- 作者：Carl van Walraven ; Monica Taljaard ; Chaim M. Bell ; Edward Etchells ; Ian G. Stiell ; Kelly Zarnke ; Alan J. Forster
- 刊名：Journal of Clinical Epidemiology
- 出版年：2010
- 出版时间：September 2010
- 年：2010
- 卷：63
- 期：9
- 页码：1000-1010
- 全文大小：950 K
ObjectiveContinuity of care is composed of provider and information continuity and can change value over time. Most studies that have quantitatively associated continuity of care and outcomes have ignored these characteristics. This study is a detailed examination of continuity of care in patients discharged from hospital that simultaneously measured separate components of continuity over time or determined the factors with which they are associated.Design Setting
Multicenter, prospective cohort study of patients discharged to the community after elective or emergent hospitalization. For all physician visits during 6 months after discharge, we identified the physician and the availability of particular information (including hospital discharge summary and any information from previous physician visits). Four physician continuity scores (preadmission; hospital admitting; hospital consultant; and postdischarge) and two information continuity scores (discharge summary and postdischarge visit information) were calculated for all patients (range: 0–1, where 0 is perfect discontinuity and 1 is perfect continuity).
Results
Four thousand five hundred fifty-three people were followed for a median of 175 days. Both provider (range of median values: 0–0.410) and information (range: 0.220–0.427) continuity scores were low and varied extensively over time. With a few exceptions, continuity measures were independent of each other. The influence of patient factors on continuity varied extensively between the continuity measures with the most influential factors being admission urgency, admitting service, and the number of physicians who regularly treated the patient.
Conclusion
Both provider and information continuity was low in patients discharged from hospital. Continuity measures can change extensively over time, which are usually independent of each other, and are associated with patient and admission characteristics. Future studies should measure multiple components of provider and information continuity over time to completely capture continuity of care.