CONTINUUM: measuring and managing the patient care process

The authors describe the CONTINUUM project which was initiated in a community hospital to manage the appropriateness, timeliness and acceptability of the patient care process on a concurrent or day-to-day basis. CONTINUUM is a quality and data-driven approach to continuous improvement of the patient care process. The St. Thomas-Elgin General Hospital researched "appropriateness of care" measurements and adapted their use for the CONTINUUM project. A concurrent care plan evaluation tool is applied to every care every day. This intensity of service (needs-based) strategy is called the ACTIVITY index. Patients are categorized ACTIV (appropriate) or non-ACTIV (perhaps inappropriate). Non-ACTIV patients are further subdivided into various "barriers to care," from which service, hospital or physician-related factors can be stratified. Practice patterns and hospital resource use are then rapidly identified. The operational dimensions of the project (bedside, organization and community) are described as well as the inhibitors and enablers of this change process.