| Although, continuity of care is considered essential to a well-functioning health delivery system, researchers have used and measured continuity in a number of different ways, and no clear conceptual framework links continuity to outcomes.; The objective of the dissertation was to validate a model of continuity based on agency theory. The premise of the model is that the role of continuity of care is to reduce information asymmetry and to increase goal alignment, thereby reducing agency loss.; Three decades of empirical literature on continuity were analyzed to ascertain whether researchers tested or, at least, recognized the effect of information exchange and goal alignment on outcomes of care; whether their findings would have been more useful had they drawn on the agency model of continuity; and whether they had other explanations that were more helpful than the model.; Results of the analysis demonstrated that most authors assumed that goal alignment was present and did not measure it. A number of authors measured information management, but many more assumed that continuity would lead to better information or used this as post hoc explanation for their findings. No rigorous study assessed the effect of both information acquisition and goal alignment on outcomes of care. The analysis indicated that an agency-based model would have enabled the authors to improve their definition of continuity, study design, methods, and analysis, and would have improved the usefulness of the studies for policymaking.; The model helps to distinguish continuity from other ideas that it is often confused with, such as coordination, communication, and the doctor-patient relationship. With certain modifications based on the literature, the model of continuity based on agency theory provides a useful conceptual tool for health services research and policy. |
