Continuity of care is a cherished term in health policy deliberations. No one will argue against continuity of care. Various policies and programs find their justification in their link to continuity of care. This is not surprising, as just about every definition of continuity of care touches on desirable characteristics like collaboration between providers and patients, ongoing management of care beyond a single health problem or encounter, and a close link between continuity and overall quality of care.
Although continuity of care promises several benefits, we rarely think about the ways our systems support continuity and help us realize the benefits of continuity. At the clinical micro-system level, continuity is critical to ensuring safe, effective and patient-centred care, largely through coordinated team-based approaches to care where there is clear accountability for the performance of that team and any hand-offs between teams. The Accountable Care Unit Initiative in Saskatchewan provides an example of the some of the ward-level factors that are necessary to support continuity of care. However, the benefits of this sort of continuity of care, whether it be shorter lengths of stay, improved patient experience in hospital settings, or better control of chronic disease in community-based settings, also depend on organizational and system-level factors.
Organizations and the professionals who work in these organizations have to be set up to support continuity through the way they define professionals’ roles in managing care, their connectivity and relationships to other care organizations, and their understanding and connection to the community in which they work. Likewise, organizations have to be set up to encourage providers to work with patients and with other providers. Although every hard-working clinician will agree that working with patients and other professionals is part of their job, many still find it a struggle to find the time to do so. Often, we point to the business case for continuity and assume that providers will be compelled to support continuity because it leads to better quality and lower cost. But however compelling this business case is, it is still not sufficient.
This takes us to the last part of the continuity puzzle: the role of system factors. Continuity of care means that patients and providers work together to make sure that they get the care they need at the time and place that they need it. This typically means that more and better care in the community (and better organized care in institutions) ends up replacing more costly care in institutions (and the cost of adverse events and other problems in institutions). However, that alone is not a compelling business case because the costs of continuity fall in one area (typically the community) and the benefits accrue somewhere else (typically in the hospital or the long-term care home). If these organizations are not integrated, there is little opportunity to connect the costs and the benefits in one organization and thus, little opportunity to realize the business case.
This means that continuity of care is everyone’s business, but what we need to do to support continuity at one level (build strong team-based approaches to care) is different from what we need to do at a different level (integrate institutions and professionals across sectors). No one group can fix continuity on their own, but we can all do something to improve continuity.