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Title of document: Defusing the Confusion: concepts and measures of continuity of healthcare
Name of author(s): Robert Reid, Jeannie Haggerty, Rachael McKendry
Name of publisher: Canadian Helath Services Research Foundation
Language of the publication: English
Language of the review: English
Summary:
Continuity of care is how one patient experiences care over time as coherent and linked; this is the result of good information flow, good interpersonal skills, and good coordination of care.
Continuity of care occurs when separate and discrete elements of care are connected and when those elements of care that endure over time are maintained and supported.
Definitions of continuity are often presumed rather than stated, and it is not possible to measure what is not clearly defined.
Continuity of care means different things to different types of caregivers, but all recognize three types: continuity of information, of personal relationships and of clinical management. The type of continuity should be agreed to before discussions or planning begin.
Informational continuity means that information on prior events is used to give care that is appropriate to the patient's current circumstance.
Relational continuity recognizes the importance of knowledge of the patient as a person; an ongoing relationship between patients and providers is the undergirding that connects care over time and bridges discontinuous events.
Management continuity ensures that care received from different providers is connected in a coherent way. Management continuity is usually focused on specific, often chronic, health problems.
Multiple measures are needed to capture all aspects of continuity; no single measure is able to reflect the whole concept. Some measures are more useful in some contexts than others.
More emphasis is needed on the development and application of direct measures of continuity from the patient's perspective and to measure continuity across organizational boundaries.
Measures based on patterns of health service use should be used with caution as indicators of continuity until researchers have tested implicit assumptions that they reflect informational, relational, and/or management continuity.
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Reviewer's comments on the document:
Continuity is the result of a combination of adequate access to care for patients, good interpersonal skills, good information flow and uptake between providers and organizations, and good care coordination between providers to maintain consistency. For patients, it is the experience of care as connected and coherent over time. For providers, it is the experience of having sufficient information and knowledge about a patient to best apply their professional competence and the confidence that their care is recognized and pursued by other providers.
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