Measuring Care Continuity: A Comparison of Claims-based Methods

Abstract

Background: Assessing care continuity is important in evaluating the impact of health care reform and changes to health care delivery. Multiple measures of care continuity have been developed for use with claims data.

Objective: This study examined whether alternative continuity measures provide distinct assessments of coordination within predefined episodes of care.

Research design and subjects: This was a retrospective cohort study using 2008-2009 claims files for a national 5% sample of beneficiaries with congestive heart failure, chronic obstructive pulmonary disease, and diabetes mellitus.

Measures: Correlations among 4 measures of care continuity-the Bice-Boxerman Continuity of Care Index, Herfindahl Index, usual provider of care, and Sequential Continuity of Care Index-were derived at the provider- and practice-levels.

Results: Across the 3 conditions, results on 4 claims-based care coordination measures were highly correlated at the provider-level (Pearson correlation coefficient r=0.87-0.98) and practice-level (r=0.75-0.98). Correlation of the results was also high for the same measures between the provider- and practice-levels (r=0.65-0.92).

Conclusions: Claims-based care continuity measures are all highly correlated with one another within episodes of care.

Appendix Figure 1

Distributions of Claims-Based Continuity Measures at the Provider Level

Appendix Figure 2

Distributions of Claims-Based Continuity Measures at the Practice Level

Appendix Figure 3

Correlation-matrices between continuity measures