Improving
Continuity of Care
in Long Term Care:
Impact of Health
Information Exchange
Rebecca Meehan, PhD
CONTINUITY OF CARE FOR OLDER adult patients transi- tioning from acute care settings (hospitals) to long term post-acute care (LTPAC) settings is essential to maintain quality of care for patients. As hospitals move toward the
exclusive use of electronic health records (EHRs) to house patient
medical data, continuity of care for patients requires visibility to this
electronic health data by unique members of the care team across a
number of care settings. For older adults in particular, these settings
include LTPAC services such as home health, short term rehabilitative and long term skilled nursing facilities. LTPAC organizations
were not eligible for federal monetary incentives from the Meaningful Use program (ARRA, 2009) and as a result have lagged behind
hospitals and other clinical providers in terms of health IT adoption
(HealthI T.gov, 2013). Yet, LTPAC settings are critical to the success
of continuity of care in an electronic data environment. Continuity
of care for older adults using different care settings necessitates
mechanisms and processes for sharing electronic data from one
setting to another. Health information exchange (HIE) is the mechanism for providing this access to achieve continuity of care.
CONTINUITY OF CARE
Continuity of care, described as a cornerstone of primary care
(Cabana & Jee, 2004; Bjorkelund, et al, 2013) has been associated with
improved health outcomes, especially for those with chronic illness
(Cabana & Jee, 2004). Other research points to a lack of continuity
of care as a system factor associated with poor health outcomes
(Naylor, et al, 2004). Gulliford, Naithani & Morgan, (2006) describe
continuity of care as multi-dimensional and able to seen from the
perspective of both the patient and provider. From a patient’s perspective, continuity of care has been defined with a focus on the
on-going interpersonal relationship between patient and provider
in managing quality and cost-effective care (AAFP, 2005). Gulliford,
et al (2006) outline the provider perspective, defined by Shortell
(1976) as: ‘the extent to which services are received as part of a coordinated and uninterrupted succession of events consistent with the
medical care needs of patients. Shortell’s definition (1976) provides
a perspective through which to consider older adults receiving care
in both LTPAC and hospital settings. Gulliford, et al (2006) go on
to offer a framework for considering the objectives of continuity of
