Understanding and measuring continuity of care in stroke.

Abstract

Background: This study investigated care for patients following an acute stroke. The focus was on the patient’s experience, with particular reference to their impressions of the continuous and discontinuous aspects of care. The study aimed to explore the meaning of continuity of care for stroke patients, the feasibility of measuring patient-perceived continuity of care in stroke, and to examine its effect on outcomes. Methods: A mixed methods approach was used, starting with a systematic review of the literature and a qualitative exploration of patients’ experiences of care. A case note review was also conducted. An existing quantitative measure of patient-perceived continuity was applied in a sample of patients [N = 310]. Two new measures of continuity of care (one patient-centred and one record-based) were developed and tested in a further sample [N = 178]. Finally, a qualitative study examined the views that stroke care professionals held on communication and continuity of care. Results: Accepted models of continuity of care did not readily transfer to the type of care or the services received by stroke survivors. Patients could, either directly or indirectly, comment on the quality of the individual elements of care they had received, and rate their feelings of satisfaction or dissatisfaction with them. They could not distinguish the overall process of care. “Achieved care” and “perceived care” could be measured quantitatively by including components of the physical, psychological and cognitive status of the patient in addition to the two new indices. An association between the measures of care and outcomes was found. Patterns of care were identified that indicated that care networks exist in stroke services. The findings suggest that it is the connectedness of individuals within these networks rather than the longevity or predictability of individual relationships that delivers good care. Conclusions: Continuity of care is a professional concept focused on the provision of statutory services. Current ideas of continuity privilege factors such as relational continuity (seeing the same person) in primary care; managerial continuity in acute care and informational continuity in areas like mental health which emphasises care planning not consultant led care. In measurement from the patient’s perspective, continuity is intimately linked to related concepts such as quality of care and patient satisfaction