Measures of Continuity of Care in Healthcare
The various measures of
Continuity of Care
April 2020
Measurement
Usual Provider of Care (UPC)
This index describes the proportion of visits to the patient’s regular care provider
out of all visits (excluding patients with <1 visit in the period).
It ranges from 0 (no visit to the regular care provider) to 1 (all visits made to the
regular care provider), when the regular care provider is known.
If the ‘Usual GP’ is not reflective of the regular care provider, UPC would need to
be calculated for the care provider the patient visited most frequently, therefore
the range will always start above 0.
Breslau N, Haug MR. Service delivery structure and continuity of care: a case study of a
pediatric practice in process of reorganization. J Health Soc Behav. 1976:339–352
.
To determine “regular” providers, and to calculate UPC
where no regular provider is defined
Usual Provider of Care (UPC)
AAAABBBC has a UPC of 0.50
The patient had 8 consultations (4 with A; 3
with B; 1 with C)
•
When we know A is the regular provider
e.g. their Usual GP the calculation is 4/8 =
0.50
•
When we don’t know who the regular
provider is, the calculation is:
(Maximum value from 4,3,1)/8 = 0.50
Which is…4/8 = 0.50
AAAAABBCCD has a UPC of 0.50 (5/10)
AABBAACAAB has a UPC of 0.60 (6/10)
AABCAABA has a UPC of 0.625 (5/8)
Worked example
Where we know who is the regular
provider:
Where we don’t know who is the
regular provider and have to
calculate the most frequent
provider:
Continuity of Care Index
This index weights both the frequency of visits to each care provider and the
dispersion (the extent to which values of a variable differ from a fixed value) of
visits between care providers (excluding patients with <1 visit in the period).
Index values range from 0 (each visit made to a different care provider) to 1 (all
visits made to a single care provider).
It rewards having fewer providers, which makes it a useful to measure of
continuity when working in teams.
Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care.
1977:347–349.
Continuity of Care Index
Worked example
AAAABBBC has a COCi of 0.32
The patient had 8 consultations (4 with A; 3 with B; 1 with C)
Calculation is: ((4
2
+3
2
+1
2
)-8)/(8×(8-1)) = 0.32
Which is… ((16+9+1)-8)/(8×7) = 0.32
Which is… (26-8)/56 = 0.32
Which is… 18/56 = 0.32
AAAABBCC has a COCi of 0.29
The patient had 8 consultations (4 with A; 2 with B; 2 with C)
Calculation is: ((4
2
+2
2
+2
2
)-8)/(8×(8-1)) = 0.29
Which is… ((16+4+4)-8)/(8×7) = 0.29
Which is… (24-8)/56 = 0.29
Which is… 16/56 = 0.29
N.B. Both have the same UPC (0.50).
Can be broken down to…
St Leonard’s Index of Continuity of
Care
Sidaway-Lee K, Pereira Gray D and Evans P. A method for measuring of continuity of care in day-
to-day general practice: a quantitative analysis of appointment data. British Journal of General
Practice 2019; 69 (682): e356-e362 [Available from https://doi.org/10.3399/bjgp19X701813]
This index is designed to be a simple measure and can be undertaken by practices
themselves for comparison within practice.
It uses individual doctor’s registered lists, applicable for short periods of time and
includes patients with 1 appointment in that period unlike UPC or CoCi. However,
it is based on a known/named/allocated GP/GP personal list.
It can be used to compare groups of patients e.g. doctors list, whole practice, age
groups and deprivation.
U = Number of patients appointments (for a set group of patients) that are
with their named/usual GP
N= Total number of patient appointments (for the same set group of patients)
U/N*100 = %
St Leonard’s Index of Continuity of
Care (SLICC)
U = Number of
patients
appointments
(for a set group
of patients) that
are with their
named/usual GP
N= Total
number of
patient
appointments
(for the same
set group of
patients)
U/N*100 = %
Worked example
All 10 patients usual GP = A
1.
AAAABBBC
2.
AA
3.
ABACC
4.
BCAABB
5.
ABA
6.
A
7.
C
8.
ABABA
9.
ACA
10.
AAB
20/37*100 = 54%
All 10 patients usual GP = B
1.
AAAABBBC
2.
AA
3.
ABACC
4.
BCAABB
5.
ABA
6.
A
7.
C
8.
ABABA
9.
ACA
10.
AAB
11/37*100 = 29.7%
This content discusses key measures of continuity of care in healthcare, including the Usual Provider of Care (UPC) index and the Continuity of Care index. The UPC index calculates the proportion of visits to a patient's regular care provider, while the Continuity of Care index considers both visit frequency and provider dispersion. Worked examples and formulas are provided for better understanding. These measures play a crucial role in assessing and improving the quality of patient care and are valuable tools for healthcare professionals.
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Presentation Transcript
Measurement The various measures of Continuity of Care April 2020
Usual Provider of Care (UPC) Breslau N, Haug MR. Service delivery structure and continuity of care: a case study of a pediatric practice in process of reorganization. J Health Soc Behav. 1976:339 352. This index describes the proportion of visits to the patient s regular care provider out of all visits (excluding patients with <1 visit in the period). It ranges from 0 (no visit to the regular care provider) to 1 (all visits made to the regular care provider), when the regular care provider is known. If the Usual GP is not reflective of the regular care provider, UPC would need to be calculated for the care provider the patient visited most frequently, therefore the range will always start above 0. To determine regular providers, and to calculate UPC where no regular provider is defined where ?? is the number of visits to a regular physician by patient i, and N is the total number of patient i s visits to a physician. where max(?1, ?2, ... ??) is the number of visits to the provider with whom the patient had the greatest number of visits, and N is the total number of visits by the patient to all providers during the same period. If the sequence of visits was AAAABBBC, then the UPC is 4/8 = 0.50.
Usual Provider of Care (UPC) Worked example Where we know who is the regular provider: AAAABBBC has a UPC of 0.50 The patient had 8 consultations (4 with A; 3 with B; 1 with C) When we know A is the regular provider e.g. their Usual GP the calculation is 4/8 = 0.50 When we don t know who the regular provider is, the calculation is: Where we don t know who is the regular provider and have to calculate the most frequent provider: KEY: ?? = number of visits to a regular physician by patient i (Maximum value from 4,3,1)/8 = 0.50 Which is 4/8 = 0.50 N = total number of patient i s visits to a physician. max(?1, ?2, ... ??) = the number of visits to the provider with whom the patient had the greatest number of visits AAAAABBCCD has a UPC of 0.50 (5/10) AABBAACAAB has a UPC of 0.60 (6/10) AABCAABA has a UPC of 0.625 (5/8)
Continuity of Care Index Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care. 1977:347 349. This index weights both the frequency of visits to each care provider and the dispersion (the extent to which values of a variable differ from a fixed value) of visits between care providers (excluding patients with <1 visit in the period). Index values range from 0 (each visit made to a different care provider) to 1 (all visits made to a single care provider). It rewards having fewer providers, which makes it a useful to measure of continuity when working in teams. k = the number of providers, ?? is the number of visits per provider i, N is the total number of visits to all providers in a given period. If the sequence of visits is AAAABBBC then the continuity of care is 0.32, while if the sequence of visits is AAAABBCC, the continuity of care is 0.29, although both have the same UPC (0.50).
Continuity of Care Index Worked example AAAABBBC has a COCi of 0.32 The patient had 8 consultations (4 with A; 3 with B; 1 with C) Calculation is: ((42+32+12)-8)/(8 (8-1)) = 0.32 Can be broken down to Which is ((16+9+1)-8)/(8 7) = 0.32 Which is (26-8)/56 = 0.32 KEY: Which is 18/56 = 0.32 N = total number of visits AAAABBCC has a COCi of 0.29 ??= the number of visits to the 'i'th provider, where i = 1,2, ... M The patient had 8 consultations (4 with A; 2 with B; 2 with C) Calculation is: ((42+22+22)-8)/(8 (8-1)) = 0.29 Which is ((16+4+4)-8)/(8 7) = 0.29 Which is (24-8)/56 = 0.29 M = the number of potentially available providers Which is 16/56 = 0.29 N.B. Both have the same UPC (0.50).
St Leonards Index of Continuity of Care Sidaway-Lee K, Pereira Gray D and Evans P. A method for measuring of continuity of care in day- to-day general practice: a quantitative analysis of appointment data. British Journal of General Practice 2019; 69 (682): e356-e362 [Available from https://doi.org/10.3399/bjgp19X701813] This index is designed to be a simple measure and can be undertaken by practices themselves for comparison within practice. It uses individual doctor s registered lists, applicable for short periods of time and includes patients with 1 appointment in that period unlike UPC or CoCi. However, it is based on a known/named/allocated GP/GP personal list. It can be used to compare groups of patients e.g. doctors list, whole practice, age groups and deprivation. U/N*100 = % U = Number of patients appointments (for a set group of patients) that are with their named/usual GP N= Total number of patient appointments (for the same set group of patients)
St Leonards Index of Continuity of Care (SLICC) Worked example U/N*100 = % All 10 patients usual GP = A All 10 patients usual GP = B U = Number of patients appointments (for a set group of patients) that are with their named/usual GP 1. AAAABBBC 1. AAAABBBC 2. AA 2. AA 3. ABACC 3. ABACC 4. BCAABB 4. BCAABB 5. ABA 5. ABA N= Total number of patient appointments (for the same set group of patients) 6. A 6. A 7. C 7. C 8. ABABA 8. ABABA 9. ACA 9. ACA 10. AAB 10. AAB 20/37*100 = 54% 11/37*100 = 29.7%
