Measuring continuity of care for clients of public mental health systems.
OBJECTIVE
The aims of this research were to generate a set of time-variant measures of continuity of outpatient care using administrative data, and to evaluate the validity of these measures for persons in the community with serious mental illness (SMI) who use public mental health services.


METHODS
Individuals with SMI were identified using multistage random sampling from shelters, streets, and public mental health clinics in Houston, Texas.


METHODS
The study design was observational, cross-sectional, and retrospective. Based on a review of the literature, five distinct conceptual dimensions of continuity of care were defined: timeliness, intensity, comprehensiveness, stability, and coordination. Repeated measures of continuity were generated for each day of the year. Construct validity was assessed by comparing continuity for housed persons and homeless persons based on the assumption that homelessness is a risk factor for low continuity of outpatient care.


METHODS
Subjects were interviewed to collect sociodemographic and clinical information. Service use was retrospectively tracked through the administrative records of multiple public sector agencies.


RESULTS
All five continuity measures demonstrated good construct validity by the fact that homelessness was significantly (p < 0.001) and substantially associated with lower continuity of care.


CONCLUSIONS
The five continuity-of-care measures are relatively easy and inexpensive to generate using administrative data. The five continuity-of-care measures may be useful for identifying individuals at risk for poor outcomes and for evaluating the ability of public service systems to keep clients engaged in care over time.
Fortney
John
J
Centers for Mental Healthcare Research, Little Rock, AR 72204, USA.
Sullivan
Greer
G
Williams
Keith
K
Jackson
Catherine
C
Morton
Sally C
SC
Koegel
Paul
P
D000328:Adult; D003155:Community Mental Health Centers / Q000458:organization & administration / Q000592:standards*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D019538:Health Care Surveys; D006302:Health Services Research; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011635:Public Health Administration / Q000592:standards*; D012189:Retrospective Studies; D013781:Texas