title: Evaluation of a patient-reported continuity of care model for older adults.
abstract: OBJECTIVE
  Although continuity of care (CoC) is a cornerstone of many health policies, there is no theoretically driven model of CoC that incorporates the experiences of older adults. We evaluated such a model in data collected for another purpose.
  
  
  METHODS
  We used data on 2,620 Medicare beneficiaries who completed all of the necessary components of the 2004 National Health and Health Services Use Questionnaire (NHHSUQ). The NHHSUQ solicited information on usual primary provider, place of care, and the quality and duration of the patient-provider relationship. We used confirmatory factor analysis to evaluate the patient-reported CoC model and examined factorial invariance across sex, race/ethnicity, Medicare plan type, and perceived health status.
  
  
  RESULTS
  Our thirteen-item CoC model consisted of longitudinal (care site and provider duration) and interpersonal (instrumental and affective) domains. Although the overall chi-square goodness-of-fit statistic was significant (χ(2) = 1,091.8, df = 57, p < .001), model fit was good based on standard indices (GFI = 0.94, NFI = 0.96, CFI = 0.96, RMSEA = 0.08). Cronbach's alpha for the longitudinal care site (two items) and provider duration (three items) scales was 0.88 and 0.75, respectively, while the instrumental and affective relationship scales (four items each) were 0.88 and 0.87, respectively. Factorial invariance between sexes was observed, with relatively minor variance across race/ethnicity, Medicare plan type, and perceived health.
  
  
  CONCLUSIONS
  We evaluated a theoretically derived model of CoC in older adults and found that the assessment of CoC should include the patient experience of both the longitudinal and the interpersonal dimensions of CoC.
authors.affiliation: Department of Health Management and Policy, College of Public Health, The University of Iowa, 105 North River Street, N207-CPHB, Iowa City, IA, 52246, USA, suzanne-bentler@uiowa.edu.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Bentler
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000592:standards*; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006299:Health Services for the Aged / Q000592:standards; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009735:Nursing Homes; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data