Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure

Abstract

PURPOSE Continuity is an important attribute of health care, but appropriate measures are not currently available. We developed an experience-based measure of continuity of care in type 2 diabetes.METHODS A 19-item measure of experienced continuity of care for diabetes mellitus (ECC-DM) was developed from qualitative patient interview data with 4 continuity subdomains: longitudinal, fl exible, relational, and team and crossboundary continuity. The measure was implemented in a survey of 193 patients with type 2 diabetes from 19 family practices. Associations of ECC-DM scores with clinician organizational characteristics were estimated.RESULTS Potential ECC-DM scores ranged from 0 to 100 with an observed mean of 62.1 (SD 16.0). The average inter-item correlation was 0.343 and Cronbach's α was 0.908. Factor analysis found 4 factors that were generally consistent with the proposed subdomains. Patients' mean scores varied signifi cantly between practices (P = .001), ranging from 46 to 78 at different family practices. Experienced continuity was lower for patients receiving only hospital clinic care than for those receiving some diabetes care from their family practice (difference 13.7; 95% confi dence interval [CI], 8.2-19.2; P <.001). Patients had higher ECC-DM scores if their family practice had a designated lead doctor for diabetes (difference 8.2; 95% CI, 2.7-13.6; P = .003). CONCLUSIONSThe results provide evidence for the reliability, construct validity, and criterion validity of the experienced continuity-of-care measure. The measure may be used in research and monitoring to evaluate patient-centered outcomes of diabetes care. Patients' experiences of continuity of care vary between health care organizations and are infl uenced by the organizational arrangements for care.

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

“…Few researchers have attempted to do this. 3,22,23 However, others have argued that the importance of continuity stems partly from the sense of responsibility that it engenders in doctors. 18,24,25 This may be relevant even in situations when continuity is less important to individual patients, so it may be equally appropriate to assess whether doctors feel they are able to provide continuity.…”

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

“…Measures were needed of the patient's experience, especially of management continuity, and indeed, various measures were developed. Most, however, focus on a specifi c care context such as discharge from hospital, 5,6 or on single problems such as diabetes 7,8 heart disease, 9 or mental health. [10][11][12] Primary care requires a generic instrument, applicable to a broad range of health conditions (including multimorbidity) and patients in an ambulatory setting.…”

The Impact of Provider Continuity Care on Quality of Care of Patients With Type 2 Diabetes Mellitus in the Family Medicine Clinic Of UCTH, Calabar, Nigeria

“…These findings are supported by a study conducted by Elrayah et al [18] in an urban town in Sudan in 2005 on economic burden of families of adult type 2 diabetes mellitus. That study reported that the economic burden of managing type 2 diabetes mellitus accounts for about 65% of family's expenditure on health [19]. Consequently, type 2 diabetic patients with poor glycaemic control may belong to families with low monthly income.…”