Measuring continuity in primary care: how it is done and why it matters

Area of Science:

• Primary Care Research
• Health Services Research
• Quality Improvement

Background:

• Continuity of care (COC) is a cornerstone of primary care, linked to better patient outcomes, satisfaction, and reduced healthcare costs.
• The patient-physician relationship is highly valued, yet in some settings like residency clinics, patients may see their primary care provider (PCP) less than 50% of the time.
• Numerous benefits of COC for both patients and providers highlight the need for standardized measurement.

Purpose of the Study:

• To address the need for understanding and comparing different measures of continuity of care (COC).
• To guide primary care professionals in selecting the most appropriate COC measure for quality improvement efforts.
• To explore the variations and key distinguishing factors among the at least 32 different COC measures.

Main Methods:

• Review and analysis of existing continuity of care (COC) measurement methodologies.
• Identification of key factors influencing COC measure variations, including data sources (claims, EMRs), purpose (research vs. clinical), perspective (patient vs. provider), and visit characteristics.
• Examination of how PCP identifiability impacts COC measurement formulas.

Main Results:

• At least 32 distinct measures have been employed to assess continuity of care (COC).
• Variations in COC measurement stem from data source limitations, intended use, patient/provider perspectives, and visit patterns.
• Key differentiators among COC formulas include the data source used and the ability to identify a consistent primary care provider (PCP).

Conclusions:

• There is no single "correct" formula for measuring continuity of care (COC).
• A nuanced understanding of COC measurement is crucial for advancing primary care research and clinical quality improvement.
• While imperfect, COC formulas and indices offer a valuable metric for assessing patient-provider interaction consistency.