Association between Continuity of Care and Health-Related Quality of Life

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Figure 1.
Measurement timeline for health-related quality of life (HRQOL) domains and continuity of care (COC). T0, Time zero; Y1, year 1; Y2, year 2; Y3, year 3.
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Figure 2.
Consort diagram.
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Figure 3.
Example processes and outcomes relevant to the care of individuals with multiple chronic conditions.

Table 1.

Demographic, Clinical, and Outcome Characteristics of Seniors with Multiple Chronic Conditions at Baseline (2010) (N = 961)

Characteristic
Age (years)
Mean (SD)	75.6 (5.7)
Median (5%, 95%)	75 (68, 86)
Morbidity level
Quan^*
Mean (SD)	4.4 (2.6)
Median (5%, 95%)	4 (1, 9)
Chronic Disease Score²⁵
Mean (SD)	6.2 (3.1)
Median (5%, 95%)	6 (1, 12)
Sex
Male	431 (44.9)
Female	530 (55.2)
Race
White	875 (91.1)
Black	37 (3.9)
American Indian/Alaska Native	12 (1.3)
Asian/Pacific Islander	6 (0.6)
Other	22 (2.3)
Unknown	9 (0.9)
Hispanic ethnicity	70 (7.3)
Low SES	129 (13.4)
Income ($)
<15,000	124 (12.9)
15,000–30,000	242 (25.2)
30,000–45,000	177 (18.4)
45,000–60,000	144 (15.0)
60,000–75,000	58 (6.0)
75,000–90,000	38 (4.0)
≥90,000	63 (6.6)
Don't know	67 (7.0)
Refused to answer	48 (5.0)
Continuity of Care Index²⁰ (n = 816)^{^†}
Mean (SD)	0.24 (0.22)
Median (5%, 95%)	0.18 (0.00, 0.71)
Self-reported general health status^{^‡} (n = 961)
Mean (SD)	48.7 (22.0)
Median (5%, 95%)	50 (0, 75)
Physical well-being^{^§} (n = 958)
Mean (SD)	36.4 (11.4)
Median (5%, 95%)	36 (19, 54)
Emotional well-being^{^¶} (n = 958)
Mean (SD)	54.8 (9.0)
Median (5%, 95%)	57 (37, 66)

Data are number (%) of participants unless otherwise indicated. Population norms for health-related quality of life measures = 50.
↵* Quan adaptation of the Elixhauser Comorbidity Index.²⁶
↵† Primary and specialty care, year before baseline.
↵‡ Rated as excellent, very good, good, fair, or poor.
↵§ Score from the Physical Component Summary of the 36-item Rand instrument.
↵¶ Score from the Mental Component Summary of the 36-item Rand instrument.
SD, standard deviation; SES, socioeconomic status.

Table 2.

Adjusted Associations Between Health-Related Quality of Life and Continuity of Care

Outcome	Estimate	Standard Error	P Value
Self-reported health status^*
COC	−1.0140	2.4976	.6848
Time	−0.6441	0.7656	.4005
Age	−0.1461	0.1180	.2158
Female sex	−2.4423	1.3275	.0661
Quan ECI²⁵	−2.4220	0.2593	<.0001
Physical well-being^{^†}
COC	−0.0886	1.1783	.9401
Time	−0.0166	0.3455	.9616
Age	−0.2626	0.0595	<.0001
Female sex	−2.6292	0.6705	<.0001
Quan ECI²⁵	−1.0025	0.1308	<.0001
Emotional well-being^{^‡}
COC	0.6339	1.0623	.5508
Time	0.4004	0.3309	.2266
Age	−0.0205	0.0477	.6666
Female sex	−0.7597	0.5352	.1561
Quan ECI²⁵	−0.3495	0.1046	.0009

Bold indicates associations significant at P <= .05.
↵* Rated as excellent, very good, good, fair, or poor by 961 patients (1602 observations).
↵† Score from the Physical Component Summary of the 36-item Rand instrument (completed by 961 patients [1598 observations]).
↵‡ Score from the Mental Component Summary of the 36-item Rand instrument (completed by 961 patients [1598 observations]).
COC, continuity of care; Quan ECI, Quan adaptation of the Elixhauser Comorbidity Index.