title: Validation of a generic measure of continuity of care: when patients encounter several clinicians.
abstract: OBJECTIVE
  Patients who regularly see more than one clinician for health problems risk discontinuity and fragmented care. Our objective was to develop and validate a generic measure of management continuity from the patient perspective.
  
  
  METHODS
  Themes from 33 qualitative studies of patient experience with care from various clinicians were matched to existing instruments to identify potential measures and measurement gaps. Adapted and new items were tested cognitively, and the instrument was administered to 376 adult patients consulting in primary care for a variety of health conditions but seeing clinicians in a variety of settings. After initial psychometric analysis, the instrument was modified slightly and readministered after 6 months. The analysis identified reliable subscales and their association with indicators of continuity.
  
  
  RESULTS
  Observed factors correspond to 8 intended constructs, with good reliability. Three subscales (12 items) relate to the principal clinician and cover management and relational continuity. Four subscales (13 items) are related to multiple clinicians and address team relational continuity and problems with coordination and gaps in information transfer. Two (11 items) pertain to the patient's partnership in care. Subscales correlate well and in expected directions with indicators of discontinuity (wanting to change clinicians, suffering, and sense of being abandoned, medical errors) and degree of care organization.
  
  
  CONCLUSIONS
  The instrument reliably assesses both positive and negative dimensions of continuity of care across the entire system, and the subscales correlate with continuity effects. It supports patient-centered and relationship-based care and can be used as a whole or in part to assess coordination and continuity in primary care.
authors.affiliation: Department of Family Medicine, McGill University, Canada. Jeannie.Haggerty@mcgill.ca
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Haggerty
authors.forename: Danièle
authors.initials: D
authors.lastname: Roberge
authors.forename: George K
authors.initials: GK
authors.lastname: Freeman
authors.forename: Christine
authors.initials: C
authors.lastname: Beaulieu
authors.forename: Mylaine
authors.initials: M
authors.lastname: Bréton
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000295:instrumentation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires