Abstract
BackgroundContinuity of care is a key component of care in complex and chronic conditions. Despite its importance, it is often absent in chronic-disease management. One challenge has been identifying tools to measure care continuity. In one context important to families, namely pediatric palliative care, we undertook a project to identify continuity and to pilot the use of network analysis as a tool.MethodsNetwork analysis studies patterns of relationships or interactions between members, providing qualitative and quantitative description of network structure.ResultsIn this report we applied network analysis to paper records of clinical consultations and reports for 6 patients with complex conditions. A high degree of discontinuity was identified, and care was fragmented amongst specialist and generalist providers. Information was shared selectively and often moved in only one direction.ConclusionsFamilies have anecdotally reported frustration with poor continuity of care. Network analysis can be a useful tool in describing the discontinuity of care experienced by families dealing with complex and chronic conditions. This tool could be expanded to other systems such as electronic health records and many other health care situations.
Highlights
Continuity of care is a key component of care in complex and chronic conditions
The care network for patient #3 was the most extensive and included the broadest array of services and supports (Table 3). It was the sole care network in the study to explicitly include the parents in the formal clinical reporting process
In the network for patient #2, the pediatrician (42; Figure 2) who was most active in sending out ties was not copied in turn on the remaining communication that occurred during the study period. In this pilot project, we sought to determine the general potential of network analysis for evaluating patterns of communication between health care providers - an important aspect of continuity of care - and, the feasibility of mapping out the formal clinical reporting process using data obtained from patient records
Summary
Continuity of care is a key component of care in complex and chronic conditions Despite its importance, it is often absent in chronic-disease management. Continuity of care is valued by patients and, by extension, parents caring for children with chronic health conditions [4,5]. There is, a dearth of research developing and testing approaches to support continuity of care for children with chronic diseases. To this aim, studies are needed to enrich our understanding of continuity in pediatric care from multiple perspectives (e.g., parents, other formal and informal caregivers, health professionals) and across the multiple dimensions named above
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