A Population-based Assessment of the Continuity of Ambulatory Care

Shorr, Gregory; Nutting, Paul A.

doi:10.1097/00005650-197706000-00001

Cited by 16 publications

(5 citation statements)

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“…Shorr and Nutting (1977) used computerized outpatient data to calculate the rates of successful completion of related clinical elements of care for a set of acute and chronic health problems, and Fletcher et al (1984) measured the integration of services based on whether the primary care and referral physicians were aware of one another's involvement in a patient's care.…”

Section: Measurement Of Continuitymentioning

confidence: 99%

“…Bass and Windle (1972) defined continuity as "the relatedness of past and present care in conformity with the therapeutic needs of patients," Breslau and Reeb (1975) as the extent to which a single physician manages the health care needs of a patient, and Shortell (1976) as "the extent to which services are received as part of a coordinated and uninterrupted succession of events consistent with the medical care needs of patients" (p. 378). Shorr and Nutting (1977) viewed continuity as "rates of transition between major clinical elements" such as screening, definitive diagnostic evaluation, treatment, and follow-up. Rogers and Curtis (1980) asserted that continuity is present when "at least one participating element [patients and their families and providers] has prior knowledge of the other" (p. 124).…”

Section: Historical Conceptualizations Of Continuity Definitions Of Cmentioning

confidence: 99%

“…Another line of inquiry has measured whether information about previous problems and services was available to treating clinicians and, if so, whether such information was recognized by the clinician (Starfield et al 1976;Starfield et al 1977;Simborg, Starfield, and Horn 1978). Shorr and Nutting (1977) used computerized outpatient data to calculate the rates of successful completion of related clinical elements of care for a set of acute and chronic health problems, and Fletcher et al (1984) measured the integration of services based on whether the primary care and referral physicians were aware of one another's involvement in a patient's care.…”

Section: Measurement Of Continuitymentioning

confidence: 99%

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Continuity of Care: A Reconceptualization

Donaldson

2001

Med Care Res Rev

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Although continuity of care is considered an essential feature of good health care, researchers have used and measured continuity in many different ways, and no clear conceptual framework links continuity to outcomes. This article of offers a reconceptualization and definition of continuity based on agency theory. It posits that the value of continuity is to reduce agency loss by decreasing information asymmetry and increasing goal alignment. Three decades of empirical literature on continuity were examined to assess whether this model would provide greater clarity about continuity. Some authors measured improved information transfer, but more appeared to assume that continuity would lead to better information. Most authors appeared to have assumed that goal alignment was present and did not measure it. The model of continuity based on agency theory appears to provide a useful conceptual tool for health services research and policy.

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Section: Measurement Of Continuitymentioning

confidence: 99%

Section: Historical Conceptualizations Of Continuity Definitions Of Cmentioning

confidence: 99%

Section: Measurement Of Continuitymentioning

confidence: 99%

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Continuity of Care: A Reconceptualization

Donaldson

2001

Med Care Res Rev

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“…Resource availability, organization structure and community needs have to be taken into consideration in answering whether a specific service should be included in the comprehensive package (Rivo et al, 1994;Schorr and Nutting, 1977;Starfield, 1998b). Although primary care in Shanghai is not based on community needs, CHCs provide a much broader range of services under the current organizational and resource constraints.…”

Section: Discussionmentioning

confidence: 99%

The Shanghai case: a qualitative evaluation of community health reform in response to the challenge of population ageing

Wei

Zakus

Liang

et al. 2005

Health Planning & Management

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Shanghai's health care system is facing a serious challenge of an ageing population, as 14% of its 17 million residents are 65 or older. In 2000, a community health reform was implemented to provide comprehensive and continuous primary care to community residents with a focus on seniors. The study employed the theoretical framework of examining primary care in terms of the constellation of its four unique elements (first contact, comprehensiveness, longitudinality and coordination) and three healthcare components (structure, process and outcome). The study aimed to evaluate the extent to which the reform has achieved its process goals and how the organizational context influenced the level of implementation. In-depth interviews with 25 health providers, 15 seniors and four community leaders were carried out. The study found that the Shanghai community health reform has improved the structure and process of primary care regarding first contact, comprehensiveness and longitunality. However, the reform is constrained by structural barriers on seniors' financial access to resources and the capacity of primary care providers. The previous organization system also constrains the reform in CHCs financing and administration. The Shanghai case illustrates that a broad societal view has to be taken when analysing health reforms, which requires the involvement of multiple sectors including the government, health providers and health consumers.

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“…A principal advantage of the tracer approach is that it solves the case-mix dilemma. Shorr and Nutting (1977) used seven health-care tracers to study the continuity of ambulatory care. Using the frequency of patient visits to a variety of health providers as the measurement criterion-they called this the transi tion rate-they found that higher transition rates were associated with less continuity of care.…”

Section: Department O F Family and Community Medicine University O Fmentioning

confidence: 99%