Continuity and Transitions Tool
What is continuity?
Haggerty (2003) defines continuity as the experience of an individual patient of health care that is delivered over time. Continuity has three components:
- Informational continuity – The use of information on past events and personal circumstances to make current care appropriate for each individual
- Management continuity – A consistent and coherent approach to the management of a health condition that is responsive to a patient‘s changing needs
- Relational continuity – An ongoing therapeutic relationship between a patient and one or more providers
Why is continuity important?
Greater continuity is associated with higher quality of care as viewed by parents (Christakis 2002). It improves preventive practices (Ettner 1996), enhances patient-provider communication, and is more cost effective (McBurney 2004), as demonstrated by fewer ED visits and hospitalizations (Christakis 2001).
When does providing continuity become challenging?
With the growing complexity of medical care and increasing mobility of families, most people do not have a single physician who provides for their comprehensive health care needs in every setting for life. Every point where care is transferred from one provider to another marks a transition across which we must find strategies to maintain the continuity of care for the patient. Some examples of critical transitions include:
- Clinical site: clinic, emergency department, hospital (and within hospital)
- Interdisciplinary: PCP, specialist, paraprofessionals, school
- Age: between pediatric and adult care, assisted- and self-care
- Location: when a family moves
- Plan early
- Expect that complex patients will need to go to the emergency room or be hospitalized
- Start planning for transition to adult care at age 14
- Consider all settings in which care will occur and how that care will happen, including: home, vocational, educational, and recreational
- Create systems that optimize communication between disciplines
- Maintain a portable medical summary or care plan. The American Academy of Pediatrics website http://www.medicalhomeinfo.org/tools/assess.html has examples of care plans and formats for portable medical records.
Christakis et al. Continuity of care is associated with high-quality care by parental report Pediatrics 2002; 109: e54.
Christakis et al. Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. Pediatrics 2001; 107:524-9.
Ettner SL. The timing of preventive services for women an dchildren: the effect of having a usual source of care. Am J Public Health. 1996;86:1748-54.
Haggerty et al. Continuity of care: a comprehensive review. BMJ 2003;327:1219-1221.
McBurney P, Simpson K, Darden P. Potential cost savings of decreased emergency department visits through increased continuity in a pediatric medical home. Ambulatory Pediatrics 2004; 4(3):204-8.