An evaluation of Mongolia’s universal patient-held health booklets as a tool for continuity of care in chronic disease patients: a cross-sectional study: Can universal patient-held booklets promote continuity of care and patient-centred care in low resource countries? The case of Mongolia

Research output: Contribution to journalArticlepeer-review


  • Hussein Ibrahim
  • Uyanga Munkhbayar
  • Claire Humphries
  • Chimedsuren Ochir
  • Aira Toivgoo
  • Indermohan Narula

Colleges, School and Institutes


Objective: To describe a nationwide Patient-held Health Booklet system and investigate its use and completeness for clinical information transfer during chronic non-communicable disease (NCD) outpatient visits in Mongolia. 

Design: Cross-sectional survey and document review.

Setting: Two large government secondary-care hospital outpatient departments (OPD) in Ulaanbaatar.

Participants: 395 adult outpatients attending for NCDs. 
Outcome measure: Numbers of patient-held records brought and used by OPD doctors; Completeness of records on arrival and leaving OPD.

Results: 96% (379) brought handover documentation from previous provider/s: 94% had patient-held health Booklets, 27% other additional documents and 4% had nothing. 67% were referred from primary-care and 44% referred back for follow-up. On leaving the OPD, 93% were provided with written clinical information in the Booklet and 39% were also given other documents. 84% recalled being given verbal information. Only 40.8% of the records of the OPD consultation with written information included all three key handover information items (diagnosis, management/treatment and follow-up). The Booklets were the best completed type of document, with evidence that they were consulted by patients (80%), public (95%) and private (77%) providers. Living >1 hour away (OR=0.28; 95%CI 0.13, 0.61) decreased the likelihood of receiving written management/treatment information; living >1 hour away (OR=0.48; 95%CI 0.27, 0.87), comorbidity (OR=0.55; 95%CI 0.35, 0.87), and returning to secondary-care for follow-up (OR=0.52; 95%CI 0.33, 0.80) all independently decreased the likelihood of receiving written follow-up information. A Ministry order mandates the use of the patient-held health Booklet, but there were no other policies, guidelines or clinician training relating to their use. 

Conclusions: The universal Patient-Held Health Booklets were well-accepted, well-utilised and the best completed handover documentation. The Booklets provided a successful handover option for chronic NCD patients in Mongolia but their completeness needs improving. There is potential for their application globally.


Original languageEnglish
Pages (from-to)729-740
JournalBMJ Quality & Safety
Issue number9
Early online date26 Apr 2019
Publication statusPublished - Sep 2019


  • Clinical handover, Health systems, Patient safety, Quality improvement, Non-communicable diseases, Mongolia