Analysis of the continuity of services from the viewpoint of clinical files in the perspective of quality improvement

Purpose: According to the most recent conceptual model, the continuity of services is increasingly recognized as a robust quality indicator. However, while many authors estimate that clinical files are, in principle, good observatories of continuity; very few have studied continuity from the files’ viewpoint. Theory: Global continuity comprises three dimensions, i.e., informational continuity, management continuity and relational continuity. These three forms of continuity can be observed in clinical files by identifying continuity moments and events. Methods: In the context of a larger embedded case study, we analyzed 21 clinical cases, equally distributed in three different integrated care networks, of users followed by case managers. Their content was decorticated using a validated clinical information extractor and then transposed to a temporal line allowing a sequential identification of continuity moments and events. Results and conclusions: The clinical files allow a better understanding of the specific deployment patterns of the three types of continuity which appear to be dependant of the different contexts’ tools and norms of completion of the files.