Validation of 2 new measures of continuity of care based on year-to-year follow-up with known providers of health care.
OBJECTIVE
In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KPC-PP).


METHODS
Patients with diabetes or cardiovascular disease (N = 765) were approached in the waiting rooms of 28 primary care clinics in 3 regions of the province of Quebec, Canada; answered a survey questionnaire measuring relational continuity, interpersonal communication, coordination within the clinic, coordination with specialists, and overall coordination; and gave permission for their medical records to be reviewed and their medical services utilization data for the previous 2 years to be accessed to measure KPC. Using generalized linear mixed models, we assessed the association between KPC and the patients' responses.


RESULTS
Among the 5 different patient-reported measures or their combination, KPC-MP was significantly related with overall coordination of care: for high continuity, the odds ratio (OR) = 2.02 (95% CI, 1.33-3.07), and for moderate continuity, OR = 1.61 (95% CI, 1.06-2.46). KPC-MP was also related with the combined continuity score: for high continuity, OR = 1.52 (95% CI, 1.11-2.09), and for moderate continuity, OR = 1.48 (95% CI, 1.10-2.00). KPC-PP was not significantly associated with any of the survey measures.


CONCLUSIONS
The KPC-MP measure, based on readily available administrative data, is associated with patient-perceived overall coordination of care among multiple physicians. KPC measures are potentially a valuable and low-cost way to follow the effects of changes favoring group practice on continuity of care for entire populations. They are easy to replicate over time and across jurisdictions.
Population Health and Health Services Team of the Montreal Health and Social Services Agency, Public Health Department, and the Quebec National Public Health Institute, Department of Health Systems Analysis and Evaluation, Montreal, Quebec The Department of Epidemiology, Biostatistics and Occupational Health, McGill University Montreal, Quebec ptousi@santepub-mtl.qc.ca.
Pierre
P
Tousignant
Population Health and Health Services Team of the Montreal Health and Social Services Agency, Public Health Department, and the Quebec National Public Health Institute, Department of Health Systems Analysis and Evaluation, Montreal, Quebec.
Mamadou
M
Diop
Montreal Health and Social Services Agency, Public Health Department.
Michel
M
Fournier
Population Health and Health Services Team of the Montreal Health and Social Services Agency, Public Health Department, and the Quebec National Public Health Institute, Department of Health Systems Analysis and Evaluation, Montreal, Quebec.
Yves
Y
Roy
Department of Family Medicine, McGill University, Montreal, Quebec.
Jeannie
J
Haggerty
Department of Family Medicine, University of Ottawa, Ottawa, Ontario.
William
W
Hogg
Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Quebec.
Marie-Dominique
MD
Beaulieu
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000628:therapy; D003142:Communication; D003266:Continuity of Patient Care; D019091:Critical Pathways; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010348:Patient Care Team; D010817:Physician-Patient Relations; D010820:Physicians / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D011792:Quebec; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
continuity of patient care; group practice; patient care team; primary health care