title: Association between Continuity of Care and Health-Related Quality of Life.
abstract: BACKGROUND
  Patient-reported outcomes (PROs) are considered potential quality metrics for patients with multiple chronic medical conditions (MCC). Although continuity of care (COC) is an essential MCC care process, the association between common PROs and COC is unknown.
  
  
  METHODS
  We assessed baseline and two-year follow-up self-reported health status, physical, and emotional well-being, and COC in seniors with MCC. Using mixed effects models with repeated measures adjusting for age, gender, and morbidity, we assessed each outcome as a function of COC.
  
  
  RESULTS
  Of 2,078 seniors, 961 completed the initial survey and 806 completed follow-up. On a 0-100 scale, mean (sd) baseline self-reported health status, physical well-being, and emotional well-being were 48.7 (22.0), 36.4 (11.4), and 54.8 (9.0). On a 0 to 1 scale, mean baseline and 2-year COC were 0.24 (sd 0.22) and 0.22 (0.18). Follow-up self-reported health status, physical well-being, and emotional well-being were 48.8 (23.1), 36.5 (11.5), and 55.3 (8.8). In adjusted primary and secondary analyses using all available data, there were no associations between any outcomes and COC.
  
  
  CONCLUSIONS
  Given the measurement burden of quality assessment, negative associations between potential quality metrics and care processes are informative. Systematic assessment of PROs can inform patient-centered MCC care. However, PRO scores should be used with caution as quality measures.
authors.affiliation: From the Institute for Health Research, Kaiser Permanente Colorado, Denver (EAB, JLE, JAS, DBM, JFS, CZ); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (EAB); and the Department of Internal Medicine, University of Colorado School of Medicine, Aurora (JFS). elizabeth.bayliss@kp.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
authors.affiliation: From the Institute for Health Research, Kaiser Permanente Colorado, Denver (EAB, JLE, JAS, DBM, JFS, CZ); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (EAB); and the Department of Internal Medicine, University of Colorado School of Medicine, Aurora (JFS).
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ellis
authors.affiliation: From the Institute for Health Research, Kaiser Permanente Colorado, Denver (EAB, JLE, JAS, DBM, JFS, CZ); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (EAB); and the Department of Internal Medicine, University of Colorado School of Medicine, Aurora (JFS).
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Shoup
authors.affiliation: From the Institute for Health Research, Kaiser Permanente Colorado, Denver (EAB, JLE, JAS, DBM, JFS, CZ); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (EAB); and the Department of Internal Medicine, University of Colorado School of Medicine, Aurora (JFS).
authors.forename: Deanna B
authors.initials: DB
authors.lastname: McQuillan
authors.affiliation: From the Institute for Health Research, Kaiser Permanente Colorado, Denver (EAB, JLE, JAS, DBM, JFS, CZ); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (EAB); and the Department of Internal Medicine, University of Colorado School of Medicine, Aurora (JFS).
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.affiliation: From the Institute for Health Research, Kaiser Permanente Colorado, Denver (EAB, JLE, JAS, DBM, JFS, CZ); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (EAB); and the Department of Internal Medicine, University of Colorado School of Medicine, Aurora (JFS).
authors.forename: Chan
authors.initials: C
authors.lastname: Zeng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D000071066:Patient Reported Outcome Measures; D018802:Patient-Centered Care / Q000458:organization & administration*; D011446:Prospective Studies; D011788:Quality of Life; D057566:Self Report; D013689:Telephone
keywords: Chronic Disease; Comorbidity; Continuity of Care; Follow-up Studies; Health Status; Patient-Reported Outcome Measures; Quality of Health Care; Quality of Life; Self Report; Surveys and Questionnaires