Evashwick C J
Health Prog. 1989 Jun;70(5):36-9, 56.
The idea of a continuum of care is hardly new. In its purest form, it is simply the essence of good patient care. Today, the complex U.S. healthcare organization has emerged as a highly sophisticated but fragmented collection of service providers. We now must put energy and resources into rebuilding the comprehensiveness and continuity that represent high-quality care. The rationale for a continuum of care is that it is appropriate for patients' needs, demanded by today's consumers, an organized way of maximizing use of healthcare resources, and cost-effective for providers, patients, and payers. A continuum of care comprises services and integrating mechanisms. The services can be broken into seven basic categories: extended care, acute hospital care, ambulatory care, home care, outreach, wellness, and housing. The four basic integrating mechanisms are interentity planning and management, care coordination, case-based financing, and integrated information systems. Shaping a continuum mandates translating broad principles into pragmatic application suitable for the organization and community. The organization should define goals and objectives, identify a target population, assess services, evaluate integrating mechanisms, communicate, and prepare a business plan.
连续护理的理念并非新鲜事物。其最纯粹的形式，不过是优质患者护理的本质。如今，复杂的美国医疗保健机构已演变成一个由服务提供商组成的高度复杂但支离破碎的集合体。我们现在必须投入精力和资源来重建体现高质量护理的全面性和连续性。连续护理的基本原理在于，它符合患者需求、受当今消费者要求、是最大化利用医疗资源的一种有组织的方式，并且对提供者、患者和支付方而言具有成本效益。连续护理包括服务和整合机制。服务可分为七个基本类别：长期护理、急症医院护理、门诊护理、家庭护理、外展服务、健康管理和住房服务。四种基本的整合机制是实体间规划与管理、护理协调、基于病例的融资以及综合信息系统。塑造连续护理要求将宽泛的原则转化为适用于机构和社区的实际应用。机构应明确目标，确定目标人群，评估服务，评价整合机制，进行沟通，并制定商业计划。
