Relational Continuity

CII/CPAR Key Concepts: Relational Continuity


CII/CPAR is an important technical enabler to improved patient care because it assists clinics in identifying patients where continuity of care may be sub-optimized. Knowing that a patient is paneled to another primary provider offers an opportunity to confirm roles and responsibilities in care provision. For PCNs and clinics already investing in panel work, CII/CPAR is a natural extension of that work for better transitions of care and relational continuity.

Relational Continuity

Clinical Practice Guideline

In June 2019, Toward Optimized Practice published a clinical practice guideline for Relational Continuity with the following objective: primary care physicians and the teams they work with will understand the value of relational continuity and therefore adopt practice behaviors that result in increased relational continuity.

The guideline, summary and tools are available here.

The Relational Continuity Change Package is available here.


Relational continuity is defined as: The ongoing, trusting therapeutic relationship between a patient and a primary care physician and their team, where the patient sees this primary care physician the majority of the time.[2] Relational continuity provides the foundation of an ongoing, trusting therapeutic relationship between a patient and primary care provider(s). Once the relationship is established and documented it becomes an enabler to allow for informational continuity – the transfer of relevant patient information between multiple care providers and locations, including accumulated knowledge about the patient’s preferences, values, and context.  As each patient’s attachment is confirmed and useful information is shared, coordination of care between relevant care providers using a consistent, flexible shared care plan will allow for better outcomes and increased patient and healthcare provider satisfaction.

Via CII/CPAR, you have the opportunity to confirm your care relationship with your patients, and record it in their chart and the registry. As participation in CII/CPAR increases and each provider utilizes standardized processes to confirm attachment, a clearer view of attachment and greater accuracy of each provider’s panel will begin to emerge provincially.

CII/CPAR not only impacts relational continuity but enables informational continuity and which together support management continuity.

[1] Continuity of Care: a multidisciplinary review, JL Haggerty et al, 2013

[2] Toward Optimized Practice (TOP) Relational Continuity Working Group. 2019 June. Relational continuity clinical practice guideline. Edmonton, AB: Toward Optimized Practice. Available from: