Integrated delivery systems were created with the goal of coordinating the continuum of care. Such coordination was to achieve "seamless care delivery" "from womb to tomb." These are laudable goals, toward which many organizations are on the journey to achieve. It's fair to state that while many are moving forward, no organization has yet arrived.

The approach to and infrastructure for continuous improvement activities looks different in an integrated delivery system as opposed to a hospital or a single site care delivery organization. This difference is driven by many issues, including site-specific priorities, leadership, and customers. It is also driven by a new expectation, which is the need to measure and improve the overall health outcomes of clients (based on the belief that womb to tomb care enhances a person's state of health) and the need to access care delivered over time and across sites and provides (was care delivery seamless?). The focus of quality in individual organizations is commonly, and appropriately, the episode of care (did we provide the right care in the right way, at the rigth time, to the right person during this episode?). A commitment to providing care across a continuum requires us to commit to the quality of episodes of care, but in addition, commit to improving health outcomes of clients, as well as assuring that the continuum (cross-site) functions effectively and efficiently. That broadened focus sets the stage for different roles, different activities, and expanded expectations for the quality and performance improvement functions.

This issue of Journal of Nursing Care Quality (14:1) provides descriptions of continuum of care improvement activities. These articles can help readers to identify new opportunities for improving care and service in site-specific or cross-site venues. They also challenge us all to clarify our focus as we build approaches to coordinating the continuum of care.

Patricia Schroeder, MBA, MSN, RN

Editor