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Although continuity of care (CoC) is a cornerstone of many health policies, there is no theoretically driven model of CoC that incorporates the experiences of older adults. We evaluated such a model in data collected for another purpose.
We used data on 2,620 Medicare beneficiaries who completed all of the necessary components of the 2004 National Health and Health Services Use Questionnaire (NHHSUQ). The NHHSUQ solicited information on usual primary provider, place of care, and the quality and duration of the patient–provider relationship. We used confirmatory factor analysis to evaluate the patient-reported CoC model and examined factorial invariance across sex, race/ethnicity, Medicare plan type, and perceived health status.
Our thirteen-item CoC model consisted of longitudinal (care site and provider duration) and interpersonal (instrumental and affective) domains. Although the overall chi-square goodness-of-fit statistic was significant (χ 2 = 1,091.8, df = 57, p < .001), model fit was good based on standard indices (GFI = 0.94, NFI = 0.96, CFI = 0.96, RMSEA = 0.08). Cronbach’s alpha for the longitudinal care site (two items) and provider duration (three items) scales was 0.88 and 0.75, respectively, while the instrumental and affective relationship scales (four items each) were 0.88 and 0.87, respectively. Factorial invariance between sexes was observed, with relatively minor variance across race/ethnicity, Medicare plan type, and perceived health.
We evaluated a theoretically derived model of CoC in older adults and found that the assessment of CoC should include the patient experience of both the longitudinal and the interpersonal dimensions of CoC.
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Institute of Medicine (IOM). (1996). Primary care: America’s health in a new era. Washington, DC: National Academy of Sciences.
Institute of Medicine (IOM). (2003). Priority areas for national action: Transforming health care quality. Washington, DC: National Academy of Sciences.
Ginsburg, P. B., Maxfield, M., O’Malley, A. S., Peikes, D., & Pham, H. H. (2008). Making medical homes work: Moving from concept to practice. In Policy perspective No. 1, December 2008. Washington, DC: Mathematica Policy Research, Inc.
AAFP, AAP, ACP, & AOA. (February 2007). Joint principles of the patient centered medical home. Available at the patient-centered primary care collaborative. http://pcpcc.net/content/joint-principles-patient-centered-medical-home. Accessed 15 Feb 2012.
O’Malley, A. S., Peikes, D., & Ginsburg, P. B. (2008). Qualifying practices as medical homes. In Policy perspective No. 1, December 2008. Washington, DC: Mathematica Policy Research, Inc.
Stanek, M., & Takach, M. (2010). Evaluating the patient-centered medical home: Potential and limitations of claims-based data. Portland, ME: National Academy for State Health Policy.
Scholle, S. H., Torda, P., Peikes, D., Han, E., & Genevro, J. (June 2010). Engaging patients and families in the medical home. Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2. AHRQ Publication No. 10-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality.
National Partnership for Women and Families. (2009). Principles for patient- and family-centered care: the medical home from the consumer perspective. Available at http://www.nationalpartnership.org/site/DocServer/Advocate_Toolkit-Consumer_Principles_3-30-09.pdf?docID=4821. Accessed 31 March 2012.
National Committee for Quality Assurance. (2010a). PCMH 2011 public comment—Optional module: Recognition in patient experiences. Available at http://www.ncqa.org/portals/0/publiccomment/pcmh_publi_%20comment_patient_exp_527FINAL.pdf. Accessed 31 March 2012.
Saultz, J. W. (2003). Defining and measuring interpersonal continuity of care. The Annals of Family Medicine, 1(3), 134–143. CrossRef
Anderson, G. (2010). Chronic care: Making the case for ongoing care (p. 12). Princeton, NJ: Robert Wood Johnson Foundation.
Wei, I. I., Virnig, B. A., John, D. A., & Morgan, R. O. (2006). Using a Spanish surname match to improve identification of Hispanic women in Medicare administrative data. Health Services Research, 41(4), 1469–1481. PubMed
Morgan, R. O., Teal, C. R., Hasche, J. C., Petersen, L. A., Byrne, M. M., Paterniti, D. A., et al. (2008). Does poorer familiarity with Medicare translate into worse access to health care? JAGS, 56, 2053–2060. CrossRef
Arbuckle, J. L. (2011). Amos (Version 20.0) [computer program]. Chicago: SPSS.
Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588–606. CrossRef
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. CrossRef
Byrne, B. M. (2001). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Mahway, NF: Lawrence Erlbaum Associates.
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334. CrossRef
Ware, J. E., Kosinski, M., Dewey, J. E., & Gandek, B. (2001). How to score and interpret the single-item health status measures: A manual for users of the SF-8 Health Survey. Lincoln, RI: QualityMetric Incorporated.
Keith, T. Z. (1997). Using confirmatory factor analysis to aid in understanding the constructs measured by intelligence tests. In D. P. Flanagan, J. L. Genshaft, & P. L. Harrison (Eds.), Contemporary intellectual assessment: Theories, tests, and issues (pp. 373–402). New York: Guilford Press.
Robles, J. (1995). Confirmation bias in structural equation modeling. Structural Equation Modeling, 3, 73–83. CrossRef
Millsap, R. E. (2011). Statistical approaches to measurement invariance. New York: Routledge.
Reid, R. J., Haggerty, J. L., & McKendry, R. (2002). Defusing the confusion: Concepts and measures of continuity of healthcare. Ottawa, ON: Canadian Health Services Research Foundation.
Ridd, M. J., Lewis, G., Peters, T. J., & Salisbury, C. (2011). Patient–Doctor depth-of-relationship scale: Development and validation. The Annals of Family Medicine, 9(6), 538–545. CrossRef
Doescher, M. P., Saver, B. G., Fiscella, K., & Franks, P. (2001). Racial/ethnic inequities in continuity and site of care: Location, location, location. HSR. Health Services Research, 36(6), 78–89.
Flocke, S. A., Stange, K. C., & Zyzanski, S. J. (1997). The impact of insurance type and forced discontinuity on the delivery of primary care. Journal of Family Practice, 45(2), 129–135. PubMed
Cabana, M. D., & Jee, S. H. (2004). Does continuity of care improve patient outcomes? Journal of Family Practice, 53(12), 974–980. PubMed
Nutting, P. A., Goodwin, M. A., Flocke, S. A., Zyzanski, S. J., & Stange, K. C. (2003). Continuity of primary care: To whom does it matter and when? The Annals of Family Medicine, 1, 149–155. CrossRef
Agency for Healthcare Research and Quality. Expanded 12-month survey with CAHPS patient-centered medical home (PCMH) items. Available at https://www.cahps.ahrq.gov/Surveys-Guidance/CG/PCMH.aspx. Accessed 2 April 2012.
U.S. Dept. of Health and Human Services, Health Care Financing Administration. Medicare Current Beneficiary Survey, Access to Care: [United States]. 2nd ICPSR release. Baltimore, MD: U.S. Dept. of Health and Human Services, Health Care Financing Administration [producer]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor].
Gulliford, M. C., Naithani, S., & Morgan, M. (2006). Measuring continuity of care in diabetes mellitus: An experience-based measure. The Annals of Family Medicine, 4, 548–555. CrossRef
- Evaluation of a patient-reported continuity of care model for older adults
Suzanne E. Bentler
Robert O. Morgan
Beth A. Virnig
Fredric D. Wolinsky
- Springer International Publishing