title: Measuring patient-perceived continuity of care for patients with long-term conditions in primary care.
abstract: BACKGROUND
  Continuity of care is widely acknowledged as important for patients with multi-morbidity but simple, service-orientated indices cannot capture the full impact of continuity in complex care delivery systems. The patient's perspective is important to assess outcomes fully and this is challenging because generic measures of patient-perceived continuity are lacking. We investigate the Chao Perception of Continuity (Chao PC) scale to determine its suitability as a measure of continuity of care for patients with a long-term condition (stroke), and co-morbidity, in a primary care setting.
  
  
  METHODS
  
  
  
  METHODS
  A questionnaire study embedded in a prospective observational cohort study of outcomes for patients following acute stroke.
  
  
  METHODS
  168 community dwelling patients (58% male) mean age 68 years a minimum one year post-stroke. Functional status: Barthel Index mean =16.
  
  
  METHODS
  A 23-item questionnaire, the Chao Perception of Continuity (Chao PC) scale, sent by post to their place of residence or administered face to face as part of the final cohort study assessment.
  
  
  RESULTS
  310 patients were invited to participate; 168 (54%) completed a questionnaire. All 23 questionnaire items were entered into a Principal Component Analysis. Emergent factors from the exploratory analysis were (1) inter-personal trust (relational continuity); (2) interpersonal knowledge and information (informational and relational continuity) and (3) the process of care (managerial continuity). The strongest of these was inter-personal trust.
  
  
  CONCLUSIONS
  The context-specific items in the Chao PC scale are difficult for respondents to interpret in a United Kingdom Primary Care setting resulting in missing data and low response rates. The Chao-PC therefore cannot be recommended for wider application as a general measure of continuity of care without significant modification. Our findings reflect the acknowledged dimensions of continuity and support the concept of continuity of care as a multi-dimensional construct. We demonstrate the overlapping boundaries across the dimensions in the factor structure derived. Trust and interpersonal knowledge are clearly identified as valuable components of any patient-perceived measure of continuity of care.
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK. k.m.hill@leeds.ac.uk.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Hill
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK. M.Twiddy@leeds.ac.uk.
authors.forename: Maureen
authors.initials: M
authors.lastname: Twiddy
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK. J.Hewison@leeds.ac.uk.
authors.forename: Jenny
authors.initials: J
authors.lastname: Hewison
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK. a.o.house@leeds.ac.uk.
authors.forename: Allan O
authors.initials: AO
authors.lastname: House
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002908:Chronic Disease; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D010817:Physician-Patient Relations; D011320:Primary Health Care; D025341:Principal Component Analysis; D011446:Prospective Studies; D020521:Stroke; D011795:Surveys and Questionnaires; D035502:Trust