What continuity score should we aim for?

There is no single target. One study measured the highest continuity each setting's standard shift plan could allow and used that as the benchmark, so compare your scores with what your own staffing pattern makes possible.

Which score should we use?

Use the one your team can explain; UPC is the simplest. In Medicare claims for heart failure, COPD and diabetes, four common continuity scores were highly correlated with one another at the provider level (r = 0.87 to 0.98).

What is consistent vehicle routing?

It is the routing version of continuity: each customer is visited by the same driver at about the same time. Continuity rules in home care routing models work the same way for patients and clinicians.

Continuity of care in home visits

Updated October 8, 2026 · 3 min read

Continuity of care in home visits means each patient is seen by the same clinician, or a small named group, across the episode. Measure it per patient as the share of visits made by the clinician who made the most, and protect it by naming a primary clinician before routes are built.

Full, partial or none

Routing research names three levels. Under full continuity, one clinician makes every visit for a patient over the planning period. Under partial continuity, visits come from a restricted set of clinicians, sometimes with a reference clinician who coordinates the rest. Under none, past assignments are ignored. Most planning models treat continuity as a preference that carries a penalty when broken; a few make full continuity mandatory.

Continuity has a cost. Keeping each patient with one clinician limits who can take a visit, which can make routes less efficient.

How to measure it

Three scores from health services research work on a plain list of visits with the clinician's name:

Usual provider of care (UPC): visits by the most frequent clinician divided by all visits.
Bice-Boxerman continuity of care index (COC): add up each clinician's visit count squared, subtract the total visits, then divide by total visits times (total visits minus 1). It runs from 0, every visit by a different clinician, to 1, one clinician for every visit.
Sequential continuity (SECON): the share of back-to-back visit pairs made by the same clinician.

Worked example: 10 nursing visits in one episode
Visits by nurse	UPC	COC
A 6, B 3, C 1	0.60	(36 + 9 + 1 - 10) / 90 = 0.40
A 8, B 2	0.80	(64 + 4 - 10) / 90 = 0.64
A 10	1.00	(100 - 10) / 90 = 1.00

Moving one visit from B and one from C to nurse A lifts the COC score from 0.40 to 0.64.

What studies have found

In one large urban agency's records from 2010 to 2015, 23,886 people with dementia received home health care after a hospital stay. Of these, 26% had every nursing visit from one nurse and 8% had a different nurse at every visit. Compared with the third of patients with the highest continuity, the lowest and middle thirds had adjusted odds of rehospitalization 1.33 and 1.30 times as high (Ma et al. 2021).
In 59,854 home health patients, greater consistency in nursing staff went with a lower chance of hospitalization and emergency care, and a higher chance of improved daily-living function by discharge (Russell et al. 2011).
In 79 Norwegian patients receiving frequent long-term home care, patients averaged 51 visits from 17 different carers in four weeks, far below the continuity the shift plan made possible (Gjevjon et al. 2014).

These are associations in observational data, not proof that continuity caused the differences.

Planning for continuity

1
Name a primary clinician
At admission, give each patient a primary clinician and a backup with the same skills.
2
Make it a weighted preference
Route so the primary clinician takes the visit unless a window, skill or shift limit rules it out.
3
Change as few pairs as possible
When the day is re-planned, keep existing patient and clinician pairs where you can. Routing research names continuity as something to preserve during re-planning.
4
Track the score
Compute UPC or COC per patient each week and review the lowest scores first.

Capillary's routing, shown as a demo, plans home visits for clinicians, couriers and equipment around visit windows, skills and travel time. See Capillary for hospital-at-home programs.

Common questions

What continuity score should we aim for?: There is no single target. One study measured the highest continuity each setting's standard shift plan could allow and used that as the benchmark, so compare your scores with what your own staffing pattern makes possible.
Which score should we use?: Use the one your team can explain; UPC is the simplest. In Medicare claims for heart failure, COPD and diabetes, four common continuity scores were highly correlated with one another at the provider level (r = 0.87 to 0.98).
What is consistent vehicle routing?: It is the routing version of continuity: each customer is visited by the same driver at about the same time. Continuity rules in home care routing models work the same way for patients and clinicians.

Plan home visits around windows, skills and drive time.

Capillary's routing module plans the day for clinicians, couriers and equipment. See it with sample data.

See home-visit routing Talk to us