Healthcare fragmentation, multimorbidity, potentially inappropriate medication, and mortality: a Danish nationwide cohort study

Table 1 Measures of cross-sectoral care fragmentation

Category	Measure	Description
Clinical indicators of care fragmentation	Total contacts	Overall number of contacts to all healthcare providers*
	Involved providers	Number of different providers involved
	Involved GP clinics	Number of different GP clinics involved (daytime or out-of-hours)
	Provider transitions	Number of transitions between different providers, i.e., not seeing the same provider they saw at their last contact
	Hospital trajectories	Overall number of outpatient ambulatory care trajectories and hospital admissions
	Hospital trajectory transitions	Number of initiated/closed ambulatory care trajectories or hospital admissions/discharges
	Hospital trajectory overlaps	Number of overlapping hospital trajectories
Formel fragmentation indices**	Usual Provider of Care Index (UPC)***	Concentration of care with a single provider; the proportion of contacts to the provider whom the patient visited most times
	Continuity Of Care Index (COCI)***	Distribution of care among providers, weighting both the frequency and dispersion of contacts
	Sequential Continuity Index (SECON)***	Degree of transitions based on number of contacts to the provider whom the patient visited most recently
	Known GP Index***	Proportion of contacts to the patient’s own GP clinic out of all provider contacts

For a patient pathway example, see Additional file 1: Methods S2, details in Pollack et al. 2016 [30]
^*Providers: GP clinics (daytime and out-of-hours services), publicly funded private practice specialists (e.g., otolaryngologists, ophthalmologists, or dermatologists), or hospital departments (emergency room, inpatient and outpatient services)
^**All formal care fragmentation indices range from 0 to 1, with lower values indicating a higher degree of care fragmentation
\(^{***}UPC=\underset{}{\mathrm{max}}\left(\frac{{n}_{i}}{n}\right) COCI=\frac{\left({\sum }_{i=1}^{p}{n}_{i}^{2}\right)-n}{n(n-1)} SECON=\frac{{\sum }_{j=1}^{n-1}{c}_{j}}{n-1} Known\,GP\,Index=\frac{{n}_{own}}{n}\)
n, total number of contacts; n_i, number of contacts to provider i; p, total number of providers; c_j, takes 1 if contacts j and j + 1 are to the same provider, otherwise 0; n_own, number of contacts to the patient’s own GP clinic

ISSN: 1741-7015