Coordination of Care for Persons with Disabilities Enrolled in Medicaid Managed Care: A Conceptual Framework to Guide the Development of Measures. D. Care Coordination And Continuity Of Care


In discussions with our TAG, we raised the issue of the relationship of care coordination and continuity of care, which has been a concern within medicine, and especially primary care, for several decades. They agreed that continuity of care was a part of care coordination, specifically coordination of care received over time, but that coordination was a broader and more complex concept.

Continuity, and related terms such as "longitudinality" has been defined and measured in a number of ways over time. Our work in this area has been immeasurably enhanced by access to the research and thinking of Molla Donaldson, who provided us with her thoughtful analysis and synthesis of the research on continuity (personal communication). Continuity appears to have been of particular interest with respect to care provided by physicians. It has often been defined as the use of the same clinician over time, or in a related way by the existence of a "usual source of care" whether that was a particular individual or a group practice setting such as a community clinic (Bass 1972; Hennen 1975).

Over time, however, the concept had to be broadened to address such issues as referrals to specialists, and whether the primary care physician knew about the use of specialists and got information about the insights of specialists and the treatments they prescribed. The emergence of multi-disciplinary teams made the concept of continuity of a single provider less meaningful. In the population of the frail elderly, in particular, transitions from one care setting to another and the appropriate specification of "level of care" within the "continuum" also make it difficult to stay with a narrow definition of continuity. As we enter the 21st Century, the emergence of the "hospitalist" physician poses another challenge to individual clinician continuity as a concept and as a "norm." Indeed, the literature, fairly early, began to use the word "coordination" in defining continuity (Starfield 1976).

It may indeed be the case that continuity of provider(s) be one but not the only approach to supporting care coordination. It may be an especially significant element of care coordination for certain people with disabilities (for example, those with rare diseases or those who have developed a uniquely satisfying relationship with one or more providers or settings). But continuity of provider does not guarantee coordination, and coordination may occur in situations where provider continuity is far from perfect (Addington-Hall 1992).

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