Continuity of Care

Continuity of care is a measure designed to support services working in mental health to understand the quality of continuity of care between Te Whatu Ora district services and NGOs to gain insights into where improvement is needed to contribute to better wellbeing outcomes for tāngata whai ora who experience an acute inpatient stay.

In response to feedback from tāngata whai ora that they experience inconsistencies in connected care, the ‘continuity of care’ indicator serves as an initial marker for use by Te Whatu Ora districts (previously DHBs) and NGOs to inspire reflection and learning about how they can keep improving the way they work together.

The continuity of care indicator provides two dashboards:

The NGO national quarterly summary analyses NGO activity by Te Whatu Ora district, indicated by NGO engagement before, during, and after an acute inpatient admission. Note this dashboard includes all tāngata whai ora regardless of whether there was an NGO activity recorded in the 28 days before an acute inpatient admission.

The national quarterly continuity of care dashboard analyses NGO activity by Te Whatu Ora district and when NGO engagement occurred. This dashboard looks at unique referrals and provides a visualisation that looks at what effect NGO pre-admission care has on average length of stay (ALOS) and 28-day readmission rates in district services.

Populations

The continuity of care indicator dashboards are built using criteria for all populations, where this data is reported by services into PRIMHD. Click here to learn more about PRIMHD

All KPI Programme indicators provide demographic information by age, gender, and ethnicity.

Data available through August 2025, sourced from the 26 January 2026 refresh of the PRIMHD DataMart.

Please note:

• Northland has incomplete community and very little inpatient data since April 2025
• MidCentral has incomplete data for October 2025

If you have any improvement ideas or feedback please email us at mhakpi.health.nz