Continuity of Care
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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).