Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, The Netherlands.
PLoS One. 2012;7(7):e42256. doi: 10.1371/journal.pone.0042256. Epub 2012 Jul 31.
Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties.
We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including 'continuity of care', 'coordination of care', 'integration of care', 'patient centered care', 'case management' and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist.
We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties.
Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta Continuity of Services Scale-Mental Health, Heart Continuity of Care Questionnaire, and Nijmegen Continuity Questionnaire.
医患连续性照护被广泛认为是家庭医学的核心价值之一。在本次系统综述中，我们旨在确定用于测量连续性照护的工具，并评估其测量属性的质量。
我们使用 PubMed、Embase 和 PsycINFO 数据库进行了系统综述，采用了广泛的搜索策略，包括“连续性照护”、“照护协调”、“照护整合”、“以患者为中心的照护”、“病例管理”及其语言变体。我们的检索时间从 1995 年至 2011 年 10 月，并纳入了描述工具的开发和/或评估其测量属性的文章，这些工具用于测量连续性照护的一个或多个维度：（1）来自了解并随访患者的同一提供者的照护（个人连续性）；（2）同一照护环境中照护提供者之间的沟通和协作（团队连续性）；（3）不同照护环境中照护提供者之间的沟通和协作（跨边界连续性）。我们使用 COSMIN 清单评估了每个工具的测量属性的方法学质量。
我们纳入了 24 篇描述 21 个工具的开发和/或评估的文章。有 10 个工具测量了连续性照护的所有三个维度。这些工具是为不同的患者或提供者群体开发的。对于大多数工具，评估了六个测量属性中的三到四个（主要是内部一致性、内容有效性、结构有效性和构念有效性）。有六个工具在至少三个测量属性的质量上得分为阳性。
大多数纳入的工具在评估的测量属性的数量或质量方面，或在测量连续性照护的所有三个维度方面都存在问题。基于本次综述的结果，我们建议根据目标人群，使用以下四个最有前途的工具之一：糖尿病连续性照护问卷、艾伯塔连续性服务量表-心理健康、心脏连续性照护问卷和奈梅亨连续性问卷。
