Abstract
BACKGROUND: Continuity for inpatient medicine has been widely discussed, but methods for measuring it have been lacking. OBJECTIVE: To measure the continuity of care experienced by hospitalized patients and to identify predictors of continuity. METHODS: This was a multisite prospective cohort study and retrospective chart review that took place at 3 hospitals: an academic tertiary care center, a Veterans Affairs medical center, and a community teaching hospital. Subjects were general medicine patients and internal medicine residents. We measured continuity of care using 3 metrics: (1) the percentage of hospital time covered by the primary intern; (2) the amount of time between admission and the first handoff of care; and (3) admission-discharge continuity. We conducted univariate analyses to identify patient and hospital factors that may be associated with each type of continuity of care. RESULTS: Our sample included 869 patients with a mean age of 62.6 years (SD = 17.2) and 34% female patients. The mean percentage of hospital time covered by the primary intern was 39.2% (SD = 16.3%). The mean time between admission and the first handoff of care was 13.3 hours (SD = 7.1). Forty percent of patients experienced admission-discharge continuity. In univariate and multivariable modeling, the site was significantly associated with each type of continuity. CONCLUSIONS: The amount of continuity varied greatly and was influenced by the site and other factors. No site maximized every aspect of continuity. Programs and institutions should decide which aspects of continuity are most important locally and design schedules accordingly.