Continuity of care and clinical outcome: a prospective cohort study.
BACKGROUND
Continuity of care is a central objective of community psychiatric services, but there is no consensus about its measurement.


OBJECTIVE
We developed measures of continuity of care suitable for routine use, and measured continuity and individual patient outcome over a period in which community services were developing.


METHODS
One hundred patients with severe mental illness receiving continuing care from two sectorised services were sampled and interviewed. Data were collected concerning their care over 20 months prior to interview. After 20 months prospective follow-up, they were re-interviewed. Continuity was defined as: perceived accessibility of services and knowledge about them, the number of keyworkers in a defined period of time, and the proportion of time out of contact with services.


RESULTS
Continuity of care improved significantly on all measures over the period of the study. Individual patient outcome also improved, but in multiple regression models including clinical and demographic variables, measures of continuity were not significant predictors of outcome. Continuity was similar for white and non-white patients.


CONCLUSIONS
Simple measures of continuity are useful in evaluating changes in the process of care, but they are not straightforwardly related to individual outcome.
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, De Crespigny Park, London, UK.
J
J
Bindman
S
S
Johnson
G
G
Szmukler
S
S
Wright
E
E
Kuipers
G
G
Thornicroft
P
P
Bebbington
M
M
Leese
D000328:Adult; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D015986:Confounding Factors, Epidemiologic; D003266:Continuity of Patient Care; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010346:Patient Care Management / Q000379:methods*; D010348:Patient Care Team / Q000706:statistics & numerical data; D011159:Population Surveillance; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom