Spooner S A
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110.
Proc Annu Symp Comput Appl Med Care. 1994:716-21.
Previously described quantitative methods for measuring continuity of care have assumed that perfect continuity exists when a patient sees only one provider, regardless of the temporal pattern and clinical context of the visits. This paper describes an implementation of a new operational model of continuity--the Temporal Continuity Index--that takes into account time intervals between well visits in a pediatric residency continuity clinic. Ideal continuity in this model is achieved when intervals between visits are appropriate based on the age of the patient and clinical context of the encounters. The fundamental concept in this model is the expectation interval, which contains the length of the maximum ideal follow-up interval for a visit and the maximum follow-up interval. This paper describes an initial implementation of the TCI model and compares TCI calculations to previous quantitative methods and proposes its use as part of the assessment of resident education in outpatient settings.
先前描述的用于衡量医疗连续性的定量方法假定，当患者只看一位医生时，就存在完美的连续性，而不考虑就诊的时间模式和临床背景。本文描述了一种新的连续性操作模型——时间连续性指数（Temporal Continuity Index）的实施情况，该模型考虑了儿科住院医师连续性诊所中健康检查之间的时间间隔。在该模型中，当就诊间隔基于患者年龄和就诊的临床背景合适时，就能实现理想的连续性。此模型的基本概念是期望间隔，它包含一次就诊的最大理想随访间隔长度和最大随访间隔。本文描述了TCI模型的初步实施情况，并将TCI计算结果与先前的定量方法进行比较，还提议将其用作门诊环境中住院医师教育评估的一部分。
