Discontinuities in the Patient Pathway

Abstract

INTRODUCTION Continuity of care represents an essential component of healthcare quality, being associated with improved clinical outcomes, reduced avoidable use of hospital services, and more efficient use of resources. In Romania, the fragmentation of healthcare services between outpatient and hospital care continues to contribute to discontinuities in the patient pathway.
OBJECTIVE To analyze the discontinuities between outpatient and hospital services and to identify management solutions for improving continuity of care.
METHODOLOGY The study uses a narrative review of the literature published between 2010 and 2024. Scientific studies indexed in PubMed and Google Scholar, as well as recent reports published by the World Health Organization, OECD, and the European Commission, were analyzed. The analysis focused on indicators such as avoidable hospitalizations, 30-day readmissions, informational continuity, and resource utilization.
RESULTS International literature and recent European reports indicate that Romania continues to record values above the European Union average regarding avoidable hospitalizations associated with chronic diseases. International studies report 30-day readmission rates ranging approximately between 10% and 20%, a significant proportion of which are considered potentially avoidable. OECD PaRIS 2024 data highlight a low level of interoperability of health information systems in Romania compared with the OECD average, while duplication of investigations is described in the literature as a frequent consequence of fragmented care. At the same time, recent investments in the digitalization of the healthcare system through the National Recovery and Resilience Plan create favorable conditions for improving continuity of care.
CONCLUSIONS Discontinuities between outpatient and hospital care affect healthcare system efficiency and quality of care. Improving coordination between levels of care, developing outpatient services, and strengthening interoperability of health information systems represent essential strategic directions for optimizing the patient pathway.