A preliminary attempt to measure continuity of care in a Community Mental Health Center

Bass, Rosalyn D.; Windle, Charles

doi:10.1007/bf01441436

Cited by 19 publications

(11 citation statements)

References 6 publications

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“…Indeed, a number of researchers have argued that, despite its appeal, continuity is an ill-defined construct and that its measurement needs to be improved before definitive statements regarding relations between COC and outcomes can be made (Adair et al 2003;Bachrach 1981;Bass and Windle 1972;Johnson et al 1997;Rogers and Curtis 1980;Sytema et al 1997;Ware et al 1999).…”

Section: Introductionmentioning

confidence: 97%

Continuity of Care: Validation of a Self-Report Measure to Assess Client Perceptions of Mental Health Service Delivery

Joyce

Adair

Wild

et al. 2009

Community Ment Health J

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The psychometric characteristics of an instrument to assess perceived continuity of care among mental health patients were examined. 441 adults with severe and persistent mental illness were recruited from 70 inpatient, outpatient, emergency and community treatment programs (n = 259 females; M age = 42.5, SD = 10.3 years) in Alberta, Canada. Respondents completed a 43-item self-report questionnaire to rate perceived continuity. Item quality was assessed by examining missing data and frequency distributions. In a randomly selected subsample (n = 171), exploratory factor analysis identified 3 dimensions: (1) perceived attentiveness to individual needs or changes in illness or life circumstances (Individualized Care; alpha = .64); (2) perceptions of a coherent system characterized by good communication between providers (Responsive System; alpha = .71); and (3) perceived responsiveness on the part of a primary provider (Responsive Caregiver; alpha = .52). In a second random subsample (n = 181), confirmatory factor analysis provided support for this 3-factor structure and the inclusion of a second-order "continuity" factor (alpha = .72), and informed further item reduction. Split-half reliability for the second-order factor was calculated. Associations between the factors and "objective" measures of continuity, as well as relevant clinical, quality of life, and service satisfaction variables, are reported. Use of the measure for clinical and research purposes and its limitations are considered.

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Section: Introductionmentioning

confidence: 97%

Continuity of Care: Validation of a Self-Report Measure to Assess Client Perceptions of Mental Health Service Delivery

Joyce

Adair

Wild

et al. 2009

Community Ment Health J

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“…Some authors assert that COC also makes care more cost-efficient (3). At the same time, many commentators have noted that COC is a conceptually underdeveloped, vague, and overinclusive construct lacking a solid empirical foundation (3,6,(8)(9)(10)(11)(12). For example, Johnson and others comment that "research on the measurement of continuity has been notably sporadic and discontinuous .…”

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confidence: 99%

Continuity of Care in Mental Health Services: Toward Clarifying the Construct

et al. 2004

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C ontinuity of care (COC) is widely regarded as central to the provision of mental health services. It has recently assumed greater importance in conjunction with the decentralization of service delivery in mental health systems across Europe (1) and North America (2-4). Clinicians commonly assume that, if COC is absent from the services provided to patients with chronic and debilitating conditions, the result may be social isolation, economic hardship, and threats to quality of life. The concept has been characterized by some as a "strategic first choice" in the case of service planning and

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“…Any sustained focus on continuity appeared much later in the mental health research agenda (Bachrach 1981). By the early 1970s, Bass and Windle (1973) could locate only two empirical studies that had directly addressed continuity of care in mental health. This may be due, in part, to the emphasis on centralized, long-term, institutional care for individuals with serious mental disorders that, in theory, provided care under a "one-stop shopping" model (Steinwachs 1979;Bachrach 1981;Prior 1993).…”

Section: Mental Healthmentioning

confidence: 99%

“…Continuous care happens when consumers have a seamless experience that connects their medical care to their medical needs (Bass and Windle 1973). It requires a stable client-caretaker relationship and communication among any medical team members who are involved in a client's care.…”

Section: Introductionmentioning

confidence: 99%

Can We Conceptualize and Measure Continuity of Care in Individual Episodes? The Case of Mental Health Services in Puerto Rico

Alegrı́a

Pescosolido²,

Santos³

et al. 1997

Sociological Focus

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While continuity of care becomes a more pressing issue given changes in the locus of medical care under reform initiatives, our ability to understand how socio-medical factors shape the continued use of medical care services is limited by current conceptual and measurement tools. In this paper, we reconsider the possibility of measuring continuity of care for individuals during the course of an episode of illness. We recognize the inherent heterogeneity in the notion of "continuity" and suggest that different scenarios produce breaks in the use and delivery of services. We lay out two crucial distinctions. The first targets the type of breaks in continuous care, distinguishing among provider, sector and system continuity. Second, we examine the source of provider continuity, separating breaks in health service use that result from the client's failure to remain in treatment and the health care system's failure to provide for continuous care. We suspect that these scenarios represent different social processes and may be related to varying social, medical and organization factors. We argue that attempts to measure continuity of care must be tailored to both a longitudinal account of an illness episode and the specific nature of health problems. Here, we describe one way to gather data and we present an interview-based module focused on contact with formal practitioners consulted for selfreported mental health problems. Using data from the second wave of the ongoing, longitudinal study, Mental Health Care Utilization Among Puerto Ricans Study (1993-1994, N -3,263), we provide preliminary analyses of the extent and nature of continuity of care among individuals who live in low income areas of the island. We find that this approach is not only possible but feasible given the availability of computer-based algorithms. Just over one third (35.1 percent) of individuals meet criteria for our definition of continuity of care. Most breaks in service use are client-initiated (85.2 percent). We conclude by discussing the role of social scientists in reformulating theories of health care contacts that capture the experience of illness in an era characterized by community-based, managed care.Please address all communications to the first or second authors. We acknowledge support from the National Institute of Mental Health (Research Grants ROI MH42655, R24 MH51669; Research Scientist Development Awards KOl MH00849 and K02 MH012989 to the second author). We would like to thank Marisol Pena and Jose Calderon for their programming aeeietance, and Paul Cleary, Donald Steinwachs and Daniel Freeman for their advice and comments on various versions of this project.

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A preliminary attempt to measure continuity of care in a Community Mental Health Center

Cited by 19 publications

References 6 publications

Continuity of Care: Validation of a Self-Report Measure to Assess Client Perceptions of Mental Health Service Delivery

Continuity of Care: Validation of a Self-Report Measure to Assess Client Perceptions of Mental Health Service Delivery

Continuity of Care in Mental Health Services: Toward Clarifying the Construct

Can We Conceptualize and Measure Continuity of Care in Individual Episodes? The Case of Mental Health Services in Puerto Rico

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