Do claims-based continuity of care measures reflect the patient perspective?

Med Care Res Rev. 2014 Apr;71(2):156-73. doi: 10.1177/1077558713505909. Epub 2013 Oct 24.


Continuity of care (CoC) is a cornerstone of the patient-centered medical home (PCMH) and one of the primary means for achieving health care quality. Despite decades of study, however, CoC remains difficult to define and quantify. To incorporate patient experiences into health reform evaluations, it is critical to determine if and how well CoC measures traditionally derived from administrative claims capture patient experiences. In this study, we used claims data and self-reported continuity experiences of 2,620 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire to compare 16 claims-based CoC indices to a multidimensional patient-reported CoC measure. Our results show that most claims-based CoC measures do not reflect older adults' perceptions of continuous patient-provider relationships, indicating that claims-based assessments should be used in tandem with patient reports for defining, quantifying, and evaluating CoC in health care delivery models.

Keywords: continuity of care; older adults; patient reports.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Continuity of Patient Care* / standards
  • Female
  • Humans
  • Insurance Claim Reporting* / statistics & numerical data
  • Male
  • Medicare
  • Physician-Patient Relations
  • Professional-Patient Relations
  • Surveys and Questionnaires
  • United States