Continuity of care: synthesis and conceptual analysis of the NIHR, Service and Delivery Organisation Programme’s research

Researchers: Gillian Parker, Anne Corden and Janet Heaton

Funder: NIHR Service and Delivery Organisation Programme

Duration: November 2008 – May 2009

Background

Following a scoping exercise in 2000 the National Institute of Health Research (NIHR) Service and Delivery Organisation (SDO) Research & Development Programme commissioned a comprehensive programme on 'continuity of care'. It included six empirical research projects and three review projects. The empirical projects conducted were concerned with continuity of care in the context of:

type 2 diabetes mellitus
primary care
cancer
learning disability and stroke
stroke
severe mental health conditions.

In 2005 the SDO commissioned a review of progress, with synthesis and analysis from Professor George Freeman and colleagues. That review was published in June 2007 (Freeman et al., 2007). Some of the empirical projects included longitudinal elements, and were then still in progress.

After all the empirical studies had reported, the SDO wished to complete the process of review and commissioned SPRU to write a synthesis report.

Aims

We were commissioned to conduct a short piece of work to build on and complete the synthesis and conceptual analysis of the SDO Continuity of Care Programme. This included:

a synthesis of findings from each empirical project
an account of advances made in conceptualising continuity of care
discussion of differences in such concepts between groups with different care needs
an account of advances made in measuring continuity of care, and differences here between groups with different care needs
identification of generalisable messages for enhancing continuity of care.

Methods

This desk-based review was carried out systematically adopting largely qualitative methods of synthesis for the results of the SDO programme. All outputs from the completed projects were read, and material extracted into an analysis framework in order to explore:

what continuity of care is;
what influences the definition and experience of continuity of care, and how this varies by individual characteristics and patient group;
what outcomes continuity of care is associated with, and how this varies by individual characteristics and patient groups;
how projects measured continuity of care, the psychometric properties of the measure developed, and whether there are underlying commonalities here.

Findings from this review were considered in the light of the original scoping report (Freeman et al., 2001); an existing Canadian review of continuity of care (Haggerty et al., 2003), and the interim summary report of the programme (Freeman et al., 2007). A draft report was sent to the research teams who conducted the empirical projects, for suggestions and comment before submission to SDO.

Policy and practice aims

Implications for policy and practice include understanding that continuity is co-constructed among professionals, service
users and carers, and there is unlikely to be a single, identifiable way of delivering it. Different service users give
different weights to the components of continuity, and these probably vary over time. It is the discussions between
professionals and service users about needs, and about what is achievable in addressing them, that will deliver a sense of
experienced continuity.

Publications

2012

'Continuity of care': a critical interpretive synthesis of how the concept was elaborated by a national research programme, (forthcoming)
Heaton, J., Corden, A. and Parker, G., International Journal of Integrated Care.

2011

Experiences of and influences on continuity of care for service users and carers: synthesis of evidence from a research programme, invited review, 2011
Parker, G., Corden, A. and Heaton, J., Health and Social Care in the Community, 19, 6, 576-601.

2010

Continuity of care: Findings of a conceptual review and synthesis of the NIHR SDO programme of research, 2010
Parker, G., Corden, A. and Heaton, J., Research Works, 2010-02, Social Policy Research Unit.

Synthesis and Conceptual Analysis of the SDO's Programme's Research on Continuity of Care, 2010
Parker, G., Corden, A. and Heaton, J., National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre.

References

Freeman, G., Shepperd, S., Robinson, I., Ehrich, K. and Richards, S. (2001) Continuity of Care: Report of a scoping exercise for the NCCSDO, National Coordinating Centre for Service Delivery and Organisation, London.

Haggerty, J., Reid, R., Freeman, G., Starfield, B., Adair, C. and McKendry, R. (2003) Continuity of care: a multi-disciplinary view, British Medical Journal, 327, 1219-21.

Freeman, G., Woloshynowych, M., Baker, R., Boulton, M., Guthrie, B., Car, J. et al (2007) Continuity of Care 2006: What have we learned since 2000 and what are policy imperatives now?, National Coordinating Centre for Service Delivery and Organisation, London.