Measurements of patient care continuity should encompass all of the components of health care delivery—structure, process, and outcome. “Structure” in health care delivery refers to the way a health care entity organizes itself and sets up operations. Health care structures include elements such as the physical plant, configuration of management structure, and organizational linkages with other providers. “Process” refers to specific interventions performed by health care professionals that result in an outcome. Some examples of processes related to continuity of care are transfer of information, patient assessment, and development of a discharge plan. “Outcome” refers to the results of patient interactions with health care professionals and services.

Structure measurements look at the capacity of practitioners and providers to furnish seamless health care services. Measurements of structure that relate to continuity of care generally focus on availability of services and the ability to communicate across the continuum. Below are some examples of structure measurements that can be useful for determining whether continuity of care problems exist within a health care organization:

• Length of time between requests for special services not provided within the organization and patient receipt of services
• Percent of transferring facilities with whom your organization has a formal transfer agreement
• Percent of staff that receive orientation and continuing education in continuity of care activities (e.g., initial assessment, screening for high-risk patients, discharge planning)
• Percent of non-English speaking patients for whom educational materials are available in their primary language

To begin identifying continuity of care structure measurements for your organization, ask yourself: What organizational structures support, or should support, continuity of care in my organization? Rank the structures you list and focus your continuity of care structure measures accordingly.

There are numerous processes and linkages throughout the continuum of care that affect the seamlessness of health services. Process measurements should focus on activities that are critical to ensuring continuity of care. For example, patients being discharged from the hospital to their homes need detailed instructions about follow-up care, and family members or other caregivers may need training to provide care. Process measurements could evaluate provision of patient instructions for follow-up care and provision of necessary training for family members. Here are some examples of the continuity of care questions your process measurements could help answer:

• How often does important information (e.g., the patient’s cognitive and physical function, medical and social status, resuscitation status, drugs, drug allergies, family support) accompany the patient when he or she is transferred from one care facility to another?
• What percent of patients are given adequate and complete follow-up instructions at the time of release from a setting or service?
• How often are patients contacted following an unexplained missed appointment for a clinic visit, diagnostic test, or elective hospital admission?
• What percent of patients with chronic conditions are contacted to remind them of the need for preventive or health maintenance examinations?
• How many patient records have a complete and up-to-date list of the patient’s current medications and allergies?
• What percent of inpatients have an adequate and timely assessment of their discharge needs?
• How often are terminally ill patients offered appropriate guidance about advance-care planning in the end-of-life experience?
• What percent of patients receive appropriate referrals to community support services?
• How often are parents encouraged to play a part in the care coordination for their child?
• What percent of patients with chronic conditions are assigned a case manager?
• How often does everyone providing care to a patient use the same treatment plan?
• How often does the nurse caring for a hospitalized patient talk with the nurse who will care for the patient after discharge?

To begin identifying processes that affect the continuity of care in your organization, ask yourself: What tasks must be performed properly and what linkages must work well to achieve continuity-of-care goals in my organization? Focus your continuity-of-care process measurements on these critical tasks and linkages.

Outcome measurements focus on the end result of health care processes. The patient, the environment, caregivers, and other factors can influence outcomes. Therefore, selecting outcome measurements that correlate directly with continuity-of-care tasks is difficult. It is most likely that the results of any outcome measurements you choose will be affected by many factors, not just continuity of care tasks. That’s why a family of structure, process, and outcome measures is needed to adequately evaluate the continuity-of-care function.

To select outcome measurements that can be used to evaluate the end result of continuity-of-care tasks in your organization, ask yourself: What can happen if we do not perform this task as expected? For example, what if discharge planning is not initiated in a timely manner during a patient’s hospitalization? What might happen? The end result or outcome might be an extended hospital stay—something you can measure and monitor to determine if you have timeliness problems with discharge planning activities. Identify what could go wrong and then measure how often this undesirable outcome happens in your organization.

Used by permission from Brown-Spath & Associates, copyright 2006. Visit www.brownspath.com.