August 7, 2019

Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission

BACKGROUND This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission. METHODS Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting […]
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BACKGROUND This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission. METHODS Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients' number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness. RESULTS Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient's age > or = 65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09-4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14-1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19-0.63) or bottles (OR, 0.55; 95% CI, 0.27-1.10) at admission was beneficial. CONCLUSION Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.
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http://psnet.ahrq.gov/resource.aspx?resourceID=17753

August 7, 2019

Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians

Weiss B. Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. [Booklet]. Http://med.fsu.edu/userFiles/file/ahec_health_clinicians_manual.pdf Published May 2007. Accessed July 25, 2014. In the pages that follow, this manual reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes […]
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Weiss B. Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. [Booklet]. Http://med.fsu.edu/userFiles/file/ahec_health_clinicians_manual.pdf Published May 2007. Accessed July 25, 2014. In the pages that follow, this manual reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes patients with limited literacy. The manual then provides practical tips for clinicians to use in making their office practices more “user friendly” to patients with limited literacy, and gives suggestions for improving interpersonal communication between clinicians and patients. Finally, the manual concludes with several “case discussions” based on vignettes in the accompanying instructional video.
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http://med.fsu.edu/userFiles/file/ahec_health_clinicians_manual.pdf

August 7, 2019

Ask Me 3

Ask Me 3. National Patient Safety Foundation. Http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/ Accessed July 25, 2014. Ask Me 3 is a patient education program designed to improve communication between patients and health care providers, encourage patients to become active members of their health care team, and promote improved health outcomes. The program encourages patients […]
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Ask Me 3. National Patient Safety Foundation. Http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/ Accessed July 25, 2014. Ask Me 3 is a patient education program designed to improve communication between patients and health care providers, encourage patients to become active members of their health care team, and promote improved health outcomes. The program encourages patients to ask their health care providers three questions: What is my main problem? What do I need to do? Why is it important for me to do this?
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http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/

August 7, 2019

The Joint Commission, Speak Up: Planning Your Folow-Up Care

The Joint Commission and the Centers for Medicare & Medicaid Services. Speak UP: Planning Your Follow-up Care. Educational Brochure. http://www.jointcommission.org/Speak_Up_Planning_Your_Follow-up_Care/ Published April 2010. Updated July 8, 2013. Accessed July 25, 2014. The Joint Commission, together with the Centers for Medicare and Medicaid Services, launched a national campaign to urge patients […]
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The Joint Commission and the Centers for Medicare & Medicaid Services. Speak UP: Planning Your Follow-up Care. Educational Brochure. http://www.jointcommission.org/Speak_Up_Planning_Your_Follow-up_Care/ Published April 2010. Updated July 8, 2013. Accessed July 25, 2014. The Joint Commission, together with the Centers for Medicare and Medicaid Services, launched a national campaign to urge patients to take a role in preventing health care errors by becoming active, involved and informed participants on the health care team. The program features brochures, posters and buttons on a variety of patient safety topics.
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http://www.jointcommission.org/PatientSafety/SpeakUp/speak_up_recovery.html

August 7, 2019

The Hospital to Home (H2H) National Quality Improvement Initiative

H2H (Hospital to Home). American College of Cardiology and the Institute for Healthcare Improvement. Http://cvquality.acc.org/Initiatives/H2H.aspx. Accessed July 25, 2014. The Hospital to Home (H2H) Initiative is a resource for hospitals and cardiovascular care providers committed to improving transitions from hospital to “home” and reduce their risk of federal penalties associated […]
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H2H (Hospital to Home). American College of Cardiology and the Institute for Healthcare Improvement. Http://cvquality.acc.org/Initiatives/H2H.aspx. Accessed July 25, 2014. The Hospital to Home (H2H) Initiative is a resource for hospitals and cardiovascular care providers committed to improving transitions from hospital to "home" and reduce their risk of federal penalties associated with high readmission rates. H2H Projects are "See You in 7", "Mind Your Meds", and "Signs and Symptoms".
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http://cvquality.acc.org/Initiatives/H2H.aspx

August 7, 2019

CMS: Your Discharge Planning Checklist

Centers for Medicare & Medicaid Services (CMS). Your Discharge Planning Checklist. [Booklet/Form]. http://www.medicare.gov/publications/pubs/pdf/11376.pdf.Revised January 2012. Accessed July 25, 2014. The Centers for Medicare & Medicaid Services (CMS) has developed a checklist that prompts patients and caregivers to ask questions about key discharge planning topics including their likely care needs, the […]
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Centers for Medicare & Medicaid Services (CMS). Your Discharge Planning Checklist. [Booklet/Form]. http://www.medicare.gov/publications/pubs/pdf/11376.pdf.Revised January 2012. Accessed July 25, 2014. The Centers for Medicare & Medicaid Services (CMS) has developed a checklist that prompts patients and caregivers to ask questions about key discharge planning topics including their likely care needs, the options for continuing care, post-discharge care instructions, community-based resources, and more. The checklist is intended to encourage patients and caregivers to actively participate in the discharge planning process and reflects CMS' goal to achieve high-value, person-centered health care. Providers can make use of the checklist by: (1) making staff aware of the checklist; (2) including it in pre-administration and/or admission paperwork; and, (3) by encouraging staff to work with patients and caregivers to complete the checklist.
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http://www.medicare.gov/publications/pubs/pdf/11376.pdf

August 7, 2019

Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention.

Coleman EA, Smith JD, Frank JC, et al. J Am Geriatr Soc.Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention. J Am Geriatr Soc. 2004;52(11):1817-1825. http://www.caretransitions.org/documents/Preparing%20patients%20-%20JAGS.pdf . Accessed August 7, 2014. RESULTS: The adjusted odds ratio comparing rehospitalization of intervention subjects with that of […]
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Coleman EA, Smith JD, Frank JC, et al. J Am Geriatr Soc.Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention. J Am Geriatr Soc. 2004;52(11):1817-1825. http://www.caretransitions.org/documents/Preparing%20patients%20-%20JAGS.pdf . Accessed August 7, 2014. RESULTS: The adjusted odds ratio comparing rehospitalization of intervention subjects with that of controls was 0.52 (95% confidence interval (CI)50.28–0.96) at 30 days, 0.43 (95% CI50.25–0.72) at 90 days, and 0.57 (95% CI50.36–0.92) at 180 days. Intervention patients reported high levels of confidence in obtaining essential information for managing their condition, communicating with members of the healthcare team, and understanding their medication regimen. CONCLUSION: Supporting patients and caregivers to take a more active role during care transitions appears promising for reducing rates of subsequent hospitalization. Further testing may include more diverse populations and patients at risk for transitions who are not acutely ill.
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http://www.caretransitions.org/documents/Preparing%20patients%20-%20JAGS.pdf

August 7, 2019

One Patient, Many Places: Managing Healthcare Transitions. Part III: Financial Incentives and Getting Started.

Coleman EA, Fox PD on behalf of the HMO Care Management Workgroup. One Patient, Many Places: Managing Healthcare Transitions. Part III: Financial Incentives and Getting Started. Annals of Long-Term Care. 2004;12(11):14-16. http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%203%20-%20ALTC.pdf . Accessed August 7, 2014. Part III addresses the need to align financial and structural incentives to improve […]
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Coleman EA, Fox PD on behalf of the HMO Care Management Workgroup. One Patient, Many Places: Managing Healthcare Transitions. Part III: Financial Incentives and Getting Started. Annals of Long-Term Care. 2004;12(11):14-16. http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%203%20-%20ALTC.pdf . Accessed August 7, 2014. Part III addresses the need to align financial and structural incentives to improve patient flow across care venues and steps organizations can take to initiate a quality improvement strategy for transitional care.
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http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%203%20-%20ALTC.pdf

August 7, 2019

One Patient, Many Places: Managing Healthcare Transitions. Part II: Practitioner Skills and Patient and Caregiver Preparation.

Coleman EA, Fox PD on behalf of the HMO Care Management Workgroup. One Patient, Many Places: Managing Healthcare Transitions. Part II: Practitioner Skills and Patient and Caregiver Preparation. Annals of Long-Term Care. 2004;12(10):34-39. http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%202%20-%20ALTC.pdf . Accessed August 7, 2014. Part II focuses on enhancing practitioners’ skills and support systems and […]
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Coleman EA, Fox PD on behalf of the HMO Care Management Workgroup. One Patient, Many Places: Managing Healthcare Transitions. Part II: Practitioner Skills and Patient and Caregiver Preparation. Annals of Long-Term Care. 2004;12(10):34-39. http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%202%20-%20ALTC.pdf . Accessed August 7, 2014. Part II focuses on enhancing practitioners’ skills and support systems and enabling patients and caregivers to play a more active role in their transitions.
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http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%202%20-%20ALTC.pdf

August 7, 2019

One Patient, Many Places: Managing Healthcare Transitions. Part I: Introduction, Accountability, and Information Transfer.

Coleman EA, Fox PD on behalf of the HMO Care Management Workgroup. One Patient, Many Places: Managing Healthcare Transitions. Part I: Introduction, Accountability, and Information Transfer. Annals of Long-Term Care. 2004;12(9):25-32. http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%201%20-%20ALTC.pdf . Accessed August 7, 2014. This three-part series addresses how health care organizations (i.e., organized or integrated care […]
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Coleman EA, Fox PD on behalf of the HMO Care Management Workgroup. One Patient, Many Places: Managing Healthcare Transitions. Part I: Introduction, Accountability, and Information Transfer. Annals of Long-Term Care. 2004;12(9):25-32. http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%201%20-%20ALTC.pdf . Accessed August 7, 2014. This three-part series addresses how health care organizations (i.e., organized or integrated care systems or large provider groups that receive payment under either a capitated or fee-for-service basis) can improve the quality of transitions among care venues for patients with complex care needs. Poorly executed transitions are associated with inefficiencies and duplication of services that needlessly increase the cost of care and potentially lead to greater utilization of hospital, emergency, post-acute, and ambulatory services. This three-part article includes recommendations for actions that health care organizations can take to improve the quality of care delivered to their patients undergoing transitions. Part I begins with an introduction that is followed by ensuring accountability for patients in transition and facilitating the effective transfer of information.
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http://www.caretransitions.org/documents/One%20Pt%20Many%20Places%20Part%201%20-%20ALTC.pdf

August 7, 2019

Factors Influencing Models of End-of-Life Care in Nursing Homes.

Rice KN, Coleman EA, Fish R, et al. Factors Influencing Models of End-of-Life Care in Nursing Homes. J Palliat Med. 2004;7(5):668-675. http://online.liebertpub.com/doi/abs/10.1089/jpm.2004.7.668 . Accessed August 7, 2014. Approximately 20% of deaths in the United States occur in nursing homes. Dying nursing home residents have unique care needs, which historically have […]
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Rice KN, Coleman EA, Fish R, et al. Factors Influencing Models of End-of-Life Care in Nursing Homes. J Palliat Med. 2004;7(5):668-675. http://online.liebertpub.com/doi/abs/10.1089/jpm.2004.7.668 . Accessed August 7, 2014. Approximately 20% of deaths in the United States occur in nursing homes. Dying nursing home residents have unique care needs, which historically have been inadequately addressed. The goal of this study was to determine what factors influence nursing home administrators' choice of model for end-of-life care in their facilities. Thirty nursing home administrators in the Denver, Colorado, metropolitan area were interviewed. The interview used open-ended questions about: facilities' end-of-life care programming and factors that influenced which model was used; scalar questions measuring administrators' attitudes about aspects of end-of-life care; and questions that assessed key demographic characteristics of participants. Twenty-nine of the 30 facilities included in this study reported contracting with hospice. Five were also in the process of creating in-house palliative care teams, and an additional five were negotiating with hospice agencies to dedicate beds for use as hospice units. For profit status, larger facility size, and shorter duration of administrator tenure were found to be associated with greater likelihood of considering implementation of a facility-based end-of-life care model. When asked about obstacles to providing quality end-of-life care, the majority of participants (n = 16) cited an educational deficit among physicians, staff, or the public as the most significant, while an additional seven cited staff shortages and turnover. These results suggest at least two potential avenues for change to improve end-of-life care in nursing homes: (1) educational efforts on the topics of end-of-life and palliative care among both practitioners, residents, and their families, and (2) creating incentives to improve staff recruitment and retention.
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http://www.liebertonline.com/doi/abs/10.1089/jpm.2004.7.668

August 7, 2019

Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care.

Coleman EA, Berenson RA. Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care. Ann Intern Med. 2004; 140:533-536. http://annals.org/article.aspx?articleid=717858 . Accessed August 7, 2014. Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients […]
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Coleman EA, Berenson RA. Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care. Ann Intern Med. 2004; 140:533-536. http://annals.org/article.aspx?articleid=717858 . Accessed August 7, 2014. Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care in the same location. Transitional care, which primarily concerns the relatively brief time interval that begins with preparing a patient to leave one setting and concludes when the patient is received in the next setting, poses challenges that distinguish it from other types of care. Many transitions are unplanned, result from unanticipated medical problems, occur in “real time” during nights and on weekends, involve clinicians who may not have an ongoing relationship with the patient, and happen so quickly that formal and informal support mechanisms cannot respond in a timely manner. This article describes the challenges involved in and potential solutions for improving the quality of transitional care.
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http://www.annals.org/content/141/7/533.abstract?sid=e687968f-50f0-4a9c-bc8f-617558bc306d

August 7, 2019

Identifying Post-Acute Medication Discrepancies in Community Dwelling Older Adults: A New Tool.

Smith JD, Coleman EA, Min S-J.Am J Geriatr Pharmacother. 2004;2(2):141-148. http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf . Accessed August 7, 2014. Results: Across all 3 clinical disciplines, the mean interrater reliability (κ) for the 20 vignettes was 0.56 (15% low agreement, 80% good agreement, and 5% excellent agreement). Within disciplines, the κ statistic was as […]
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Smith JD, Coleman EA, Min S-J.Am J Geriatr Pharmacother. 2004;2(2):141-148. http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf . Accessed August 7, 2014. Results: Across all 3 clinical disciplines, the mean interrater reliability (κ) for the 20 vignettes was 0.56 (15% low agreement, 80% good agreement, and 5% excellent agreement). Within disciplines, the κ statistic was as follows: nurses, 0.68; pharmacists, 0.50; and physicians, 0.64. Intrarater reliability ranged from 0.58 to 0.69. Conclusions: By capturing transition-related medication discrepancies, the MDT fills an important gap in national efforts to promote patient safety. MDT items are actionable at both the patient and system level, suggesting that this tool could be used to foster continuous quality improvement efforts.
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http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf

August 7, 2019

The Care Transitions Intervention: A Patient-Centered Approach to Facilitating Effective Transfers Between Sites of Geriatric Care.

Parry C, Coleman EA, Smith JD, Frank JC, Kramer AM. The Care Transitions Intervention: A Patient-Centered Approach to Facilitating Effective Transfers Between Sites of Geriatric Care. Home Health Services Quarterly. 2003;22(3):1-18. http://www.caretransitions.org/documents/The%20CTI%20-%20HHCSQ.pdf . During an episode of illness, older patients may receive care in multiple settings; often resulting in fragmented […]
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Parry C, Coleman EA, Smith JD, Frank JC, Kramer AM. The Care Transitions Intervention: A Patient-Centered Approach to Facilitating Effective Transfers Between Sites of Geriatric Care. Home Health Services Quarterly. 2003;22(3):1-18. http://www.caretransitions.org/documents/The%20CTI%20-%20HHCSQ.pdf . During an episode of illness, older patients may receive care in multiple settings; often resulting in fragmented care and poorly-executed care transitions. The negative consequences of fragmented care include duplication of services; inappropriate or conflicting care recommendations, medication errors, patient/caregiver distress, and higher costs of care. Despite the critical need to reduce fragmented care in this population, few interventions have been developed to assist older patients and their family members in making smooth transitions. This article introduces a patient-centered interdisciplinary team intervention designed to improve transitions across sites of geriatric care.
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http://www.caretransitions.org/documents/The%20CTI%20-%20HHCSQ.pdf

August 7, 2019

Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care for Persons with Continuous Complex Care Needs.

Coleman E. Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care for Persons with Continuous Complex Care Needs. J Am Geriatr Soc. 2003;51(4):549-555. http://www.caretransitions.org/documents/Falling%20through%20the%20cracks%20-%20JAGS.pdf . Accessed August 7, 2014. Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is […]
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Coleman E. Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care for Persons with Continuous Complex Care Needs. J Am Geriatr Soc. 2003;51(4):549-555. http://www.caretransitions.org/documents/Falling%20through%20the%20cracks%20-%20JAGS.pdf . Accessed August 7, 2014. Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, and quality improvement entities. This article begins with a definition of transitional care and then discusses the nature of the problem, its prevalence, manifestations of poorly executed transitions, and potentially remediable barriers. Necessary elements for effective transitions are then presented, followed by promising new directions for quality improvement at the level of the delivery system, information technology, and national health policy. The article concludes with a proposed research agenda designed to advance the science of high-quality transitional care.
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http://www.caretransitions.org/documents/Falling%20through%20the%20cracks%20-%20JAGS.pdf

August 7, 2019

Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society (AGS) Position Statement.

American Geriatrics Society. Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society (AGS) Position Statement. Journal of the American Geriatrics Society. 2007;51(4): 556-557. http://www.caretransitions.org/documents/Improving%20the%20quality%20-%20JAGS. Pdf. Published March 2007. Accessed August 7, 2014. The assisted living (AL) setting is subject to multiple transitional care points. […]
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American Geriatrics Society. Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society (AGS) Position Statement. Journal of the American Geriatrics Society. 2007;51(4): 556-557. http://www.caretransitions.org/documents/Improving%20the%20quality%20-%20JAGS. Pdf. Published March 2007. Accessed August 7, 2014. The assisted living (AL) setting is subject to multiple transitional care points. Each transition is an opportunity for a collaborative, multidisciplinary process. Of course, this can only occur with careful planning at both ends of the transition. For this process to be successful, a coordinated system involving several members of the multidisciplinary team is required. One important component of ensuring a successful process is open, regular communication with all the critical channels. By having a point person in the AL facility serve as the liaison and educator between each channel, a successful transitional care process can be achieved.
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http://www.caretransitions.org/documents/Improving%20the%20quality%20-%20JAGS.pdf

August 7, 2019

Diffusing Our Innovations.

Boult C, Coleman E. Diffusing Our Innovations. Journal of the American Geriatrics Society. 2003;51(1):127-128. http://onlinelibrary.wiley.com/doi/10.1034/j.1601-5215.2002.51035.x/abstract . Accessed August 1, 2014. The purpose of the “Models and Systems of Geriatric Care” section is to disseminate descriptions of successful or promising approaches to the organization, financing, or delivery of health care for […]
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Boult C, Coleman E. Diffusing Our Innovations. Journal of the American Geriatrics Society. 2003;51(1):127-128. http://onlinelibrary.wiley.com/doi/10.1034/j.1601-5215.2002.51035.x/abstract . Accessed August 1, 2014. The purpose of the “Models and Systems of Geriatric Care” section is to disseminate descriptions of successful or promising approaches to the organization, financing, or delivery of health care for older people. Most of the articles published in this section will provide detailed descriptions of how models or systems have been developed, implemented, operated, staffed, improved, financed, marketed, or received by patients, caregivers, or providers. These articles seek to convey sufficient information to allow JAGS ’s readers to adapt the described programs for implementation in their local environments. Commentaries and review articles about geriatric models or systems are also welcome. Articles that focus on comparisons between the outcomes of models or systems should be submitted to the Clinical Investigations Section, rather than to this Section.
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http://onlinelibrary.wiley.com/doi/10.1034/j.1601-5215.2002.51035.x/abstract

August 7, 2019

The Association Between Care Coordination and Emergency Department Use in Older Managed Care Enrollees.

Coleman E, Eilertsen T, Magid D, et.al. The Association Between Care Coordination and Emergency Department Use in Older Managed Care Enrollees. International Journal of Care Integration. 2002;2. http://www.caretransitions.org/documents/The%20assoc%20between%20care%20coord%20-%20IJIC.pdf Results: Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. […]
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Coleman E, Eilertsen T, Magid D, et.al. The Association Between Care Coordination and Emergency Department Use in Older Managed Care Enrollees. International Journal of Care Integration. 2002;2. http://www.caretransitions.org/documents/The%20assoc%20between%20care%20coord%20-%20IJIC.pdf Results: Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. Similarly, no differences were found in the number of different physicians or medication prescribers involved in the patients’ care. Four-week follow-up after potentially high-risk events for subsequent ED use, including changes in chronic disease medications, missed encounters, and same day encounters, did not differ between subjects with inappropriate ED use and controls. Conclusion: Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic. Future research should focus on the development of new measures and on approaches that better isolate the role of care co-ordination from other potential variables that influence utilization.
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http://www.caretransitions.org/documents/The%20assoc%20between%20care%20coord%20-%20IJIC.pdf

August 7, 2019

Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices

BACKGROUND Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. OBJECTIVES We examine whether and how practices use commercial EMRs to […]
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BACKGROUND Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. OBJECTIVES We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-arounds practices have created to address new coordination challenges. DESIGN, SETTING Semi-structured telephone interviews in 12 randomly selected communities. PARTICIPANTS Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. RESULTS Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs’ potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity). CONCLUSIONS There is a gap between policy-makers’ expectation of, and clinical practitioners’ experience with, current electronic medical records’ ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.
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http://www.springerlink.com/content/j02w23143245j24r/

August 7, 2019

Challenges of Systems of Care for Frail Older Persons: The United States of America Experience

Coleman E. Challenges of Systems of Care for Frail Older Persons: The United States of America Experience. Aging Clinical Experimental Research. 2002;14(4):233-238. http://www.caretransitions.org/documents/Challenges%20of%20Systems%20-%20ACER%20Abstract.pdf. Accessed August 1, 2014. The concomitant demographic and economic imperatives of an increasingly aged and frail population in the United States provide a compelling rationale for the […]
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Coleman E. Challenges of Systems of Care for Frail Older Persons: The United States of America Experience. Aging Clinical Experimental Research. 2002;14(4):233-238. http://www.caretransitions.org/documents/Challenges%20of%20Systems%20-%20ACER%20Abstract.pdf. Accessed August 1, 2014. The concomitant demographic and economic imperatives of an increasingly aged and frail population in the United States provide a compelling rationale for the development of systems of care that provide greater integration and improved quality of care. After providing the supporting statistics that illuminate the challenges faced by this country, this article then examines the current organization and financing of services pertinent to the care of frail older adults. These individual services, however, comprise a continuum of care more by default than by design. Greater integration is needed to meet the needs of this population that requires care from different providers in multiple settings. Fortunately, innovations are being implemented that integrate acute care with chronic and long-term care, providing reason for hope that the health care system in the United States is responding to these imperatives.
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http://www.caretransitions.org/documents/Challenges%20of%20Systems%20-%20ACER%20Abstract.pdf