Definition: Continuum of Care

Source: HIMSS HIE Committee
by Bill Young ,  Chris Clark ,  John Kansky, FHIMSS, CPHIMS ,  and Erik Pupo, MBA, CPHIMS, FHIMSS
May 14, 2014

Note: This resource is part of Ambulatory HIE Toolkit.

A high-level overview of the various services, settings, mechanisms and conditions included in the concept of the continuum of care.

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Continuum of Care is a concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care.

The Continuum of Care covers the delivery of healthcare over a period of time, and may refer to care provided from birth to end of life. Healthcare services are provided for all levels and stages of care.

Services and Mechanisms

Continuum of Care includes both services and integrating mechanisms.

The services can be broken down into seven basic categories:

  • Extended care
  • Acute hospital care
  • Ambulatory care
  • Home care
  • Outreach
  • Wellness
  • Housing

The four basic integrating mechanisms are:

  • Planning and management
  • Care coordination
  • Case-based financing
  • Integrated information systems

Array of Healthcare Services

The Continuum of Care can include a wide set of services, and does not usually refer to a formal system of care delivery.  The following are examples of the types and settings of healthcare services that are regularly connected through the Continuum of Care.

  • Acute healthcare services
  • Hospitals
  • Emergency departments
  • Inpatient services
  • Outpatient services
  • Urgent care
  • Physician practices
  • Long-term care
  • Assisted living
  • Skilled nursing facilities
  • Rehabilitation centers
  • Home care
  • Visiting nurse services
  • Hospices / Palliative care
  • Behavioral health
  • Wellness care
  • Government / Public health services
  • Care management
  • Research

 In addition to these healthcare settings, the Continuum of Care may also extend to include:

  • Home care
  • Homeless patients (street or shelter)
  • Domestic travel
  • International travel

Characteristics and Conditions

The Continuum of Care will vary for each patient depending on their unique needs. Common characteristics and conditions include:

  • Prenatal care
  • Genetic birth defects causing pre-/post-natal morbidity/mortality
  • Genetic anomalies that increase risk of physical or behavioral illness
  • Newborn care
  • Healthy patient / Preventive care
  • Healthy lifestyle counseling
  • Unhealthy lifestyle / High risk factor care
  • Acute illness
  • Acute injury
  • Chronic illness or morbid conditions
  • Recovery from physical illness
  • Recovery from mental illness or addiction
  • Rehabilitation for physical injury
  • Imminent death
  • Deceased – care for the emotional, financial and societal needs of the family, as well as public health and research
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