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.
Highlights
Continuity of care is an important characteristic of good health care. [1,2,3,4] In the literature, continuity often refers to the extent by which care is provided by the same person
[6] Besides personal continuity, it includes the seamless provision of care by a group of professionals in the medical home, and continuity between different care settings, e.g. general practice and specialist care. [6,7,8] As more and more care providers are involved in individual patient care, the communication and cooperation aspects of care become increasingly important
Selection Criteria We included all articles describing the development and/or evaluation of the measurement properties of an instrument measuring - what we will define in this review as - continuity of care [6,7,8]: (1) care from the same provider who knows and follows the patient, (2) communication and cooperation between care providers in one care setting, and (3) communication and cooperation between care providers in different care settings
Summary
Continuity of care is an important characteristic of good health care. [1,2,3,4] In the literature, continuity often refers to the extent by which care is provided by the same person (personal continuity). From the 1990’s on, continuity of care is increasingly seen as a multidimensional concept. Measuring continuity of care in its multidimensional meaning requires a robust and solid measurement instrument. As we found that other concepts like coordination and integration of care show great overlap with continuity of care [6], the limited continuity scope seems too narrow for a complete overview of instruments. Existing reviews have not systematically appraised the measurement properties of the instruments found. We performed a systematic review to identify the instruments measuring continuity of care, to assess the dimensions of continuity in those instruments, and to evaluate their measurement properties. We aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties
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