Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Clin Epidemiol. 2010 Sep;63(9):1000-10. doi: 10.1016/j.jclinepi.2010.01.023.
Continuity 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.
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).
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.
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.
连续护理由提供者连续性和信息连续性组成，并且可以随时间改变其价值。大多数定量关联连续性护理和结果的研究都忽略了这些特征。本研究详细检查了从医院出院的患者的连续性护理，同时测量了随时间推移的连续性的单独组成部分，或确定了与它们相关的因素。
多中心、前瞻性队列研究，研究对象为择期或紧急住院后出院到社区的患者。对于出院后 6 个月内的所有医生就诊，我们确定了医生和特定信息的可用性（包括医院出院总结和之前医生就诊的任何信息）。为所有患者计算了四个医生连续性评分（入院前；医院入院时；医院顾问；和出院后）和两个信息连续性评分（出院总结和出院后就诊信息）（范围：0-1，其中 0 表示完全不连续，1 表示完全连续）。
4553 人随访中位数为 175 天。提供者（中位数范围：0-0.410）和信息（范围：0.220-0.427）连续性评分均较低，且随时间广泛变化。除了少数例外，连续性测量彼此独立。患者因素对连续性的影响在连续性测量之间差异很大，最有影响力的因素是入院紧急程度、入院科室和经常治疗患者的医生数量。
从医院出院的患者的提供者和信息连续性都较低。连续性测量在随时间广泛变化，通常彼此独立，并且与患者和入院特征相关。未来的研究应该随着时间的推移测量提供者和信息连续性的多个组成部分，以完全捕获连续性护理。
