Introduction

With the advent of managed care organizations and integrated health care systems, more is now known about how to provide the best care across specific settings (eg, the home, hospital, nursing home). A major criticism of the health care system of the recent past was that care in specific settings was compartmentalized--each episode of care was treated as a discrete phenomenon instead of as a part of a larger endeavor, ie, the ongoing provision of health care to the patient. The renewed emphasis on primary vs. specialty care has changed the process of care; patients are now continuously monitored by health care practitioners who can appreciate the continuum of events that contribute to their patients' health status and functional capabilities. Communication among primary care physicians, specialists, other health care practitioners, and patients and their family members is critical to ensuring that patients receive the appropriate care across all settings.