Open Access
Subscription Access
Visit Entropy: comparing a novel method to existing continuity of care measures
Abstract
Introduction: Continuity of care is a key characteristic of primary care yet there is little agreement on an accepted measure of continuity. Density (Usual Provider Continuity, Primary Provider Continuity), dispersion (Continuity of Care Index), and sequence (Sequence of Care Index) are often used measures, but they each have specific drawbacks when applied to patients with multi-comorbidity who are cared for within a patient-centered medical home practice.
Methods: A new measure of continuity called Visit Entropy was developed using mathematical constructs from information theory and physics. This was compared to four existing measures of continuity in a dataset of 811 hospitalized primary care patients.
Results: Visit Entropy is inversely related to other measures of continuity of care. It has a less skewed distribution and it helps differentiate the substantial number of patients at the extremes of other measures of continuity of care. Visit Entropy also eliminates the problem of undefined values caused by division by zero seen in other continuity measures.
Conclusions: Visit Entropy solves many of the shortcomings of existing continuity measures when applied to a dataset of primary care patients cared for within a medical home practice. Further study is indicated to determine if Visit Entropy is associated with the benefits commonly ascribed to continuity of care and if it matches patient and physician perceptions of continuity of care.
Keywords
References
Starfield, B. (2009). Family medicine should shape reform, not vice versa. Family Practice Management 16 (4) 6-7.
Saultz, J.W. (2003). Defining and measuring interpersonal continuity of care. Annals of Family Medicine 1 (3) 134-143.
Rodriguez, H.P., Rodgers, W.H., Marshall, R.E. & Safran, D.G. (2007). The effects of primary care physician visit continuity on patients' experiences with care. Journal of General Internal Medicine 22 (6) 787-793.
Jee, S.H. & Cabana, M.D. (2006). Indices for continuity of care: a systematic review of the literature. Medical Care Research and Review 63 (2) 158-188.
Mattsson, L.G. & Westman, G. (1987). Evaluation of provider continuity in primary care: actual versus random and potential continuity. Family Practice 4 (4) 251-259.
Eriksson, E.A. & Mattsson, L.G. (1983). Quantitative measurement of continuity of care. Measures in use and an alternative approach. Medical Care 21 (9) 858-875.
Rogers, J. & Curtis, P. (1980). The concept and measurement of continuity in primary care. American Journal of Public Health 70 (2) 122-127.
Breslau, N. & Reeb, K.G. (1975). Continuity of care in a university-based practice. Journal of Medical Education 50 (10) 965-969.
Vogeli, C., Shields, A.E., Lee, T.A., Gibson, T.B., Marder, W.D., Weiss, K.B. & Blumenthal, D. (2007). Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine 22 (Supplement 3) 391-395.
Parekh, A.K. & Barton, M.B. (2010). The challenge of multiple comorbidity for the US health care system. Journal of the American Medical Association 303 (13) 1303-1304.
Bodenheimer, T., Wagner, E.H. & Grumbach, K. (2002). Improving primary care for patients with chronic illness. Journal of the American Medical Association 288 (14) 1775-1779.
Rohrer, J.E., Angstman, K.B., Maxson, J.A. & Furst J.W. (2013). Family Medicine Patients Who Use Retail Clinics Have Lower Continuity of Care. Journal of Primary Care & Community Health 4 (2) 150-153.
Saultz, J.W. & Lochner, J. (2005). Interpersonal continuity of care and care outcomes: a critical review. Annals of Family Medicine 3 (2) 159-166.
Guastello, S.J. (2010). Entropy, in Nonlinear Dynamical Systems Analysis for the Behavioral Sciences Using Real Data, (S.J. Guastello & R.A.M. Gregson, eds.). London: CRC Press.
Guastello, S.J., Gorin, H., Huschen, S., Peters, N.E., Fabisch, M., Poston, K. & Weinberger, K. (2013). The minimum entropy principle and task performance. Nonlinear Dynamics, Psychology and Life Sciences 17 (3) 405-423.
Guastello, S.J., Gorin, H., Huschen, S., Peters, N.E., Fabisch, M. & Poston, K. (2012). New paradigm for task switching strategies while performing multiple tasks: entropy and symbolic dynamics analysis of voluntary patterns. Nonlinear Dynamics, Psychology and Life Sciences 16 (4) 471-497.
Linville, P.W. (1987). Self-complexity as a cognitive buffer against stress-related illness and depression. Journal of Personality and Social Psychology 52 (4) 663-676.
Ohanian, H.C. (1989). Physics. 2nd Edition. New York: W.W. Norton & Company.
Cover, T.M. & Thomas, J.A. (2006). Elements of Information Theory. Second Edition. Hoboken, New Jersey: John Wiley & Sons, Inc.
Shannon, C.E. (1948). A Mathematical Theory of Communication. Bell System Technical Journal 27, 379-423, 623-656.
Charlson, M.E., Pompei, P., Ales, K.L. & MacKenzie, C.R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 40 (5) 373-383.
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.C., Saunders, L.D., Beck, C.A., Feasby, T.E. & Ghali, W.A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care 43 (11) 1130-1139.
Martin, J.C., Avant, R.F., Bowman, M.A., Bucholtz, J.R., Dickenson, J.R., Evans, K.L., Green, L.A., Henley, D.E., Jones, W.A., Matheny, S.C., Nevin, J.E., Panther, S.L., Puffer, J.C., Roberts, R.G., Rodgers, D.V., Sherwoord, R.A., Stange, K.C., Weber, C.W. & Future of Family Medicine Project Leadership Committee. (2004). The Future of Family Medicine: a collaborative project of the family medicine community. Annals of Family Medicine 2 (Supplement 1) S3-32.
Crabtree, B.F., Nutting, P.A., Miller, W.L., Stange, K.C., Stewart, E.E. & Jaén, C.R. (2010). Summary of the National Demonstration Project and recommendations for the patient-centered medical home. Annals of Family Medicine 8 (Supplement 1) S80-90; S92.
Collaborative, P.C.P.C. (2007). Joint Principles of the Patient-Centered Medical Home. Washington DC: Patient Centered Primary Care Collaborative.
CMS. (2014). Meaningful Use. [cited 2014 5/20/2014]; Available from: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html.
Zhai, C. & Lafferty, J. (2001). A Study of Smoothing Methods for Language Models Applied to Ad Hoc Information Retrieval. SIGIR '01 ACM: New Orleans, LA
DOI: http://dx.doi.org/10.5750/ejpch.v3i3.1002
Refbacks
- There are currently no refbacks.