Measuring continuity of care for clients of public mental health systems.

OBJECTIVES The aims of this research were to generate a set of time-variant measures of continuity of outpatient care using administrative data, and to evaluate the validity of these measures for persons in the community with serious mental illness (SMI) who use public mental health services. DATA SOURCES Individuals with SMI were identified using multistage random sampling from shelters, streets, and public mental health clinics in Houston, Texas. STUDY DESIGN The study design was observational, cross-sectional, and retrospective. Based on a review of the literature, five distinct conceptual dimensions of continuity of care were defined: timeliness, intensity, comprehensiveness, stability, and coordination. Repeated measures of continuity were generated for each day of the year. Construct validity was assessed by comparing continuity for housed persons and homeless persons based on the assumption that homelessness is a risk factor for low continuity of outpatient care. DATA COLLECTION Subjects were interviewed to collect sociodemographic and clinical information. Service use was retrospectively tracked through the administrative records of multiple public sector agencies. PRINCIPAL FINDINGS All five continuity measures demonstrated good construct validity by the fact that homelessness was significantly (p < 0.001) and substantially associated with lower continuity of care. DISCUSSION The five continuity-of-care measures are relatively easy and inexpensive to generate using administrative data. The five continuity-of-care measures may be useful for identifying individuals at risk for poor outcomes and for evaluating the ability of public service systems to keep clients engaged in care over time.