CARE - Continuity and quality of care in nursing

Continuity of care

The present knowledge base regarding the concept of Continuity of Care within health service and nursing research reflects fragmented evidence whilst also highlighting an interchangeable use of different concepts such as transitional care, integrated care, coordinated care and continuity of care. At present Freeman and colleagues (2000; 2002) (1, 2) are those offering the most comprehensive definition of continuity of care. Their definition is yet to be explored and tested but it will initially offer a solid departure base for studying continuity (or discontinuity) of care. Considering the present evidence concerning the operationalisation and definition of Continuity of Care, each unique research project is therefore expected to, within its project design, to succinctly articulate its specific and wider contribution to the concept of Continuity of Care within health service research, nursing, nursing education and nursing research.

Multiaxial definition of Continuity of Care (1, 2)

Experienced: experience of a coordinated and smooth progression of care from the user’s point of view

Flexible: to be flexible and adjust to the needs of the individual over time

Cross-boundary: effective communication between professionals and services and with service users

Information: excellent information transfer following the service user

Longitudinal: care from as few professionals as possible, consistent with other needs

Relational: to provide one or more named individual professionals with whom the user can establish and maintain a therapeutic relationship

Long-term: uninterrupted care for as long as the service user requires it

Contextual: Care which should sustain a person’s preferred social and personal relationship in the community and enhance quality of life

Quality of Care

The second theoretical framework is a multidimensional health care quality model based on Institute of Medicine’s (IOM) quality model (2001) (3) and its six domains: Person-centredness, Timeliness, Efficiency, Effectiveness, Safety and Equity. In the new quality model proposed by Lachman and colleagues (2021) (4) five of the domains are kept and the domain Eco-friendly is added. Rather than being a separate domain, Person-centredness is the overarching “umbrella domain” in the new model and seen as a precondition for quality in all domains. Furthermore, the concept of "kin-centred care" is introduced, highlighting the shared humanity and interdependence of all individuals involved in healthcare, i.e. those who receive and those who deliver healthcare. Principles of Transparency and Leadership surrounds the domains. The model focuses co-creation of better health rather than disease management, in line with the holistic perspective of nursing. The new multidimensional model provides us with a theoretical framework for operationalising and defining quality of care and serves as a point of departure for studying quality of care as a concept and a phenomenon within nursing.

References

1. Freeman, G, Shepperd, S, Robinson, I, Ehrich, K, Richards, S. Continuity of Care: Report of a Scoping Exercise for the SDO Programme of NHS R&D. National Co-ordinating Centre for Service Delivery and Organisation: London; 2000.

2. Freeman, G, Weaver, T, Low, J, de Jonge, E, Crawford, M (2002). Promoting Continuity of Care for People with Severe Mental Illness whose Needs Span Primary, Secondary and Social Care. National Co-ordinating Centre for Service Delivery and Organisation: London; 2002.

3. Institute of Medicine (US) Committee on Quality of Health Care in America: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US): 2001.

4. Lachman, P., Batalden, P., & Vanhaecht, K. (2021). A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health. F1000Research. 2021, 9:1140. DOI: https://doi.org/10.12688/f1000research.26368.3

The projects within the platform will depart from a set of strategic methodological frameworks of importance for the development of sustainable research. Using a set of methodological frameworks will ensure that effectiveness and usability aspects are strong parts of our projects’ design. Each project will be designed with a strong external, but unique relation, to the overarching and unifying core concepts: Continuity of Care and Quality of Care. Amalgamating projects around the core concepts will support the development of an incremental knowledge loop (learn, create, share, and learn again) regarding the concepts per se and in relation. It will also contribute to a sustainable knowledge development within health services research, with the specific focus on nursing and nursing science, and the individual topics in foci.

Methodological frameworks (5, 6, 7)

Medical research Council’s Framework for Complex Interventions (MRC):

Adding value:
Ensuring quality in design and methods

Public, patient and Professional Involvement (PPPI):

Adding value:
Setting research agendas
Hight priority questions asked
Important outcomes assessed

Ensuring value in Research (EViR):

Ensuring value:
Setting justifiable research priorities

References:

5. Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061. DOI: https://doi.org/10.1136/bmj.n2061

6. Gray R, Brasier C, Zirnsak T-M, Ng AH. Reporting of patient and public involvement and engagement (PPIE) in clinical trials published in nursing science journals: a descriptive study. Res Involv Engagem. 2021;7(1):88. DOI: https://doi.org/10.1186/s40900-021-00331-9

7. EViR Ensuring Value in Research. Southampton: EViR; 2022: https://evir.org