Continuity of care in mental health services: toward clarifying the construct.

OBJECTIVE To clarify "continuity of care" (COC), a construct associated with the delivery of services for persons suffering from severe and persistent mental illness (SPMI), with attention to the service recipient's perception of COC. METHOD The study involved a systematic appraisal of the literature on COC, supplemented by interviews with 36 SPMI patients and their families. Statements highlighting attributes of COC were extracted from both sources. RESULTS Comments by patients and families corresponded to descriptions of COC in the mental health literature. Attribute classifications by independent teams of judges showed good consistency. The following 4 attribute domains of the COC construct were identified: service delivery, accessibility, relationship base, and individualized care. CONCLUSIONS Service recipients' perceptions of COC overlapped with representations of the construct in the mental health literature. The qualitative inquiry resulted in a draft, 47-item, self-report questionnaire for use in studies of interventions designed to facilitate COC.