Summary of Definitions of Continuity of Care

APPENDIX G - SUMMARY OF DEFINITIONS OF CONTINUITY OF CAREAuthor(s) Year Definition of ContinuityMindlin R.L., DensenP.M.Bass R.D.Bass R.D., Windle C.1969 “An infant was considered to receive medical care with continuity if he had a single source of medical care duringthe year, or if, having had more than one, he got the subsequent sources only by referral only from earlier sources.”1972 “Continuity is the relatedness between past and present care in conformity with the client's therapeutic needs.”“Continuity exists to the extent that: 1) there are no obstacles to a client remaining in or moving from any of thecenter’s direct treatment services in conformity with his therapeutic needs; and 2) administrative mechanisms relatepast and present care by providing 1. stable client-caretaker relationships; b. necessary communication, written andverbal, among caretakers participating in the client’s treatment program; and c. contact with clients who missappointments or go on unauthorized leave, and so appear to be prematurely dropping out of treatment.”1972 “[T]he relatedness between past and present care in conformity with the therapeutic needs of the client.”Byrd J.T.1972 “Appropriate care and treatment in accord with the needs of the client.”Teeter R.B.1972 “Coordination of in-patient and out-patient care, planning for necessary post-hospital follow-up, and focus duringthe hospital stay on the post-hospital life of the patient.”Bass R.D., Windle C.1973 “Relatedness between present and past care in conformity with client’s therapeutic needs.” Operationally,continuity of care exists when: “1. there are no obstacles to a client remaining in or moving between services inconformity with his therapeutic needs; 2. administrative mechanisms relate present and past care by providing a)stable client-caretaker relationships; b) necessary written and verbal communication among staff within andbetween the center’s services; and c) contacts with clients who appear to be dropping out of treatment or lost duringtransfer between treatment persons or services.”Sedgely D.J. 1973 “The relatedness between past and present care, in conformity with the client’s need.” (Bass 1973)Breslau N., Reeb K.G.1975 “[T]he extent to which a single physician manages health needs of a patient: the more the patient visits are with asingle physician, the more is the care considered continuous.”Hansen, M.F. 1975 Three elements: 1. “A continuing relationship between a physician or health professional and a patient”; 2.“Continuity of data or information”; 3. “The actual accomplishment of care itself.”Hennen B.K.1975 Four dimensions of "continuity of environment": 1) chronological – “Those aspects of health applied to changesover time, such as individual human development and family development.” 2) geographical – “the provision ofprimary care regardless of the site.” 3) interdisciplinary – “those aspects of continuity that cross the traditionalclinical disciplines.” 4) interpersonal – “Includes doctor-patient relationships, interpersonal family relationships,1

Author(s) Year Definition of Continuityand interprofessional relationships.”McWhinney I.R.1975 Continuity of care in family practice: “is not delineated by the nature of the disease” and is a “continuity of personalresponsibility”, “terminated only by death, by mutual agreement, or by decision of one of the parties.”Amyot A., Lavoie J.G. 1976 [Commitment to the patient and his/her changing needs regardless of site of care; can only be provided by a team –that acts as a substitute mother. Preferably team should be assigned on a geographic basis to be able to transcendorganizational barriers.] [Fr.]Breslau N., Haug M.R. 1976 “Continuity of seeing one’s ‘own’ physician.” “ The extent to which pediatric care was given to a family by a single(‘own’) pediatrician.”McGuire H.D. 1976 “…[A]n uninterrupted succession of care, a planned effort on the part of providers to assure patients continuity ofservices, if not by the same individual on all occasions, at least by health professionals who are familiar with thepatient’s condition and treatment program. This also implies uninterrupted succession when the patient’s needsrequire a transfer to another source of care…”Shortell S.M.1976 “Continuity of medical care can be defined as the extent to which medical care services are received as acoordinated and uninterrupted succession of events consistent with the medical care needs of patients.” Underlyingtraits implied by the definition include: “1) the extent to which the provider seen for the first visit is also seen in thenext and subsequent visits; 2) the extent to which broken appointments, whether due to provider or patient, areminimized; 3) the extent to which duplication of tests, examinations, history taking, and procedures is minimized;4) the extent to which appropriate follow-up care, including patient compliance, is maximized; and 5) the extent towhich medical care can be received in a single location.”Starfield B.H., SimborgD.W., Horn S.D., et al.Bice, T.W.,Boxerman, S.B.Shorr G.I., NuttingP.A.Shortell S.M.,Richardson W.C.,LoGerfo J.P., et al.Starfield B., SimborgD., Johns C., et al.1976 Continuity of medical record: “having the patient seek care from the same facility.”Continuity of practitioner: “patients saw the same physician on repeated visits.”1977 Continuity if care is “the extent to which a given individual’s total number of visits for an episode of illness of aspecific time period are with a single or group of providers.”1977 Transition rates of the population among critical elements of the process. Primary prevention to secondaryprevention to intervention. Specific illness, care process (succession of events over time), not provider specific.1977 “Number of different contact points (e.g., emergency room, physician’s office, outpatient clinic, etc.) for receivingcare out of total number of contact points available… . The two percentages are standardized to take into accountdifferences in the denominator. The scoring is then reversed by subtracting from 100 so that the higher numberindicates greater continuity.”1977 Continuity of practitioner: “When the same practitioner saw the patient on follow-up.”2

Author(s) Year Definition of ContinuityHinman E.J.1978 3 elements for a continuity of care system: “first, there must be an organized system within which the care isprovided; second, there must be providers with the training and motivation to assure that the proper care is given(the principal provider of this care will be the primary physician); and third, there must be extensive patientinvolvement in the delivery process.”Cook, R.L.1979 “Continuity involves (1) patient participation in the planning, implementation, evaluation, and revision of hi/hernursing care based on reliable information; and (2) the continuous flow of relevant information about the patientbetween appropriate health-team members.”Hadac R.R., SmithC.K., Gordon M.J.1979 “Continuity of medical care can be defined as the extent to which medical care services are received as acoordinated and uninterrupted succession of events consistent with the medical care needs of patients.” (Shortell)Pereira Gray D.J.1979 Distinguishes between "personal" and "continuous" care. Personal refers to trusting and committed relationship.Continuous care refers to seeing same physician over time.Rosenthal J.M., Miller1979 “Effective inter-institutional communication.”D.B.Steinwachs D.M.1979 “Provider continuity” is “the extent to which individuals only one provider for their medical care.”Test M.A.Davis M.Z.Horan M.J., Steinwachs D.M.,Smith C.R., et al.Patten R.C., FribergR.1979 Dimensions of continuity: 1. “Cross-sectional care” – “at any given point in a chronically mentally ill person’streatment, the person must be involved in a system of care that is comprehensive (in meeting unmet needs) andintegrated.” 2. “Longitudinal continuity” – “care that is continuous and integrated over time.”1980 Continuity of care refers to “the integration over time of staff and patient information and actions directed towardfurthering the physical and social-psychological rehabilitation of the patient, beginning in the hospital andcontinuing after discharge.”1980 “The receipt of coordinated and uninterrupted health care services.”1980 Several definitions: 1. “Seeing the same physician over a period of time.” 2. “Receiving care in the same locationand having a single medical record.” 3. “The number of physicians seen in a single spell of illness.” 4. “The rate ofcomplete immunization, the number of hospitalizations supervised by the regular provider.” 5. “The number offamily members seeing the same physician.”Phillips W.R., Little T.L. 1980 “All visits with their own family physician.”Rogers J., Curtis P.1980 Model of Continuity includes: 1. Elements – Provider (“physicians and nurses, paramedical workers, socialworkers, etc.”) Consumer (“individuals, nuclear families and even larger cohorts of people (schools, industrialunits, etc.”) Medical interaction (direct – “May occur visually, verbally, or by the written word i.e., face-to-face,through the telephone or via medical records, messages, etc.”; indirect – “uses the same communication method but3

Author(s) Year Definition of Continuityis undertaken by an intermediary, i.e., a mother discussion her absent child’s problem with a nurse, or a nursegiving the physician a message from a patient.”; 2. Knowledge Base – “The consumer element does not usuallypossess recorded prior knowledge about the provider, but may have unrecorded first or secondhand knowledgeabout this person (i.e., a physician’s reputation for kindness, medical skill, willingness to do home visits, etc.).”“The provider will usually have some recorded knowledge concerning the summer – medical records, hospitalsummaries, laboratory tests and correspondence (i.e., the script of direct and indirect encounters between thecontinuity elements). In addition the provider may have considerable unrecorded knowledge from multiple sources,both first and secondhand. The completeness and use of this knowledge has direct implications on the quality andlevel of continuity” 3. Continuity Environment – Hennen’s dimensions: “chronological, geographical,interdisciplinary, relationship, informational, accessibility and stability.”Roos L.L., Roos N.P.,Gilbert P., et al.Starfield B.Bachrach, L.Banahan Jr. B.F.,Banahan B.F.Breslau N., et al.1980 Multiple definitions: 1. “The extent to which medical services are received as a succession of coordinated anduninterrupted events.” 2. “Care received by a patient from a single physician (provider continuity).” 3. “Carereceived from multiple but related physicians such as those practicing as a group (site continuity).” 4. “Care linkedby a referral (Referral continuity).”1980 Longitudinality: “Care over time regardless of the presence of specific pathology.” Implies regular source of careand use of regular source of care over time. Continuity: “the way in which information about diagnosis andmanagement of a problem is conveyed from one visit to the next.”1981 “Continuity of care may be understood as a process involving the orderly, uninterrupted movement of patientsamong the diverse elements of the service delivery system.” Dimensions of continuity: temporal (longitudinal),individual (patient-centred), cross-sectional (comprehensive), flexibility (not a linear progression), relationship(between patient and providers), accessibility, and communication (between patient and providers)1981 “Continuity of care is a phenomenon that exists when (1) the patient perceives a dependency on the physician formedical care, and (2) the physician perceives a responsibility for the patient’s medical care.”1981 “[C]ontinuous care from the same physician.”Dietrich, A.J., Olson,A.L.Dorsky D.L., Housley C.E.Joseph B., Ryan C.F., BoudrealtT.M.M.A., Rice C.A.1981 “A continuing relationship with a personal physician.”1981 “To provide a patient’s transfer protocol and shared service agreement delineating the cooperation between the twoinstitutions in order to facilitate and insure efficient and effective patient care.”1981 “Passage of patients from inpatient to community care.”1981 “Continuous care by one provider.”4

Author(s) Year Definition of ContinuityWall E.M.1981 Multiple definitions: 1. “Personal responsibility neither limited by the nature of the illness nor by the time spentwith the patient.” 2. “The extent to which services are received as part of a coordinated and uninterruptedsuccession of events consistent with the medical care needs of patients.” 3. “The expectation of an enduringrelationship.” 4. “The amount of prior knowledge possessed by the elements (consumers and providers) involved inmedical care.” 5. “A process variable that accounts in part for the relationship between system organization andphysician utilization.” 6. “The extent to which a single physician manages the health needs of a patient.”Breslau N. 1982 “Continuous care from a single physician.”Dietrich A.J., MartonK.I.McWhinney I.Nassif D., Garfink C.,Greenfield C.Eriksson E.A.,Mattsson L.Fletcher R.H., O'Malley M.S.,Earp J, et al.Honovich D.Ejlertsson G., Berg S.Fletcher R.H.,O'Malley M.S.,Fletcher S.W., et al.Freeman G.K.1982 “Ongoing care from a person (such as a physician or other health professional) or from an institution (such as ahealth maintenance organization, hospital, or clinic).”1982 Hennen’s four dimensions of the “continuity environment”: “chronological, geographic, interdisciplinary, andinterpersonal.” Rogers and Curtis’ model of continuity includes Hennen’s dimensions, as well as: “informational,accessibility, and stability dimensions”.1982 “Structural continuity”: “pertains to the site of medical encounter and the way in which the delivery of services isorganized”. This definition assumes “that patients who receive all routine and nonemergent, nonroutine care at onesite are more likely to been seen by one physician or team of health care workers, and will, at least, have anintegrated medical record.” “Process continuity”: “the coordinated delivery of care over a period of time orthroughout an illness episode".1983 “The extent to which the same provider is seen during a sequence of visits.”1983 Strength of belief in the following statement, “You should see the same doctor on every visit.”1983 “Taking responsibility for your patients after discharge from your facility.”1984 “Seeing one's own physician on all visits.”1984 “Percent of all visits to the primary care physician.” Coordination is defined as “written evidence that the otherphysician was aware of the primary physician’s involvement, and that 1) the primary physician arranged visit to theother physician or knew about it beforehand; or 2) the primary physician was aware of the patient’s visit to theother physician after the visit.”1984 Personal/longitudinal continuity: “where one doctor may look after the same patient for many years ‘acrosssignificant life cycle changes of the patient.’”5

Author(s) Year Definition of ContinuityGodkin M.A., Rice1984 “[T]he degree to which the medical care of an individual patient is provided by a single physician.”C.A.Wasson J.H., Sauvigne A.E.,Mogielnicki R.P., et al.1984 Provider continuity: “the ongoing relationship between a patient and a health care provider, independent of thepatient’s particular medical problem.”Austin E. 1985 Continuity of care is “the frequency of visit utilization.”Berg. SCoyle N., MonzilloE., Loscalzo M., et al.Ejlertsson G., Berg S.Given C.W., BransonM., Zemach R.Brody S.J.Gruppen, L.D., Wolf, F.M.,Voorhees, C.V., et al.Quartier, F.Roland M., Mayor V.,Morris R.Tessler R.C., WillisG., Gubman G.D.Torrey EFZweig S., Kruse J.,LeFevre M.1985 “In comprehensive health services organizations, the continuity dimension tends to reflect the orchestration ofmedical services, while in a specialized medical organization continuity usually refers to the extent to which thecare of patients is given consistently by a single physician.”1985 “Continuity of care implies a stable therapeutic relationship between patient and care provider, the care beingappropriate to the patient’s needs. Implicit in this system is a necessity for the primary health care provider toremain involved with the patient and family throughout the course of the disease.”1985 “Maintaining a long-term patient/doctor relationship, regardless of that the problem may be.”1985 Ideal continuity: “where the patient receives care from the same physician at each visit.”1986 “Continuity of care embraces all providers with as many of the services delivered in concert or separately asrequired.”1986 The physician's preference for “maintaining full responsibility for the patient’s care and only consult with aspecialist.”1986 Long-term therapeutic relationship between a patient and provider(s). [French]1986 “Identification of one doctor as the provider of primary care for an individual patient over a long period of time.”1986 3 dimensions: Discharge planning – “the transition from hospital to the community”; Successful and rapid transfer– “services which are recommended are actually received, and…delivery of services begins in a timely fashion”;Implementation of individualized service plans – “services should be consecutive and related, with clientsexperiencing few if any breaks.”1986 “A process involving the orderly, uninterrupted movement of patients among the diverse elements of the servicedelivery system.”1986 Continuity of care: “whether patients had none, some, or most prenatal care with a delivering physician.”6

Author(s) Year Definition of ContinuityBachrach, L.1987 “Continuity of care means that the patient will be able to receive all of the different services that he or she needs,even through the service system is fragmented and even though many different service delivery agencies must beinvolved in his or her treatment.” It also means that “the service system must be accessible to the patient, accessiblein many different ways” including psychological access, financial access, geographic access and access over longperiods.Freeman G.K.1987 “The patient seeing the same doctor at each visit”Mattsson L.G., Westman G. 1987 “The extent to which each individual sees only one physician.”Ruane T.J., Brody H. 1987 “Continuity of care related to those aspects of medical care outside the present time, that is past and future.” Threeelements: “Cognitive elements include the knowledge that the physician must have to provide good continuingcare.” “Management elements…include those structural aspects of the medical care system in which the physician’spractices can facilitate or hinder optimal continuing care.” The relationship elements of continuity consist of“expectations about the physician’s personal availability and responsibility.”Tessler R.C.1987 “Comprehensive discharge planning, successful and rapid transfer and implementation of the program-specifictreatment plan.”Chao J. 1988 “Continuity of care may be conceptualized as an attitude on the part of the patient and provider rather than as asuccession of visits to the same provider.”Baker F., Vischi T.1989 Seven dimensions of continuity: “1) longitudinal – client treatment matches client progress even if care givers,treatment modalities or treatment sites change; 2) individualized – client care is planned for and with particularclients and their families; 3) comprehensive – the full range of services needed by a patient are made available; 4)flexible – the services provided to a client change as that individual’s needs change; 5) personal – clients can relyon relationships with a person or persons interested in them as individuals; 6) accessible – service delivery to aclient is experienced as free of barriers; 7) informative – continuity of information exists through opencommunications between client and service providers”Beland F.1989 “A characteristic of a physician visit.” “A visit is considered to be continuous respective to past visits made to thisphysician.”Conkling V.K.1989 Continuity of care is a “coordinated multidisciplinary program to restore an ill or disabled individual to his or hermaximum capabilities in physical, mental, social, vocational and economic usefulness.”Hjortdahl, P.1989 “Continuity of care can be defined as medical care provided over time for the patient by one health care regardlessof the presence of specific pathology or not.”7

Author(s) Year Definition of ContinuityKekki P. 1989 Gives several explicit definitions of continuity from Finland, Poland and Sweden.Pineault R., Lescop J.Weiss G.L., RamseyS.A.Banks N.J., Palmer R.H.Biehn J.T.Hjortdahl, P.Shegda L.M.,McCorkle R.Harding J.Herrick C.A., GoodykoontzL., Herrick R.H., et al.Hjortdahl P.,Borchgrevink C.F.Kersten D., HackenitzE.Lauria M.M.1989 Interdisciplinary or referral continuity is “the extent to which [the public and private sectors] are complementary toeach other.”1989 “An ongoing relationship between provider and patient.”1990 “The plan of care for a particular patient progresses without interruption.”1990 “Continuity of care in a teaching practice is defined as the responsibility for care undertaken by the team members,whereby patients can feel assured that their ongoing medical care will not be interrupted or compromised in the faceof inevitable turnover.”1990 4 different components: “The chronological component involves the provision of patient care over time. Implicit inthis concept is accumulated knowledge about the patient…; the comprehensiveness component involves taking careof the wide array of medical problems encountered in general practice…; the personal component includes empathyand personal involvement with the patient, lasting over time, overlapping parts of the interpersonal dimension; theresponsibility component entails a longitudinal attitude and willingness to care for or coordinate the differentmedical needs of the patient.”1990 “Coordinated process of activities that involves the client and health care providers working together to facilitatethe transition of health care from one institution, agency or individual to another.”1991 “Continuity is the assurance that knowledge of the details of one patient interaction is used in subsequentinteractions.” Differentiates 8 types of continuity: hospital-hourly, hospital-daily, hospital-weekly, hospitalrecurrent,hospital-ambulatory, ambulatory-hospital, ambulatory-recurrent, ambulatory coverage.1991 Stedman’s (1982) definition: “Continuity is the absence of disruption or a succession of parts that are intimatelyunited.”1991 “Medical care over time provided by one health care worker regardless of the presence of any specific disease.”1991 “Continuity of care is the extent to which services are received as part of a coordinated and uninterruptedsuccession of events consistent with the [nursing] needs of the patients”. (Shortell)1991 “[T]he systematic assurance of uninterrupted, integrated medical and psychosocial care of patient, in accord withthe patient’s wishes, from assessment of symptoms in the prediagnostic period, throughout the phase of activetreatment, and for the duration of posttreatment monitoring and/or palliative care.”8

Author(s) Year Definition of ContinuitySemke J.1991 “A process involving the orderly, uninterrupted movement of patients among the diverse elements of the servicedelivery system.” (Bachrach 1991).Barbato A., TerzianE., Saraceno B., et al.Brekke J.S., TestM.A.Hjortdahl, P.Liaw ST., Litt J.,Radford A.White D.Anderson M.A., Helms L.Bachrach L.L.Commonwealth ofAustraliaFreeman G.K.,Richards S.C.Gabel L.L., LucasJ.B., Westbury R.C.1992 “A process involving the uninterrupted movement of patients over time through the diverse elements of the servicedelivery system.” (Bachrach 1991)1992 2 dimensions: “cross-sectional ‘continuity refers to the need at any one point in time for the client to be involved ina system of care that is comprehensive and integrated.’” “Longitudinal continuity means care that is continuousand integrated over time.”1992 Traditional aspect of continuity: “Medical care provided over time by one health care worker.” Revised definitionof continuity: “‘A sense of overall, direct or coordinative responsibility for the different medical needs of thepatient.’”1992 Five dimensions of the continuity environment: “firstly chronological continuity, which refers to care provided overtime to a defined population (also known as longitudinal continuity); secondly geographical continuity referring tosite continuity and/or provider continuity regardless of site (office, hospital, home)… Thirdly interdisciplinarycontinuity or the role of the general practitioner in tackling or coordinating the undifferentiated illnesses, themultifactorial causes and the range of services available. Fourthly interpersonal or relational continuity refers tocontinuity of process that involves the quality of relationships...Informational continuity refers to the medicalrecord as well as all forms of communication between the patient and provider.”1992 Gives several definitions from the literature including: “A broad number of strategies intended to ensure long-term,comprehensive support for people with mental health problems in managing day-to-day life in the “natural milieu”or non-institutional environment.” “ The coordination of diverse services required for the treatment of any type ofchronic or complex illness.”1993 “Coordinating the delivery of ongoing health care services in a variety of health care settings.” “Discharge planning[is] a means of achieving continuity of care [and] is the process in which a patient’s continuing health needs areidentified and communicated to providers at the next level of care.”1993 Canadian definition of continuity of care: “A general practitioner or family physician who, in addition to medicaltasks, takes on direct responsibility for connecting patients with the mental health service system.”1993 “Continuity of care is the provision of long-term, barrier-free access to the necessary range of mental health,general health, social and disability services.”1993 “Seeing the same doctor each time.”1993 Long-term relationship with physician. Ten domains characterise continuity from patient perspective: 1)“familiarity with physician” 2) “physician's knowledge of patient” 3) “satisfaction with care” 4) “confidence inphysician” 5) “personal attributes of physician” 6) “friendship with physician” 7) “professional growth of physician9

Author(s) Year Definition of Continuity(currency of medical knowledge)” 8) “availability of physician” 9) “location of physician's office” 10) “ease ofcommunication with physician.”O'Hare P.A., YostL.S., McCorkle R.Beddar, S.M., Aikin,J.L.Bostrom, J., Tisnado, J.,Zimmerman, J., et al.Brown L., Cox G.B., JonesW.E., et al.Cameron B.Freeman G.K.,Richards S.C.Holzman M.D., Elkins C.C., NeuzilD.F., et al.Shern D.L., Wilson N.Z., CoenA.S. et al.1993 “The continuity of care process is ‘…directed to the problems associated with the initial phases of the disease andto the continuing management of those not cured of the disease’. Attention to educational, psychosocial, andrehabilitation needs is part of the ongoing process of comprehensive care for patients and families. Continuity ofcare as a process includes cognitive, management, and relational elements.”1994 “[C]ontinuity of care is a philosophy and standard of care that involves patient, family , and health care providersworking together to provide a coordinated, comprehensive continuum of care.”1994 Continuity of nursing care: “how often patients are actually cared for by the same nurse during hospitalization.”1994 “A process involving the orderly, uninterrupted movement of patients among the diverse elements of the servicedelivery system” (Bachrach 1991).1994 “Continuity of care is the desired end product of the discharge process, which enables clients to maximize theirpotential for wellness in a dignified manner while minimizing discomfort and stress.”1994 Personal continuity: “seeing the same doctor”. “An on-going doctor-patient relationship built up over time.”1994 “…[W]orking with a critically ill patient and serially observing response to therapy for complex problems.”1994 “The likelihood that an individual saw a case manager, therapist or psychiatrist some time during the year and thenumber of times that this person reported being terminated from mental health care during the same period.”Spooner S.A. 1994 “[T]he extent to which same provider is seen during sequence of visits.” (Eriksson, Mattsson 1983)Volpe F. 1994 “[H]ealth care…provided in a manner that includes constant awareness of the patient’s past medical history, signs,symptoms, findings, treatments, and responses to treatments, all the while with interrelationships being seen whenthey exist.” “Being attuned to the patient’s feelings about the care provided, because a patient’s cooperation isneeded to achieve maximum continuity.”Buetow S.A.1995 “Longitudinality refers to care from the same doctor, group of doctors or facility over time, regardless of thepatient’s health problem.”Emanuel E.J., Dubler N.N. 1995 “Once established, a patient’s relationship with a competent and compassionate physician who is providing most ofhis or her care should endure over time.”Farrell S.P.1995 “The successful initiation and maintenance of face-toface contact by CSB (Community Service Board) staff withclients in state hospitals, and the provision of services post-discharge.”10

Author(s) Year Definition of ContinuityHospital Food Nutrition Focus 1995 “A component of patient care quality consisting of the degree to which the care needed by a patient is coordinatedamong practitioners and across organizations and time.”Prendergast P.J.1995 “A process that involves the orderly, uninterrupted movement of patients among the diverse elements of the servicedelivery system.” (Bachrach 1991) “Continuity of treatment refers to the maintenance of specific treatmentstrategies over time; continuity of caregivers refers to the specific relationship between the patient and the treatmentproviders; continuity of caring refers to the use of that caregiving relationship to provide longitudinal support toVivier P.M.,Lewander W.J., BlockS.H., et al.Achterberg, T.V.,Stevens, F.C.,Crebolder, H.F., et al.Alberta Association of RegisteredNursesAnsel M.G.Bell, R.vulnerable individuals.” (Harris & Bergman 1998)1995 Longitudinality is “’the presence and use of a regular source of care over time.’”Continuity is “’the means by which separate parts of (an illness) episode (either the follow-up of an acute illness orthe ongoing care of a chronic one) are joined.’”1996 “Interdisciplinary continuity can be seen as continuity in complex, multidisciplinary services. Appropriate referralsand coordination of services are examples of interdisciplinary continuity. Interpersonal continuity involves thequality and the endurance of relationships between clients and care providers. …Informational continuity refers tothe completeness of information available to and documented by care givers, thus preventing unnecessary orduplicate care or treatment.”1996 “Continuity of care is the comprehensive, coordinated, and integrated provision of appropriate health services.”1996 Cross-sectional continuity is “the comprehensiveness and level of integration of a client at any given point of timethey are involved in the community support system.” Longitudinal continuity is “care that is provided continuouslyin an integrated fashion.”1996 Continuity is provided by “having the same nurse visits the same client at the same time as often as possible.”Bickman L.1996 Continuum of care: “availability (and accessibility) to the full range and level of mental health services required tomeet the changing needs of children with mental health disorders.” Continuity of care: “The delivery of coordinatedservices on an individualized basis.”Escott-Stump S. 1996 “Coordination of health care activities by all disciplines within and outside the institution before admission, duringadmission, before discharge and at discharge.”Mustard C.A., MayerT., Black C., et al.O'Malley A.S., Forrest C.B.1996 Continuity of care and regular source of care: “The longitudinal characteristic of patient-provider affiliation overtime.”1996 Continuity with a community health care facility is “identification of a CHC as the site for both routine and sickcare.” Continuity with a specific clinic is “identification of a specific clinician for sick care needs.”11

Author(s) Year Definition of ContinuityOwen C. 1996 “The relationship between general practitioner and patient in the long temporal axis.”Pilotto L.S.,McCallum J.,Raymond C., et al.Weiss L.J., Blustein J.Weyrauch K.F.Alegria M.,Pescosolido B.A.,Santo D., et al.Anderson M.A., Foreman M.D.,Theis S.L., et al.Castledine G.Chung R.S., Verghese J., DiazJ., et al.Elder W.G.1996 “The uninterrupted responsibility of one doctor for a patient’s care”. Dimensions that affect the quality and level ofcontinuity (the continuity environment): “Chronological – continuity of care over time; geographical – continuity ofcare at different sites; interdisciplinary – holistic or specialized care; relationship – relationships with health careproviders; informational – medical information supporting continuity; accessibility – continuity improved by easyaccess to care and advice; and stability – continuity affected by stability or mobility of health care provider andpatient’s family and community”.1996 “The maintenance of enduring patient-provider relationships over a period of time.”1996 “Patients seeing their own physician versus someone else.”1997 “Single provider continuity occurs when 1) one provider is seen in three of more visits within a six month period, 2)for the same problem (as defined by the respondent) and 3) without a gap of more than two months within thatperiod unless the problem is reported to be solved.” “Multiple provider continuity occurs when 1) at least onemember in a team of providers is seen in three or more visits within a six month period, 2) for the same problem (asdefined by the respondent), 3) without a gap of more than two months within that period unless the problem isreported to be solved and 4) with an explicit referral or sharing of in formation among the providers.” “Systemcontinuity is the situation in which 1) 3 or more visits occur within a six month period, 2) for the same problem (asdefined by the respondent), 3) without a gap of more than two months within that period, 4) within the same system(public or private) of care.” “Sector continuity represents the situation where there are 1) 3 or more visits occurwithin a six month period, 2) for the same problem (as defined by the respondent), 3) without a gap of more thantwo months within that period unless the problem is reported to be solved and 4) within the same sector of care.”1997 “Involves a series of comprehensive, coordinated linkages across time, settings, providerse, and consumers ofhealth.”1997 “Continuity suggests something which is unbroken, uninterrupted and continuous, a linkage between a sequence ofevents or related factor. In the case of nursing care, the expectation is that the same nurse will follow the patientthrough the key stages of his/her hospitalization or during a specific period in the community setting.”1997 “A programmatic provision for the trainee to participate in all phases of surgical experience (pre operative,operative, post operative and return follow-up).”1997 Continuity of care: “continuous relationship with a provider or clinic throughout an episode of care.” Continuum ofcare: “matching patient need with appropriate type and intensity of care over trajectory of illness.”12

Author(s) Year Definition of ContinuityFlocke S.A.1997 “Continuous care by a physician or team over time.” “Longitudinality is defined as the length of the relationshipwith the physician.”Flocke, S.A., Stange,K.C., Zyzanski, S.J.Freeman G., HjortdahlP.Hawton K.1997 “Development of an ongoing relationship with communication, trust, and partnership with patients is a centralelement to providing quality of care.”1997 Longitudinal continuity: “Care given by one practitioner over a defined time. Personal: “an ongoing therapeuticrelationship between patient and practitioner.”1997 “Patient being seen by the same therapist for both initial assessment and subsequent treatment.”Hundley V.A., Milne J.M.,Glazener C.M. et al.Johnson S., ProsserD., Bindman J.Meijer W.J., VermeijD.J.B.Schultz A.A., Geary P.A., CaseyF.S., et al.Smith T.E., Hull J.W., Hedayat-Harris A., et al.Stewart A.L., Grumbach K.,Osmond D.H., et al.Zurek E.L.Bickman L., Salzer M.S., LambertE.W., et al.Citro, R., Ghosh S.,Churgin P.G.Forrest C.B., StarfieldB.1997 “Continuity of carer” is the same midwife “both during labour, at delivery and after delivery.”1997 Cross-sectional aspects: “continuity between service providers, comprehensiveness, and accessibility.”Longitudinal aspects: “continuity of contact (does the service stay in contact with the patient), continuity ofprovider, continuity through discharges and transfers, implementation of service plans.”1997 “Continuity of care implies continuity of caregiver or coordination among practitioners, among organizations, andover time.”1997 Continuum of care: “Coordinated process of activities that results when patients and health care providers worktogether to facilitate the transition from one level of care to another.” (Zarle 1989)1997 “The same clinicians provide clients with core services for the duration of their treatment in the program.”1997 “Length of time the person has been coming to the place.”1997 “Coordination of activities involving patients, providers and payers to promote the delivery of health care.”1998 Continuum of care: “availability (and accessibility) to the full range and level of mental health services required tomeet the changing needs of children with mental health disorders.” Continuity of care: “The delivery of coordinatedservices on an individualized basis.”1998 “The delivery of care in an uninterrupted and coordinated manner and in accordance with the patient's needs.”1998 A “’sustained partnership’” between patients and providers that addresses the ‘majority of a populations’ healthneeds.’” “Continuity implies that individuals use their primary source of care over time for most of their health careneeds.”13

Author(s) Year Definition of ContinuityGill J.M., Mainous1998 “Seeing the same health care provider over time.”A.G.Hill J., Schofield P.F.1998 “Effective hand-over procedures and clear communication between doctors.”Saarento O., ÖiesvoldT., Sytema S., et al.Sahlberg-Blom E.,Ternestedt B.M.,Johansson J.E.Smith L.L., AldersonC., Bowser J., et al.Waldenström U.,Turnbull D.AIDS Policy LawBrekke J.S., Ansel M.,Long J., et al.Chaudry R.V., Brandon W.P.,Schoeps N.B.Downing A., Hatfield B.Hecht F.M., Wilson I.B., Wu A.W.,et al.Love M.M., MainousA.G.Perrin J.M.1998 “The degree to which the service system links episodes of treatment into a seamless, uninterrupted whole, inconformity with the needs of the patient.” “Continuity of care is a multidimensional concept including integrationand coordination of services, communication among the various service providers and the stability of patientcaregiverrelationship over time.”1998 “Continuity of care means that the patient receives adequate care and treatment on a regular basis, and that thedifferent care episodes are connected in such a way that care actions occur in a similar way and the care culture isthe same. Continuity of care is partially dependent on continuity of person, and means that as few people aspossible provide the care, while continuity of care site means that the patient stays at the same place for a longerperiod of time.”1998 Continuous treatment teams: “consistent group of care providers giving on-going care in whatever setting the clientis found.”1998 “[C]ontinuity of midwifery care…[is] that provided by a midwife or small group of midwives from early pregnancyto the postnatal period.”1999 “Continuity of care – which includes not only access to medications but also to education, prevention and supportservices – is a necessity given the fact that most inmates eventually return to the communities where they lived.”1999 Longitudinal continuity – “the extent to which clients are involved in treatment continuously over time withoutgaps in service.” Service intensity – “the number of service contacts or total duration of service contacts over aspecified period.”1999 “Access to a regular doctor.”1999 “No service user is lost to services.” “There is a named key worker (case manager) who both delivers andcoordinates care.”1999 “Maintaining consistent providers over time and planning for follow-up.”1999 “A continuous long-term relationship between a physician and a patient….”1999 Continuity is an “uninterrupted connection or succession; close union of parts.”14

Author(s) Year Definition of ContinuityPreston C., Cheater F., Baker R., etal.1999 “Receiving care from a particular professional throughout the care process, and receiving consistent, coordinatedcare from different staff working together.”Raddish M., Horn S.D., Sharkey 1999 “Number of providers caring for a patient in a managed care setting.”P.D.Sytema S., Burgess P.1999 2 dimensions: Cross-sectional continuity is “the comprehensiveness and accessibility of services required to meetthe range of needs of long term patients.” Longitudinal continuity includes “continuity of service provision(sustained contact with services), continuity of service provider (i.e. patients receive services across time from thesame staff), and continuity through discharges and transfers (i.e. flexible and rapid transfer between care levelsWare N.C., Tugenberg T.,Dickey B., et al.Anderson M.A.,Helms L.B.Bindman J., JohnsonS., Szmulker G., et al.Biró M.A., Waldenström U.,Pannifex J.H.according to varying needs of patients).”1999 “Management and treatment of [severe conditions that are chronic and debilitating] over time.” Continuum of care:“a system of interventions with multiple components of varying intensity.”2000 “Continuity requires coordination of patient information among providers involved in an episode of care.”2000 “Perceived accessibility of services and knowledge about them, the number of keyworkers in a defined period oftime, and the proportion of time out of contact with services.”2000 “Caregivers committed to a shared philosophy of care or care provided by a small group throughout thechildbearing episode.”Bull M.J., Hansen H.E., Gross C.R. 2000 “Consistency of information about a patient’s illness and care management.”Cassady C.E., Starfield B.,Hurtado M.P., et al.Chien C.F., Steinwachs D.M.,Lehman A., et alCook A., Lennox N.Fleming D.M.Freeman G., SheppardS., Robinson I., et al.2000 Longitudinality: “ongoing person-focused care.”2000 Continuity of care is “longitudinal care that is integrated and coordinated over time.” Provider continuity is “seeingthe same provider…for all mental health care over time.”2000 “Established ongoing doctor patient relationship.”2000 Hennen’s 7 dimensions: “chronological (i.e. longitudinal); geographically linked (organizational); interdisciplinary(integration of care between specialties and paramedical services); relationship (between the carer and the caredfor); information (records systems); accessibility (concerned with the organization of care rather than its location);stability (refers to the stability of a particular patient’s environment).2000 A multi-aspect definition of continuity with six elements: “1.The experience of a coordinated and smoothprogression of care from the patient’s point of view (experienced continuity). To achieve this central element theservice needs: 2. Excellent information transfer following the patient (continuity of information). 3. Effective15

Author(s) Year Definition of Continuitycommunication between professionals and services and with patients (cross-boundary and team continuity). 4. Tobe flexible and adjust to the needs of the individual patient over time (flexible continuity). 5. Care from as fewprofessionals as possible, consistent with other needs (longitudinal continuity). 6. To provide one or more namedindividual professionals with whom the patient can establish and maintain a therapeutic relationship (relational orpersonal continuity).”Freeman G.K.2000 Longitudinal continuity: “Seeing the same doctor at each contact.”Fu J.C., Lou W.Y.W.Green J.M., Renfrew M.J., CurtisP.A.Guthrie B., Wyke S.Neal R.D., Heywood P.L., MorleyS.2000 “Continuity of care describes the extent to which information about the diagnosis and management of healthproblems is conveyed from one visit to the next….This definition includes not only provider continuity but alsoother dimensions such as continuity of medical records and of geographical treatment site.”2000 Continuity of carer: “Care given by just one person.” Continuity of care: “Consistency of care from a trustedprovider.”2000 Traditionally, continuity of care has meant “a patient visits the same doctor.” Personal continuity occurs when an“ongoing doctor-patient relationship ensures that care takes account of the patient’s personal and social context.”2000 “The provision of care by one practitioner over a defined time.”Newberry P. 2000 “A continuous relationship between one physician and one patient over extended periods of time.”Roussey M., Desrues B., Turck D.,et al.Sparbel K.J.,Anderson M.A.Sturmberg J.P.Waldenström U., Brown S.,McLachlan H., et al.Donaldson M.2000 [Transfer of clinical responsibility from pediatric to adult care for very long term childhood chronic conditions e.g.Cystic Fibrosis. The success with which care is transferred depends on many factors; especially the existence of acompetent team to take care of the adult so that the patient can “separate” from trusted pediatric team to adult care.][Fr.]2000 “Continuity of care is a series of connected patient-care events both within a health care institution and amongmultiple settings. It requires coordination and linkages across time, settings, providers, and consumers of healthcare.”2000 Continuity of care “requires a stable care environment, …good communication to build a responsible doctor-patientrelationship and…the goal of achieving an improvement of the patient’s overall health.”2000 “Attendance at birth by a known caregiver.” “ Continuity of care can also mean caregivers working with a sharedphilosophy and guildelines for practice.”2001 “The degree to which health care activities are structured to increase information available to a clinician and toincrease the likelihood of goal alignment between the patient and the clinician.”16

Author(s) Year Definition of ContinuityInstitute of Medicine2001 “Continuity is a characteristic that refers to care over time by a single individual or team of health professionals(“clinician continuity”) and to effective and timely communication of health information (about events, risks,advice, and patient preferences) (“record continuity”). It applies to both space and time. It combines events andinformation about events occurring in disparate settings, at different levels of care, and over time, preferablythroughout a person’s life span. Continuity encompasses patient and clinician knowledge of one another and theeffective and timely communication of health information that should occur among patients, their families, otherspecialists, and primary care clinicians.” (p.43)Lou W.Y.W.2001 “Describes the extent to which knowledge about the diagnosis and management of health problems is conveyedforward in time, and efficient transfer of such information between patient visits as well as providers is vital tooptimal usage of available health care resources.”Shi L., Starfield B.,2001 “Longitudinality presupposes the existence of a regular source of care and its use over time.”Xu J.Center to ImproveCare of the Dying∅ Record continuity: “whether information about a patient’s history, visits, tests, allergies, medications, andpreferences are available to all clinicians who care for the patient.” Clinician continuity: “the proportion of patientvisits that are with a given ‘index’ clinician who might be identified in a variety of ways…” Site continuity: “usualsource of care.” Continuum of care: “a client-oriented system composed of both services and integratingmechanisms that guides and tracks patients over time through a comprehensive array of healthy mental health andsocial services spanning all levels of intensity of care.” Contract of attitudes: “patients’ understanding about who isin charge of their care.”17