Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Open Badges Research article

Provider connectedness and communication patterns: extending continuity of care in the context of the circle of care

Morgan Price123* and Francis Y Lau1

Author Affiliations

1 School of Health Information Science, University of Victoria, 3800 Finnerty Road Victoria, V8P 5C2 Victoria, British Columbia, Canada

2 Department of Family Practice, University of British Columbia, Vancouver, Canada

3 Medical Science Building, University of Victoria, PO Box 1700, STN CSC, Victoria BC V8W 2Y2 Canada

For all author emails, please log on.

BMC Health Services Research 2013, 13:309  doi:10.1186/1472-6963-13-309

Published: 14 August 2013



Continuity is an important aspect of quality of care, especially for complex patients in the community. We explored provider perceptions of continuity through a system’s lens. The circle of care was used as the system.


Soft systems methodology was used to understand and improve continuity for end of life patients in two communities. Participants: Physicians, nurses, pharmacists in two communities in British Columbia, involved in end of life care. Two debates/discussion groups were completed after the interviews and initial analysis to confirm findings. Interview recordings were qualitatively analyzed to extract components and enablers of continuity.


32 provider interviews were completed. Findings from this study support the three types of continuity described by Haggerty and Reid (information, management, and relationship continuity). This work extends their model by adding features of the circle of care that influence and enable continuity: Provider Connectedness the sense of knowing and trust between providers who share care of a patient; a set of ten communication patterns that are used to support continuity across the circle of care; and environmental factors outside the circle that can indirectly influence continuity.


We present an extended model of continuity of care. The components in the model can support health planners consider how health care is organized to promote continuity and by researchers when considering future continuity research.

Continuity of care; Circle of care; Quality of care; Communication; Systems thinking