Continuity of Care: A Reconceptualization

Abstract

Although continuity of care is considered an essential feature of good health care, researchers have used and measured continuity in many different ways, and no clear conceptual framework links continuity to outcomes. This article of offers a reconceptualization and definition of continuity based on agency theory. It posits that the value of continuity is to reduce agency loss by decreasing information asymmetry and increasing goal alignment. Three decades of empirical literature on continuity were examined to assess whether this model would provide greater clarity about continuity. Some authors measured improved information transfer, but more appeared to assume that continuity would lead to better information. Most authors appeared to have assumed that goal alignment was present and did not measure it. The model of continuity based on agency theory appears to provide a useful conceptual tool for health services research and policy.

Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in general practice

“…Of interest, these findings were consistent with agency theory, a theoretical framework that has been extensively used in the economics (Shapiro 2005), health economics (Sekwat 2000;Schneider and Mathios 2006) and social sciences literature (Eisenhardt 1989). In an agency framework, it is anticipated that a patient would feel less risk where there is the involvement of a HP with whom they have a long-term relationship across all aspects of care as this optimises information symmetry and goal alignment in the care encounter (Donaldson 2001). The risk of information asymmetry increases with the increasing complexity of that information and, hence, it would be anticipated that patients would have a higher requirement for continuity with increasing multimorbidity.…”

“…Agency theory has been proposed as a framework for reconceptualising interpersonal continuity of care (Donaldson 2001). Agency theory deals with the so-called 'agency problem', which exists when one person (a principal) engages another (an agent) to act on their behalf (Eisenhardt 1989), such as in a patientÀHP relationship.…”

“…In agency relationships it is held that risks arise when principals and agents have incomplete information concerning each other or have divergent goals (Shapiro 2005). Interpersonal continuity of care in health care agency relationships can be seen as a means by which patients (principals) can optimise shared knowledge and develop shared goals with their HPs (agents) (Donaldson 2001). Thus, agency theory may have value as a framework for research into complex care systems, such as multidisciplinary teams, and the evaluation of the degree to which the functions of interpersonal continuity valued by patients are expressed (Donaldson 2001).…”

Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results.

“…In addition, most studies of care continuity have followed people for relatively short periods (12 months or less) (Adair et al, 2005), yet the kinds of clinician-patient relationships necessary for improving care may take significant time and experience to develop. Thus, what we have come to call "continuity of care" could more realistically be viewed as a group of somewhat-related measures that serve as proxies for a more complex set of interrelationships that include: (a) coordination of care between clinicians working simultaneously with one patient, (b) smooth transitions in care from one clinician or service setting to another, c) clinician-patient interaction patterns, d) learning, education, and information exchange on the part of clinicians and patients, and, perhaps most importantly, e) the construction of a shared history of illness and recovery and the development of important interpersonal ties (Chien, Steinwachs, Lehman, Fahey, & Skodol-Wilson, 2000;Donaldson, 2001;Freeman & Sheppert, 2000;Johnson et al, 1997).…”

Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study

“…Background: Accurate information transfer is an important element of continuity of care and patient safety [1][2][3][4]. Despite the demonstrated urge for improvement of communication in acute care, there is a lack of data on improvements of communication [1,4,5].…”