title: The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist.
abstract: OBJECTIVE
  Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care.
  
  
  METHODS
  We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level.
  
  
  RESULTS
  Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies.
  
  
  CONCLUSIONS
  Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Conry
authors.forename: Karen B
authors.initials: KB
authors.lastname: Mitchell
authors.forename: Annie
authors.initials: A
authors.lastname: Ericson
authors.forename: W Perry
authors.initials: WP
authors.lastname: Dickinson
authors.forename: James C
authors.initials: JC
authors.lastname: Martin
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Carek
authors.forename: Alan B
authors.initials: AB
authors.lastname: Douglass
authors.forename: M Patrice
authors.initials: MP
authors.lastname: Eiff
mesh_terms: D001071:Appointments and Schedules; D002983:Clinical Competence; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D005194:Family Practice / Q000193:education* / Q000458:organization & administration; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D007407:Interviews as Topic; D010348:Patient Care Team / Q000458:organization & administration; D010817:Physician-Patient Relations; D019984:Quality Indicators, Health Care