RT Journal Article
SR Electronic
T1 Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 548
OP 555
DO 10.1370/afm.578
VO 4
IS 6
A1 Martin C. Gulliford
A1 Smriti Naithani
A1 Myfanwy Morgan
YR 2006
UL http://www.annfammed.org/content/4/6/548.abstract
AB 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 α 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.