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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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  • Another generic measure of continuity of care: the Nijmegen Continuity Questionnaire
    Annemarie A. Uijen
    Published on: 01 October 2012
  • A Strong Start
    Thomas R. O'Neill
    Published on: 13 September 2012
  • Published on: (1 October 2012)
    Page navigation anchor for Another generic measure of continuity of care: the Nijmegen Continuity Questionnaire
    Another generic measure of continuity of care: the Nijmegen Continuity Questionnaire
    • Annemarie A. Uijen, FP and PhD graduate
    • Other Contributors:

    We would like to compliment Haggerty et al. on their paper. Continuity of care is particularly important for patients with multimorbidity. This makes a strong plea for a generic instrument that measures continuity of care regardless of morbidity and across multiple care settings. The authors have made an important contribution to filling this knowledge gap.

    As only few generic questionnaires exist, all with th...

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    We would like to compliment Haggerty et al. on their paper. Continuity of care is particularly important for patients with multimorbidity. This makes a strong plea for a generic instrument that measures continuity of care regardless of morbidity and across multiple care settings. The authors have made an important contribution to filling this knowledge gap.

    As only few generic questionnaires exist, all with their own pros and cons, it is a pity that the authors did not refer to our previously developed generic measure, the Nijmegen Continuity Questionnaire (NCQ): we developed this questionnaire in 2011 [1] and tested it more recently on its psychometric properties [2]. The NCQ has already shown to be a reliable and valid generic questionnaire that measures continuity of care as a multidimensional concept (personal and team/cross-boundary continuity) from the patient's perspective across multiple care settings.

    We identified interesting similarities between these generic questionnaires. Both instruments measure continuity of care from the perspective of the patient. Moreover, items from previous questionnaires on continuity of care inspire both instruments. And lastly, items on the communication and cooperation between care providers seem to be comparable between both questionnaires.

    But besides similarities, we also identified differences. The instrument of Haggerty et al. mainly focuses on management continuity, which seems to be comparable with team/cross-boundary continuity in the NCQ. The items of their instrument are therefore based on studies of patient experiences when care is received from various care providers over time. The NCQ also measures another important aspect of continuity of care, namely having a personal care provider in every care setting with whom the patient can develop an ongoing relationship (personal/relational continuity). This dimension has shown to be important both for patients who contacted various care providers and for patients who only contacted one care provider.

    Another difference between the two measures is the definition of continuity of care and its related discussion which items are relevant for measuring continuity of care. The instrument of Haggerty et al. includes items about the information received from care providers in terms of helpfulness for staying healthy and coping with minor complications. These items were not considered relevant for the NCQ, as another definition of continuity of care was used.

    We found in our study that it was extremely difficult for patients to have an opinion about their care team, such as 'how well do you feel known by everyone on the care team'. A lot of patients showed difficulties with answering these kind of items, especially when they felt completely known by one care provider, but hardly by another. Therefore, we decided not to include items about the care team in our final version.

    Overall, we believe that both instruments are useful in measuring continuity of care, especially for patients with multimorbidity and across multiple care settings. Which instrument to use should depend on the dimensions of continuity of care that researchers want to measure and their definition of continuity of care.

    [1] Uijen AA, Schellevis FG, van den Bosch WJ, Mokkink HG, van Weel C, Schers HJ. Nijmegen Continuity Questionnaire: development and testing of a questionnaire that measures continuity of care. J Clin Epidemiol 2011; 64(12):1391-1399

    [2] Uijen AA, Schers HJ, Schellevis FG, Mokkink HGA, Weel van C, Bosch van den WJHM. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire. Br J Gen Pract 2012; 62(600): 949-957

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (13 September 2012)
    Page navigation anchor for A Strong Start
    A Strong Start
    • Thomas R. O'Neill, VP of Psychometric Services

    This is a good paper; however I get excited when I read things on psychometrics and tend to see all the things that they could also have done. Keep in mind that no study can be all things, so regard these comments as suggested next steps, rather than criticism. I liked the attention paid to giving this instrument a strong theoretical basis and it seems that the authors have made a good start toward developing a useable C...

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    This is a good paper; however I get excited when I read things on psychometrics and tend to see all the things that they could also have done. Keep in mind that no study can be all things, so regard these comments as suggested next steps, rather than criticism. I liked the attention paid to giving this instrument a strong theoretical basis and it seems that the authors have made a good start toward developing a useable CoC scale. I see the next steps as:

    1. HOW MANY SCALES? Authors must decide how many dimensions (1?, 3?, 9?) the instrument will measure and create a separate scale for each. Dimensions are not creatures waiting to be discovered, but rather abstractions that we create to make sense of the world. The extent to which these abstractions conform to our experience is what makes them useful. The authors must assert how few scales could serve their purposes and then establish how well the data cooperate with that intent. It is critical that a position be taken in order to move forward with validation efforts. This cannot be left unanswered.

    2. PRECISION. The number of scoreable units within each scale will be related to the precision of the scores, the adequacy of which will also have to be addressed.

    3. CONSTRUCT VALIDITY. The authors should describe the theoretical construct as an item hierarchy and compare it to the observed results. This can be accomplished even with rating scale data using inexpensive software (Linacre, 1997, 2012). It is important that the theoretical and the observed hierarchies be fairly congruent because the hierarchy is what gives qualitative meaning to the scores.

    4. CUT POINTS. To help users interpret the results, the authors should identify the important cut-off thresholds and supply a rationale for them.

    5. USER MANUAL. A user's manual should be developed to describe how to administer and score the survey, as well as how to translate the raw scores into measures and make relevant comparisons to facilitate score interpretation.

    I would like to see the authors move this instrument from a pilot testing phase to production mode. More work needs to be done, but it seems very worthwhile.

    Linacre, JM (1997). Phys Medicine & Rehab: State of the Art Reviews 11 (2) 315-324.

    Linacre, JM (2012). Winsteps Item Calibration Software. www.Winsteps.com .

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
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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

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