Encyclopedia of Behavioral Medicine

Living Edition
| Editors: Marc Gellman

Continuity of Care

  • Marie BoltzEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-1-4614-6439-6_96-2



Continuity of care refers to the seamless provision of health care between settings and over time (Gulliford et al. 2006).

Traditionally, patients have viewed care continuity as a permanent relationship with a dependable, caring health-care professional (Gulliford et al. 2011). This view, defined as interpersonal continuity of care, implies that the identified professional is the sole source of care and information for the patient. To health-care providers, continuity of care has historically implied the exchange of information, e.g., between shifts of nurses, between units of a health-care facility, and between providers such as acute care and a nursing home. Coleman et al. (2006) define the flow of information between different locations or different levels of care within the same location as “transitional care” necessary to ensure the coordination and continuity of health care as patients move through different settings. Organizational approaches found to be effective in facilitating transitions between settings are the use of transition coach to educate the patient and family and coordinate among the health professionals involved in the transition (Voss et al. 2011) and the transitional care nurse (Hirschman et al. 2015) who coordinates the discharge plan and coordinates the plan in the home.

Chronological or longitudinal continuity of care describes health-care interactions that occur in the same place, with the same medical record and with the same professionals, so that there is consistent knowledge of the patient by those providing the care (Hill et al. 2014). Interdisciplinary or team-based continuity implied allows previous knowledge of the patient to be present even when the patient requires a wide range of services.

Given that health-care needs can rarely be met by a single professional or a single provider setting, a multidimensional model of continuity of care is a logical choice (Gulliford et al. 2006), one that provides a longitudinal and interdisciplinary approach, while providing the dependability and relational aspects of interpersonal continuity. This model relies on integration, coordination, and the sharing of information between different and stable providers. Evaluation of continuity of care can be conducted from the patient perspective, i.e., the experience of care, or satisfaction with the coordination of care and its interpersonal aspects. It also includes the provider’s evaluation of outcomes and care processes (team functioning and case management effectiveness).


References and Further Reading

  1. Coleman, E. A., Parry, C., Chalmers, S., & Min, S. J. (2006). The care transitions intervention: Results of a randomized controlled trial. Archives of Internal Medicine, 166, 1822–1828.CrossRefPubMedGoogle Scholar
  2. Gulliford, M., Naithani, S., & Morgan, M. (2006). What is “continuity of care?”. Journal of Health Services Research and Policy, 11(4), 248–250.CrossRefPubMedGoogle Scholar
  3. Gulliford, M., Cowie, L., & Morgan, M. (2011). Relational and management continuity survey in patients with multiple long-term conditions. Journal of Health Services Research & Policy, 16(2), 67–74.CrossRefGoogle Scholar
  4. Hill, K. M., Twiddy, M., Hewison, J., & House, A. O. (2014). Measuring patient-perceived continuity of care for patients with long-term conditions in primary care. BMC Family Practice, 15, 191.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Hirschman, K. B., Shaid, E., McCauley, K., Pauly, M. V., & Naylor, M. D. (2015). Continuity of care: The Transitional Care Model. The Online Journal of Issues in Nursing, 20(2), 1.PubMedGoogle Scholar
  6. Voss, R., Gardner, R., Baier, R., Butterfield, K., Lehrman, S., & Gravenstein, S. (2011). The care transitions intervention: Translating from efficacy to effectiveness. Archives of Internal Medicine, 171(14), 1232–1237.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.The Pennsylvania State University College of NursingState CollegePAUSA