Table 1. Five Domains of Continuity of Care.

1. Informational continuity links care between episodes and providers. It consists of the written medical documentation plus the often-unwritten patient context, values, and goals of care. Informational continuity is maintained when a primary care physician reviews the medical record to determine when a previous episode of gout occurred and what medications were used to treat it. It is also maintained when a consulting neurologist reviews the medical record provided by the primary care physician when evaluating a patient’s unilateral weakness. However, informational continuity does not imply a relationship with the patient. A lot can be known about a patient by reading their chart without ever meeting them.

2. Managerial continuity occurs when several medical professionals cooperate to provide care for a patient. This domain is especially apparent in chronic disease management and mental health care when multidisciplinary teams develop care plans for their patient. It is sometimes referred to as interdisciplinary or team-based continuity .

3. Relational continuity is found when one clinician provides care for a patient over time, connecting their past, present, and future. However, the relationship need not be cradle-to-grave. Relationship continuity can be found in the hospital if the admitting physician continues to care for the patient all the way through discharge, or if the nursing home clinician continues to follow the same residents. Relational continuity often results in unwritten informational continuity.

a. Longitudinal continuity is the most simplistic relationship form and is typically found in most family medicine and primary care practices. In common parlance, it simply implies that a single clinician provides care for the patient over time. Saultz defined it a bit more precisely and broadly as a “pattern of health care interaction that occurs in the same place, with the same medical record, and with the same professionals” allowing for a growth of knowledge about a patient over time.3

b. Interpersonal continuity is a special type of longitudinal continuity where the patient and doctor develop a partnership characterized by implicit knowledge, trust, and respect that facilitates good communication. This is the ultimate form of continuity sought by primary care medical home practices.

4. Family continuity implies the same clinician taking care of multiple family members, often from multiple generations (ie, grandfather, mother, daughter/son). That clinician possesses knowledge about the health care problems of other family members, which may impact the care of the current patient. Unfortunately, most electronic health records do not support family member linking.

5. Geographic continuity occurs when the same clinician cares for the patient in multiple locations or environments (ie, hospital, home, skilled nursing facility). The rise of hospitalists and the move away from Dr Ceriani’s full spectrum practice to the outpatient-only family physician has lowered geographic continuity.