A population-based assessment of the continuity of ambulatory care

A strategy is described in which explicit patient care criteria are used to measure the continuity of the health problem solving process. Prevalent diseases are selected to represent the work load of the health system. Continuity is defined in terms of rates of transition between the major clinical elements: screening, the definitive diagnostic evaluation, treatment, and follow-up evaluation. Results define critical dropout patterns and promote constructive assessment of the health care system. Sample data from the Indian Health Service are presented and discussed.