Evaluation and application of continuity measures in primary care settings

Given, Charles W.; Branson, Michael; Zemach, Rita

doi:10.1007/bf01321357

Cited by 20 publications

(20 citation statements)

References 6 publications

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“…Continuity of care was measured with 3 commonly used indices 19,41 : most frequent provider continuity (MFPC), 42 modified, modified continuity index (MMCI), 27,43 and continuity-of-care index (COC) 44 (Sup- 27 and COC integrates both aspects into a single metric. The primary outcome of the study was all-cause mortality.…”

Section: Data Sources and Measuresmentioning

confidence: 99%

Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

Shin

Cho

Yang

et al. 2014

The Annals of Family Medicine

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PURPOSE Continuity of care is considered a core element of high-quality primary care, but its impact on mortality and health care costs is unclear. We aimed to determine the impact of continuity of care on mortality, costs, and health outcomes in patients with newly diagnosed cardiovascular risk factors. METHODSWe conducted a cohort study of a 3% nationwide random sample of Korean National Health Insurance enrollees. A total of 47,433 patients who had received new diagnoses of hypertension, diabetes, hypercholesterolemia, or their complications in 2003 or 2004 were included. We determined standard indices of continuity of care-most frequent provider continuity (MFPC), modified, modified continuity index (MMCI), and continuity of care index (COC)-and evaluated their association with study outcomes over 5 years of follow-up. Outcome measures included overall mortality, cardiovascular mortality, incident cardiovascular events, and health care costs. RESULTSThe multivariable-adjusted hazard ratios (HRs) for all-cause mortality, cardiovascular mortality, incident myocardial infarction, and incident ischemic stroke comparing participants with COC index below the median to those above the median were HR = 1.12 (95% CI, 1.04-1.21), 1.30 (1.13-1.50), 1.57 (1.28-1.95), and 1.44 (1.27-1.63), respectively. Similar findings were obtained for other indices of continuity of care. Lower continuity of care was also associated with increased inpatient and outpatient days and costs.CONCLUSIONS Lower indices of continuity of care in patients with newly diagnosed hypertension, diabetes, and hypercholesterolemia were associated with higher all-cause and cardiovascular mortality, cardiovascular events, and health care costs. Health care systems should be designed to support long-term trusting relationships between patients and physicians.

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Section: Data Sources and Measuresmentioning

confidence: 99%

Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

Shin

Cho

Yang

et al. 2014

The Annals of Family Medicine

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“…Fortunately, empirical studies have shown that, at an organisational level, these different measures tend to give results that are highly correlated. 29,30 However, they do have different mathematical properties that can be important in some situations. In particular, continuity scores using some measures will tend to be inversely related to consultation rate, while other measures make adjustment for utilisation level.…”

Section: Which Measure?mentioning

confidence: 99%

“…In particular, continuity scores using some measures will tend to be inversely related to consultation rate, while other measures make adjustment for utilisation level. 29,30 How should data be collected?…”

Section: Which Measure?mentioning

confidence: 99%

How should continuity of care in primary health care be assessed?

Salisbury¹,

Sampson²,

Ridd³

et al. 2009

Br J Gen Pract

117

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“…One was the Most Frequent Provider Continuity Index (MFPC), which required first identifying the segment with the highest frequency of visits during the year, then calculating the fraction of total visits to that particular segment [35,36]. The higher the fraction, the more concentrated visits are to the dominant segment.…”

Section: Methodsmentioning

confidence: 99%

Measuring fragmentation of ambulatory care in a tripartite healthcare system

Liu

Yeung

2013

BMC Health Serv Res

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BackgroundHong Kong has a tripartite healthcare system, where western medicine provided in both public and private sectors coexist with Chinese medicine practice. The purpose of this study is to measure fragmentation of ambulatory care experienced by the non-institutionalized population aged 15 and over in such a tripartite system, thus shed light on the ongoing primary care reform.MethodsThis is a cross-sectional secondary data analysis using the Thematic Household Survey, which was conducted by the Hong Kong Census and Statistics Department during November 2009 to February 2010 to collect territory-wide health-related information. Among 18,226 individuals with two or more ambulatory visits during the past 12 months before interview, we grouped each visit into one of the three care segments—public western, private western and Chinese medicine. Two individual-level measures were used to quantify longitudinal fragmentation of care across segments over the one-year period: Most Frequent Provider Continuity Index (MFPC) and Fragmentation of Care Index (FCI). Both are analyzed for distribution and subgroup comparison. A Tobit model was used to further examine the determinants of fragmentation.ResultsMore than a quarter of individuals sought care in two or all three segments, with an average MFPC of 65% and FCI of 0.528. Being older, female, married, unemployed, uninsured, or born in mainland China, with lower education, lower income, higher number of chronic conditions or poorer health were found to have experienced higher fragmentation of care. We also found that, fragmentation of care increased with the total number of ambulatory care visits and it varied significantly depending on what segment the individual chose to visit most frequently—those chose private western clinics had lower FCI, compared with those chose public western or Chinese medicine as the most frequently visited segment.ConclusionsEven measured at healthcare segment level, people in Hong Kong experienced modest fragmentation of care. Individuals’ health beliefs—as a result of the persistent habitual tendency and latitude incentivized by the system—may be behind the fragmented care we saw. Efforts are needed to alter health beliefs, targeting subgroups of vulnerable population, and create environments that promote better coordinated primary care.

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Evaluation and application of continuity measures in primary care settings

Cited by 20 publications

References 6 publications

Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

How should continuity of care in primary health care be assessed?

Measuring fragmentation of ambulatory care in a tripartite healthcare system

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