continuity occurs
    • View popup
    Table 4.

    Instruments to Measure Continuity of Care

    InstrumentsInterpersonal Continuity References Using This MeasureInstrumentsInterpersonal Continuity References Using This Measure
    Measures that do not require an assigned providerMeasures that require an assigned provider
    Continuity of Care Index (COC)30-32,34,36-40Christakis et al, 2000110 Christakis et al, 1999118 Flynn, 198545 Roos et al, 198036 Sloane & Eglehoff, 198375 Wasson et al, 198466Duration of relationship14Hjortdahl, 199283 Hjortdahl & Laerum, 199247 Love & Mainous, 199969 Mainous et al, 200160 Overland et al, 200168 Weiss & Bluestein, 199684
    Number of Providers Seen (NOP)20Raddish et al, 1999117 Shortell et al, 197749Rate of provider turnover14
    Most Frequent Provider Continuity (MFPC)40,121Merenstein et al, 2001121
    Sequential Continuity Index (SECON)20,34,37,38,40Phillips & Shear, 198488 Pilotto et al, 199673 Shear et al, 198364 Wasson et al, 198466Index Provider Identification35Meredith et al, 2001114 Starfield et al, 197635 Susman et al, 198981 Wasson et al, 198466
    Likelihood of Continuity Index (LICON)20,34,38
    Likelihood of Sequential Continuity Index (LISECON)20,38Patient survey, interview, or questionnaireBreslau, 198251 Breslau & Mortimer, 198144 Ettlinger & Freeman, 198187 Ettner, 1996109 Ettner, 199997 Gill et al, 200282 Hanninen et al, 2001101 Hennelly & Boxerman, 197992 Hjortdahl & Borchgrevink, 1991116 Hjortdahl & Laerum, 199247 Howie et al, 1999104 Kearley et al, 200162 Kingston, 198358 Kogan et al, 1995133 Lambrew et al, 200278 Love et al, 200048 O’Connor et al, 1998103 O’Malley et al, 199789
    Herfindahl Index (HH)20,39
    Modified Continuity Index (MCI)31,37Gill & Mainous, 199890 Gill et al, 2000115 Neher et al, 2001124 Sturmberg & Schattner, 2001100
    Modified, Modified Continuity Index (MMCI)31Gill & Mainous, 199890 Gill et al, 2000115 Neher et al, 2001124
    Index of Concentration (CON)22,38
    GINI Index of Concentration (GINI)22,38
    K Index (K)34,39
    FRAC Index (FRAC)36Roos et al, 198036Measures of family continuity
    Measures that require an assigned providerFamily Care measure (FC)29
    Family Mean Continuity Index (FMCI)37
    Usual Provider Continuity Index (UPC)20,31,32,34,38,39,120Blankfield et al, 1990113 Boss & Timbrook, 200196 Breslau & Haug, 197663 Breslau & Reeb, 1975120 Cornelius, 199772 Flocke et al, 19975 Forrest & Starfield, 1998128 Freeman & Richards, 1994105 Freeman & Richards, 199346 Freeman & Richards, 199076 Goldberg & Dietrich, 1985139 Kibbe et al, 1993123 Mainous et al, 200160 Mainous & Gill, 199891 Roland et al, 198652 Smith, 199553 Wasson et al, 198466Family Continuity of Care Index (FCOC)37
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The Annals of Family Medicine: 1 (3)
The Annals of Family Medicine: 1 (3)
Vol. 1, Issue 3
1 Sep 2003
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Defining and Measuring Interpersonal Continuity of Care
John W. Saultz
The Annals of Family Medicine Sep 2003, 1 (3) 134-143; DOI: 10.1370/afm.23

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Defining and Measuring Interpersonal Continuity of Care
John W. Saultz
The Annals of Family Medicine Sep 2003, 1 (3) 134-143; DOI: 10.1370/afm.23
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