What is Continuity of Care?
Continuity of care is the approach to providing consistent, collaborative, and thorough medical services from beginning to end of care. In the orthopedic realm, this often involves every aspect of care from an initial new patient visit to physical therapy sessions, surgical intervention, and post operative appointments. Continuity of care is also heavily influenced by the relationship between a patient and physician/APP (Advanced Practice Provider) team, as well as the network between various medical institutions. When all of these individual relationships work in a collaborative manner longitudinally in time over the span of a patient’s treatment, continuity of care is established and patient outcome is enhanced exponentially.
Why is Continuity of Care important?
The paramount focus of continuity of care is the patient. It is intended to avoid disruption in care and to increase satisfaction and positive outcomes among all patient populations. Additionally, it can also have a beneficial effect on the productivity and contentment of providers and caregivers outside of the direct team. For example, by building a rapport and serving as a crucial role throughout the entirety of the treatment process, the APP is able to feel as though their work is meaningful, thus improving satisfaction at work. Continuity of care also allows for the cultivation of interdisciplinary relationships. Whether it be discussing care with nursing staff after surgery, developing a protocol with physical therapists, or collaborating with a patient’s primary care provider about obtaining proper clearance based on a patient’s history, all of these relationships help build a network of medical professionals that can allow for learning and advancement of each other's professions.
The role of the APP in Continuity of Care
As APP’s, our role as physician extenders has allowed for the advancement of continuity of care within orthopedic practice. APPs are able to bridge gaps between physician and patient, spend time building rapport and trust in the team, collaborate inter-professionally amongst different providers involved with care, and be available to provide ongoing support as needed by the patient. In daily practice, this can be exemplified by following up on a patient’s question, discussing discharge planning with case managers, or guiding a patient through the surgical process among innumerable other ways.
Challenges to Continuity of Care
While Continuity of Care is the ultimate goal to strive for in patient care, there are many barriers that must be recognized and addressed, in order to achieve that goal:
- Navigating Access
- Patient access to healthcare, specifically orthopedics in this case, encompasses a number of factors that affect ability to obtain medical services. One consideration is location. In the case of a patient with limited transportation options, having a provider that consistently travels to the office or hospital setting most convenient to them is extremely important. As an APP, we are able to potentially increase the availability of appointment options at that location, thereby expanding access. This is also true in terms of general appointment availability. When a patient is no longer able to travel to see a provider or appointments are booked out for many weeks, follow up may be lost and Continuity of Care threatened. Cost and insurance coverage are also factors that limit access.
- Proper Integration
- When various providers that care for a patient fail to communicate, gaps in care are introduced. As discussed before, a crucial aspect of successful Continuity of Care is inter-professional collaboration. Inaccessibility to various EMR systems, lack of lab follow ups, reports and imaging, and incomplete handoffs are all factors that contribute to failed communication between providers, therefore contributing to a decline in patient outcome.
- Patient-provider Relationship
- Trust between a patient and provider is especially important when discussing Continuity of Care. When a patient entrusts an aspect of their health with a specific provider, they are setting expectations for a specific outcome with the assistance of that provider whether it be improved pain, return to activities of daily living, increased mobility, etc. When a patient has seen that the provider has helped them achieve these goals, trust is built. When there is a breakdown in such confidence for reasons such as one way communication, lack of compassionate care, incomprehensive treatment among others, continuity of care is compromised.
How can we improve Continuity of Care?
- Increase patient access to care:
- As APP’s, allow for appointment availability and location options, if possible
- Utilizing telehealth and staying up to date on other technological advancements
- Be a consistent provider throughout treatment
- Be present from initial new patient visit to post-operative visits
- Follow up with imaging, labs, patient questions, etc.
- Foster inter-professional relationships between supervising physician, organization and beyond
- Focus on compassionate care that emphasizes shared decision making to build trust
Continuity of care is the key to improved patient outcome and satisfaction. As APP’s, we have the unique ability to address many of the challenges that threaten continuity of care. By recognizing these barriers and enacting daily changes in practice, we will be able to better advocate for our patients and strengthen the orthopedic care we provide.
