Table 2.

Extended continuity of care model [15]

Elements		Description
Original model of continuity by Haggerty and Reid [16]
1. Client and family		The perceived coordination of care for a single client over time.
2. Information continuity		The capacity of information belonging to a client, between providers and over time, to facilitate continuity of care experience [27].
3. Management continuity		The extent to which services delivered by different healthcare professionals are timely and complementary such that care is experienced as continuous [28].
4. Relationship continuity		A sustained relationship between a patient and a specific healthcare professional [29].
Extended features of model of continuity by Price and Lau [15]
1. Circle of care		An individual client’s healthcare system. The circle of care is a soft system that consists of the client, providers, other agents, and the information repositories (paper and electronic) related to that client. It is self-organizing, can span organizations, and changes based on the needs of the client and availability of resources [15].
2. Environmental influences		Factors outside the circle of care that can influence continuity of care – factors that are not related to the client, professionals, or information repositories.
3. Provider connectedness		Cohesiveness of the relationships between professionals in a circle of care.
4. Communication patterns	Transfer care	Handing off care responsibilities between care professionals of a similar capability.
	Provide current information	Ensuring that other professionals are aware of current findings and plans by sending information directly to named members of the circle of care.
	Encounter with client and family	Communicating with the client to examine the client’s condition share information, educate, and to develop a common understanding or plan.
	Request historical information	Seeking additional information from a particular professional, care team, or organization.
	Document in shared record	Documenting findings/plans in a location that is accessible to others (who have access).
	Review shared record	Review information shared by other members of the circle of care to increase knowledge of a client’s condition.
	Request generic advice	Request information and advice about options related to a client case.
	Request assessment and treatment	Contact another professional to request an action to assess and provide treatment recommendations to a client, based on their assessment.
	Orders	Request that specific activity be delegated to or performed by another professional.
	Case conference	To review, in real time with more than two individuals, the status and plans for the clients from multiple viewpoints.