Dr. Adalsteinn Brown’s Feature post about continuity of care being a shared responsibility between many providers highlighted some interesting issues about team-based approaches to care and the cross-sector relationships that are vital to supporting continuity. Health Quality Ontario’s 2013 report on Continuity of Care for Chronic Disease Management showed that higher continuity of care decreases health service utilization; there is also an association between continuity and patient satisfaction, specifically among patients with chronic diseases and multimorbidity. Let’s explore these issues in the contemporary literature.
In a retrospective cohort study of nearly 6 million adults in Ontario, Gruneir et al. (2016) found that greater continuity lessened the effect of multimorbidity on hospital utilization, revealing a need for care continuity for patients with chronic diseases across multiple providers.
In Ontario, for clients living with dementia and receiving care in the home, multimorbidity is the norm rather than the exception. In a study of approximately 30,000 Ontarians with dementia receiving home care, Mondor et al. (2017) quantified the association between levels of multimorbidity and risk of emergency department visits, and explored the role of continuity of care in modifying these relationships.
In an international example from Denmark, Doessing & Burau (2015) conducted a scoping study which considered both case complexity (i.e., patients with multimorbidity) and care complexity (i.e., the organization of care delivery at the levels of provider organizations and health care professionals). Two main approaches were used to navigate complex coordination issues: embracing complexity, and trying to reduce complexity.
How are you or your organization supporting continuity of care? Do you have experience with multimorbid patients and coordination? Share your experiences and advice in the comments below.
