Measuring Continuity of Care for Clients of Public Mental Health Systems

Authors

  • John Fortney,

    1. Address correspondence to John Fortney, Ph.D., Centers for Mental Healthcare Research, 5800 W. 10th Street, Suite 605, Little Rock, AR 72204.
    2. John Fortney, Ph.D., and Greer Sullivan, M.D., M.P.H., are with the VA HSR&D Center for Mental Health Services and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR; and the VA Mental Illness Research Education and Clinical Center, South Central VA Healthcare Network; NIMH Center for Mental Healthcare Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR.
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  • Greer Sullivan,

    1. John Fortney, Ph.D., and Greer Sullivan, M.D., M.P.H., are with the VA HSR&D Center for Mental Health Services and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR; and the VA Mental Illness Research Education and Clinical Center, South Central VA Healthcare Network; NIMH Center for Mental Healthcare Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR.
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  • Keith Williams,

    1. Keith Williams, Ph.D., is with the Department of Biometry, University of Arkansas for Medical Sciences, Little Rock, AR.
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  • Catherine Jackson,

    1. Catherine Jackson, Ph.D., Sally C. Morton, Ph.D., and Paul Koegel, Ph.D., are with RAND Health Program, Santa Monica, CA.
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  • Sally C. Morton,

    1. Catherine Jackson, Ph.D., Sally C. Morton, Ph.D., and Paul Koegel, Ph.D., are with RAND Health Program, Santa Monica, CA.
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  • Paul Koegel

    1. Catherine Jackson, Ph.D., Sally C. Morton, Ph.D., and Paul Koegel, Ph.D., are with RAND Health Program, Santa Monica, CA.
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  • This research was supported by the National Institute on Alcohol Abuse and Alcoholism (grant no. R01 AA12328 to Koegel and Burnam), the NIMH Center for Mental Healthcare Research (grant no. P50 MH48197 to G. Richard Smith), and the VA HSR&D Center for Mental Health Services and Outcomes Research (grant no. HFP 90-019 to Richard Owen).

Abstract

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.

Ancillary