Continuity of Care

Definition

Continuity of care is overseeing, documenting, and coordinating every aspect of the your care so that tasks are completed and one hand knows what the other is doing. It is the feature that makes primary care essential.

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Why You Need Continuity of Care

Your Health is Dynamic

Your environment is in constant flux, diseases wax and wane, and none of us can escape the process of aging.

The Human Body is Complex

The human body is made up of many sub-systems which not only interact with one another in unpredictable ways, but each requires its own specialist to manage.

Diagnosis and Treatment Are Rarely Straightforward

Tests often trigger more tests - a diagnostic cascade. Treatments are unpredictable in their effects and side effects - they require an iterative process of trial-and-error and careful observation over time.

Healthcare Systems Are Fragmented

Your healthcare is delivered in different locations with different record systems that are overwhelmed, impersonal, and don't communicate.

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The Three Components of Continuity of Care

Relationship Continuity

This is having the same doctor over time - from phone call to phone call, visit to visit, and year to year. With time, this doctor begins to accumulate knowledge about you - your values, your passions, and your fears. Knowledge difficult to record in a chart, yet vital to making good medical decisions.

Information Continuity

This is the maintenance and distribution of your medical records. Medical care produces a mountain of information. Your health records need to be collected and accessible in a central location. Only with full access to complete information can your doctors make accurate medical assessments.

Management Continuity

The complexity and dynamic nature of your health requires coordination. A single entity needs to assume accountability. An entity with infrastructure to ensure follow-through. That every plan is carried out from idea to completion. monitor tests, treatments, chronic conditions, specialty consultations, and ensure follow-through.

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The Benefits of Continuity of Care

From observational studies, patients with good continuity of care have better health outcomes, including:

• Greater patient satisfaction

• Increased adherence to medication

• Fewer ER visits

• Reduced hospital use

• Reduced mortality

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Reasons for Poor Continuity of Care

Unfortunately, there are several reasons for poor continuity of care in the practice of healthcare. These are systemic problems they Let's review them:

No Primary Care

Some patients have little faith in primary care. They bypass it, acting as their own primary care, referring themselves straight to specialists.

Unqualified Primary Care

Some patients use their alternative or 'functional medicine' doctor as their primary care. These doctors can be helpful in certain situations, but should be regarded as specialists, not primary care. Another scenario is to use an executive physical doctor (usually from another city) as a primary care. Unfortunately, different doctor is often assigned each year, and they are unavailable when you become ill and need them the most.

Corporate Takeover and Instability

The acquisition of independent practices by hospitals and private equity firms has introduced significant instability into primary care. It priorities profit over longitudinal physician-patient relationships. A formula that often leads to physician dissatisfaction and high staff turnover.

Fragmented Provider Coverage

Within your primary care practice, you may see different providers who may not communicate well with one another or may not have access to your records. This is common after hours or on weekends; a covering provider who does not know your case will often default to an ER referral as the safest option

Unclear Accountability

Continuity of care is shared between primary care doctors and specialists, it’s often unclear who is responsible.

Lack of Incentives

Neither primary care doctors nor specialists are incentivized to ensure continuity of care, as it is not directly reimbursed. The system favors office visits, tests, and procedures over the "invisible" work of coordination. It's better to pass the responsibility back or forward to the other doctors in the case.

Inadequate Office Resources

Continuity of care requires tremendous office resources: time, personnel, and expertise. Most primary care doctors do not have this.

Inadequate Patient Involvement

Patients know their own cases best, yet they often face tremendous difficulty with access and simply being heard.

About

Engineering Continuity of Care

The concierge model of medicine is the ideal practice model for optimal continuity of care. I have designed my practice specifically to avoid the systemic failures listed above:

Consistent Provider

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Clear Accountability

In my practice, accountability is clear. I am in charge of your case and I always assume total accountability for the coordination of your care.

Appropriate Incentives

My practice model based on a yearly fee, and only a yearly fee. This incentivizes us to provide good health outcomes, not upsell products or services. Since continuity of care is associated with such good patient outcomes, it is on the short list of priorities.

Ample Resources

With far fewer patients than a typical practice, my staff and I are never overwhelmed. We have the resources necessary to take on even the most complex case.

Direct Access

Patients are encouraged to assist with continuity of care. They can reach us directly, and more importantly, we can act as liaison between you and the specialists involved in your care.

With this my practice excels in all three components of continuity of care:

• Relationship continuity - Knowing you and your values and preferences allows me to help you make better medical decisions. I am always there to bridge the gap between you and the rest of the medical world.

• Informational continuity - My staff and I have ample time to retrieve, collate, and share your health records. Old records are retrieved from prior doctors. Current records are retrieved from specialists and facilities. All are stored and maintained in your electronic medical record. Outside facilities requiring records are handled expediently.

• Management continuity - With direct access to me, you and I will ensure follow-through with tests, treatments, and specialty referrals. To assist us, I use automated features of the electronic medical records, such as automated reminders and drug interaction checkers.

Instead of fragmented care involving multiple providers with limited access to your records and unfamiliar with your case, my Concierge practice ensure a smooth continuity of care with a central accessible provider taking charge and ensuring follow-through.