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Research ArticleMethodology

Validation of a Generic Measure of Continuity of Care: When Patients Encounter Several Clinicians

Jeannie L. Haggerty, Danièle Roberge, George K. Freeman, Christine Beaulieu and Mylaine Bréton
The Annals of Family Medicine September 2012, 10 (5) 443-451; DOI: https://doi.org/10.1370/afm.1378
Jeannie L. Haggerty
1Department of Family Medicine, McGill University, Canada
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  • For correspondence: Jeannie.Haggerty@mcgill.ca
Danièle Roberge
2Département de Sciences de la santé communautaire, Université de Sherbrooke, Canada
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George K. Freeman
3Department of Primary Care & Social Medicine, Imperial College, London, United Kingdom
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Christine Beaulieu
4St. Mary’s Hospital Research Centre, Montréal, Canada
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Mylaine Bréton
2Département de Sciences de la santé communautaire, Université de Sherbrooke, Canada
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Abstract

PURPOSE Patients who regularly see more than one clinician for health problems risk discontinuity and fragmented care. Our objective was to develop and validate a generic measure of management continuity from the patient perspective.

METHODS Themes from 33 qualitative studies of patient experience with care from various clinicians were matched to existing instruments to identify potential measures and measurement gaps. Adapted and new items were tested cognitively, and the instrument was administered to 376 adult patients consulting in primary care for a variety of health conditions but seeing clinicians in a variety of settings. After initial psychometric analysis, the instrument was modified slightly and readministered after 6 months. The analysis identified reliable subscales and their association with indicators of continuity.

RESULTS Observed factors correspond to 8 intended constructs, with good reliability. Three subscales (12 items) relate to the principal clinician and cover management and relational continuity. Four subscales (13 items) are related to multiple clinicians and address team relational continuity and problems with coordination and gaps in information transfer. Two (11 items) pertain to the patient’s partnership in care. Subscales correlate well and in expected directions with indicators of discontinuity (wanting to change clinicians, suffering, and sense of being abandoned, medical errors) and degree of care organization.

CONCLUSION The instrument reliably assesses both positive and negative dimensions of continuity of care across the entire system, and the subscales correlate with continuity effects. It supports patient-centered and relationship-based care and can be used as a whole or in part to assess coordination and continuity in primary care.

  • outcome and process assessment (health care)
  • delivery of health care
  • continuity of patient care
  • health care evaluation mechanisms
  • Received for publication May 25, 2011.
  • Revision received December 16, 2011.
  • Accepted for publication December 30, 2011.
  • © 2012 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 10 (5)
The Annals of Family Medicine
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September/October 2012
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Validation of a Generic Measure of Continuity of Care: When Patients Encounter Several Clinicians
Jeannie L. Haggerty, Danièle Roberge, George K. Freeman, Christine Beaulieu, Mylaine Bréton
The Annals of Family Medicine Sep 2012, 10 (5) 443-451; DOI: 10.1370/afm.1378

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Validation of a Generic Measure of Continuity of Care: When Patients Encounter Several Clinicians
Jeannie L. Haggerty, Danièle Roberge, George K. Freeman, Christine Beaulieu, Mylaine Bréton
The Annals of Family Medicine Sep 2012, 10 (5) 443-451; DOI: 10.1370/afm.1378
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Subjects

  • Methods:
    • Mixed methods
  • Other research types:
    • Health services
    • Professional practice
  • Core values of primary care:
    • Continuity
    • Relationship
  • Other topics:
    • Research capacity building
    • Patient-centered medical home
    • Patient perspectives

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