Associations Between Continuity of Care and Patient Outcomes in Mental Health Care: A Systematic Review
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Search Strategy
Inclusion and Exclusion Criteria
Study Screening and Selection
Quality Assessment
Results
Study and country | Design | Follow-up | N | Type of CoC measure | Outcomes measured | Results |
---|---|---|---|---|---|---|
Adair et al. (35), Canadaa | Prospective cohort | 17 months | 411 | Observer-rated scale, patient-rated scale | Symptom severity, functioning, service satisfaction, other (quality of life) | No association between CoC and symptom severity; CoC associated with better functioning, service satisfaction, and quality of life |
Bindman et al. (31), UK | Prospective cohort | 20 months | 100 | Patient-rated scale, breaks in care, change in keyworker | Hospitalization, symptom severity, functioning | No associations between CoC and hospitalization, symptom severity, or functioning |
Brekke et al. (30), US | Prospective cohort | 12 months | 41 | Contact intensity, breaks in care | Hospitalization, symptom severity, functioning | No association between CoC and hospitalization; CoC associated with reduced symptom severity and improved functioning |
Catty et al. (37), UK | Prospective Cohort | 24 months | 180 | Continuity measures created from factorial analysis | Hospitalization, symptom severity, functioning, other (quality of life, therapeutic relationship, care needs met) | Consolidation and care coordination factors associated with reduced odds of hospitalization; regularity associated with a higher risk of being hospitalized; meeting needs associated with an increase in symptoms the previous year but a decrease the following year |
Chien et al. (25), US | Retrospective cohort | 12 months | 351 | Continuity indices | Other (Medicaid cost, life satisfaction, satisfaction with health) | Better CoC associated with reduced Medicaid costs; CoC not associated with life satisfaction or satisfaction with health |
Greenberg et al. (26), US | Retrospective cohort | 8 months | 131 | Continuity indices, contact intensity, contact regularity | Symptom severity, functioning, other (therapeutic alliance, life satisfaction, commitment to treatment, substance abuse, violence, employment) | No associations between CoC and outcomes |
Greenberg & Rosenheck (32), US | Retrospective cohort | 3–6 months | 181,651 | Contact intensity, contact regularity, time to contact after discharge | Functioning | CoC associated with better functioning; for continuing outpatient group, intensity of contact associated with poorer functioning |
Greenberg et al. (27), US | Prospective cohort | 4 months | 2,357 | Continuity indices, contact regularity, time to contact after discharge | Symptom severity, other (substance abuse, violent behavior) | No significant associations between CoC and symptom severity or substance abuse; better CoC associated with reduced violent behavior |
Grinshpoon et al. (33), Israel | Retrospective Cohort | 6 months | 908 | Time to contact after discharge | Hospitalization | Better CoC associated with lower risk of rehospitalization |
Heffernan & Husni (39), UK | Retrospective cohort | 24 months | 26 | Changes in keyworker. | Hospitalization | No association between CoC and number of days in a hospital |
Hoertel et al. (28), France | Retrospective cohort | 36 months | 14,515 | Continuity of Care Index | Other (mortality rate) | Likelihood of death significantly lower among patients with better CoC |
Huff (34), US | Retrospective cohort | 1 month | 3,755 | Time to contact after discharge, total number of services used | Hospitalization | Contact within 5 days of discharge related to a reduced risk of rehospitalization; however, greater service utilization associated with increased risk of hospitalization |
Lehman et al. (41), US | Quasi-experimental | 12 months | 661 | Patient-rated scale, changes in keyworker | Hospitalization, symptom severity, functioning, other (life satisfaction) | CoC associated with reduced symptom severity; no significant differences found in hospitalization, functioning, or life satisfaction |
Mitton et al. (36), Canadaa | Prospective cohort | 17 months | 437 | Observer-rated scale | Other (health care costs) | No association between CoC and total cost (a trend, p=.054); better CoC associated with lower hospital costs and higher community costs |
Olfson et al. (42), US | Prospective cohort | 3 months | 208 | Consultation with outpatient consultant before discharge | Hospitalization, symptom severity, functioning, other (employment, medication adherence) | CoC associated with reduced symptom severity; no associations between CoC and hospitalization, functioning, employment, or medication adherence |
Sweeney et al. (38), UK | Cross sectional | None | 167 | Patient-rated scale | Other (therapeutic relationship, health needs, social needs) | CoC associated with better therapeutic relationships and more health and social needs met |
Sytema & Burgess (29), Australia and The Netherlands | Retrospective cohort | 48 months | 2,257 | Breaks in care, time-to-contact after inpatient discharge | Hospitalization | No association between CoC and hospitalization |
Vita et al. (44), Italy | Retrospective cohort | 18 months | 99 | Contact regularity | Other (medication adherence) | Regular CoC (1 visit a month) associated with better medication adherence; greater intensity of contact (more than 1 visit a month) related to poorer medication adherence |
Study Designs
Measurement of CoC
Type of measure and study | N items in instrument | N studies using measure |
---|---|---|
Multicomponent CoC measure | ||
Indices | ||
Continuity of Care Index (25–28) | — | 4 |
Usual-provider continuity (25) | — | 1 |
Sequential continuity (25) | — | 1 |
Modified Continuity Index (26,27) | — | 2 |
ECHO factors (37)a | 7 | 1 |
Observer-rated scales: ACSS-MH observer (35,36)b | 17 | 2 |
Patient-rated scales | ||
ACSS-MH patient (35) | 37 | 1 |
CONTINU-UM (38)c | 51 | 1 |
Perceived accessibility score (31) | 10 | 1 |
Met needs score (41) | 2 | 1 |
Single-component CoC measure | ||
Contact intensity | ||
Summed minutes of contact (30) | — | 1 |
N days with at least 1 contact (26) | — | 1 |
Total N of contacts (32) | — | 1 |
Contact regularity | ||
N months with at least 1 contact (26,27,32) | — | 3 |
N of 2-month periods with at least 2 contacts (27) | — | 1 |
Breaks in care | ||
N days from missed contact to next contact (31) | — | 1 |
N of 30-day gaps without contact (30) | — | 1 |
N of 90-day gaps without contact (29) | — | 1 |
Summed N of days of 90-day gaps (29) | — | 1 |
Time to contact after inpatient discharge | ||
Visit within 30 days (27,32) | — | 2 |
Visit within 5 days (34) | — | 1 |
N days between discharge and first visit (29,33) | — | 2 |
Changes in keyworker. | ||
Total N of keyworkers (31) | — | 1 |
Change in keyworker (39,41) | — | 2 |
Keyworker allocated (41) | — | 1 |
Total N of services used (34) | — | 1 |
Consultation with outpatient consultant before discharge (42) | — | 1 |
Association Between CoC and Outcomes
Study | Hospital readmission | Symptoms | Social functioning | Service satisfaction | Other |
---|---|---|---|---|---|
Lehman et al. (41)b | = | – | = | = | |
Olfson et al. (42) | = | + | = | = | = |
Brekke et al. (30) | = | + | + | ||
Sytema & Burgess (29) | = | ||||
Bindman et al. (31) | = | = | = | ||
Chien et al. (25)b | = + | ||||
Huff (34) | + | ||||
Greenberg et al. (27) | = | + | |||
Greenberg et al. (26) | = | = | = | ||
Adair et al. (35)b | = | + | + | + | |
Mitton et al. (36) | + – = | ||||
Greenberg & Rosenheck (32)b | + | ||||
Vita et al. (44) | + – | ||||
Heffernan & Husni (39) | = | ||||
Grinshpoon et al. (33) | + | ||||
Sweeney et al. (38)b | + | ||||
Catty et al. (37) | + – | + – | = | + – = | |
Hoertel et al. (28)b | + | ||||
Outcome scorec | 2 | 1 | 3 | 1 |
Hospitalization Outcomes
Duration of hospitalization.
Relative risk of rehospitalization.
Number of days to readmission.
Symptom Severity
Social Functioning
Service Satisfaction
Other Outcomes
Quality Assessment
Study | Newcastle-Ottawa Scalea | Steinberg et al. instrumentb | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Rater 1 | Rater 2 | Rater 1 | Rater 2 | Rater’s evaluationc | ||||||
Rating | Rankd | Rating | Rankd | Rating | Rankd | Rating | Rankd | Rater 1 | Rater 2 | |
Adair et al. (35) | 7 | 2 | 9 | 1 | .92 | 4 | .85 | 3 | Good | Good |
Bindman et al. (31) | 7 | 2 | 8 | 2 | .89 | 6 | .73 | 6 | Moderate | Moderate |
Brekke et al. (30) | 5 | 4 | 5 | 5 | .77 | 11 | .67 | 8 | Moderate | Moderate |
Catty et al. (37) | 7 | 2 | 6 | 4 | .85 | 8 | .77 | 5 | Moderate | Moderate |
Chien et al. (25) | 5 | 4 | 6 | 4 | .92 | 4 | .83 | 4 | Good | Good |
Greenberg et al. (26) | 6 | 3 | 3 | 7 | .92 | 4 | .57 | 11 | Poor | Poor |
Greenberg & Rosenheck (32) | 5 | 4 | 4 | 6 | .89 | 6 | .62 | 10 | Poor | Moderate |
Greenberg et al. (27) | 6 | 3 | 6 | 4 | .96 | 3 | .86 | 2 | Moderate | Good |
Grinshpoon et al. (33) | 6 | 3 | 6 | 4 | .79 | 10 | .83 | 4 | Moderate | Moderate |
Heffernan & Husni (39) | 6 | 3 | 6 | 4 | .86 | 7 | .86 | 2 | Poor | Poor |
Hoertel et al. (28) | 8 | 1 | 8 | 2 | 1.00 | 1 | .92 | 1 | Good | Good |
Huff (34) | 7 | 2 | 7 | 3 | .65 | 13 | .69 | 7 | Moderate | Moderate |
Lehman et al. (41) | 6 | 3 | 9 | 1 | .90 | 5 | .63 | 9 | Good | Moderate |
Mitton et al. (36) | 8 | 1 | 7 | 3 | .81 | 9 | .69 | 7 | Moderate | Moderate |
Olfson et al. (42) | 7 | 2 | 8 | 2 | .97 | 2 | .73 | 6 | Moderate | Poor |
Sweeney et al. (38) | 5 | 4 | 5 | 5 | .69 | 12 | .67 | 8 | Moderate | Good |
Sytema & Burgess (29) | 7 | 2 | 6 | 4 | .53 | 15 | .57 | 11 | Poor | Poor |
Vita et al. (44) | 6 | 3 | 7 | 3 | .58 | 14 | .54 | 12 | Moderate | Poor |
Studies Since Previous Systematic Review
Discussion
Conclusions
References
Information & Authors
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Authors
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Funding Information
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