Measurement Properties of Questionnaires Measuring Continuity of Care: A Systematic Review

Abstract

BackgroundContinuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties.MethodsWe did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including ‘continuity of care’, ‘coordination of care’, ‘integration of care’, ‘patient centered care’, ‘case management’ and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist.ResultsWe included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties.ConclusionsMost included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta Continuity of Services Scale-Mental Health, Heart Continuity of Care Questionnaire, and Nijmegen Continuity Questionnaire.

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

“…Patient Reported Experience Measures proved to provide more information than patient satisfaction questionnaires by encouraging the users to describe their actual experience of the care received [11]. A review of the instruments measuring continuity of care showed that most available instruments on continuity of care from patients' perspective are designed to assess this construct in specific adult populations and settings, such as patients with diabetes, cancer, mental health problems, previously hospitalised patients, complex and chronic diseases, people being treated in primary care settings or patients in general regardless of morbidity or care setting [12]. To our knowledge, only one questionnaire has been developed to measure continuity of care in child population from the family's perspective, but it applies only to mental health care [13].…”

Alberta CancerBridges Development of a Care Plan Evaluation Measure

“…This is a reliable and valid short questionnaire developed in Canada that Manitoba investigators modified for use at the time of discharge to pcp follow-up 43 . Delivering more highly evaluated scps should improve survivors' continuity of care [44][45][46] .…”

Evaluating Continuity During Transfer to Adult Care: A Systematic Review

“…Interestingly, engagement and retention in adult care correspond to 2 key challenges of transfer: ensuring continuity between pediatric and adult care, a type of "crossboundary continuity, " 42 and build a new patient-provider relationship (ie, initiate a new "relational continuity"). 43,44 Some authors have also considered informational continuity, corresponding to the availability of information about medical history to ensure appropriate care.…”

“…42 Their relevance to the transfer to adult care and their validity in youths with chronic diseases should be evaluated. Also, several authors suggested developing subjective measures of continuity.…”

“…Also, several authors suggested developing subjective measures of continuity. 42,43 There were few data available to evaluate the difference in continuity of care outcomes between structured and unstructured programs. Two studies found a shorter transfer time 26,34 and better attendance in adult care 34 for patients involved in a structured transition program than those with no structured transition.…”