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

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. METHODSThemes 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 modifi ed slightly and readministered after 6 months. The analysis identifi ed reliable subscales and their association with indicators of continuity. RESULTSObserved 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. CONCLUSIONThe 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.

Measuring parents’ perspective on continuity of care in children with special health care needs

“…It consisted of items assessing how well the coordinator knows all health care needs, maintains regular contact with the family of children and with other clinicians and is updated about care provided by other clinicians. This factor was consistent with the 'coordinator role' dimension of the questionnaire 'Patient Perceived Continuity from Multiple Clinicians' developed and validated by Haggerty et al [16].…”

“…SpeNK-Q was derived from the results of the SpeNK-I qualitative study [14] and was based on Haggerty's constructs of informational, management and relational continuity [15,16]. In the SpeNK-I study, 16 families of children with special health care needs were interviewed to explore their experiences and perceptions on informational, management and relational continuity of care from hospitalisation to the first months after discharge to the home.…”

“…First, we reviewed the literature about measures of continuity of care [9] and found that no measures for continuity of care specific for children. Thus, we chose to refer to Haggerty's generic measure of continuity of care and Miller's study [10,15,16] to generate item statements about continuity of care for children from parents' perspective. Second, we adapted 36 items from Haggerty's generic measure about care received by adult patients to parents' perspective on their child's care and to the Italian health care organisational context.…”

Integrating Quantitative and Qualitative Results in Health Science Mixed Methods Research Through Joint Displays

“…Displays found in exploratory sequential designs were statistics-by-themes and instrument development displays. The displays demonstrated the potential to represent mixing by linking the qualitative findings to scale items 25 or to the quantitative analysis. 26 The convergent design joint displays were statistics-by-themes or side-by-side comparisons.…”

“…Haggerty et al 25 conducted an exploratory sequential design study to develop and validate an instrument to assess continuity of care from patients' perspectives. They examined themes from 33 qualitative studies of patient care experiences and matched codes to existing instruments and added new items.…”