NTOCC believes in the commitment of healthcare workers, practitioners, and leaders and in their ability to make a difference in improving transitions of care. To further NTOCC’s reach for improving the quality of care transitions, we have added to our Implementation and Evaluation Plan by offering this additional module: the emergency department to home transition. The methodology used here is the same for the introductory module released in 2008—implement a plan and evaluate it to see how it is working. This document is intended to be used in conjunction with the original document, “Improving on Transitions of Care: How to Implement and Evaluate a Plan.” This plan includes evaluation questions, acceptable metrics or measures, tools, and tips applicable to emergency departments, home caregivers, and primary care offices. As with other NTOCC strategies, communication is the most important component of any plan, tool, or quality improvement effort.

August 7, 2019

Improving on Transitions of Care: Emergency Department to Home

NTOCC believes in the commitment of healthcare workers, practitioners, and leaders and in their ability to make a difference in improving transitions of care. To further NTOCC’s reach for improving the quality of care transitions, we have added to our Implementation and Evaluation Plan by offering this additional module: the […]
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NTOCC believes in the commitment of healthcare workers, practitioners, and leaders and in their ability to make a difference in improving transitions of care. To further NTOCC’s reach for improving the quality of care transitions, we have added to our Implementation and Evaluation Plan by offering this additional module: the emergency department to home transition. The methodology used here is the same for the introductory module released in 2008—implement a plan and evaluate it to see how it is working. This document is intended to be used in conjunction with the original document, “Improving on Transitions of Care: How to Implement and Evaluate a Plan.” This plan includes evaluation questions, acceptable metrics or measures, tools, and tips applicable to emergency departments, home caregivers, and primary care offices. As with other NTOCC strategies, communication is the most important component of any plan, tool, or quality improvement effort.
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http://www.ntocc.org/Portals/0/ImplementationPlan_EDToHome.pdf

August 7, 2019

The “continuum of care” for older adults: design and evaluation of an educational series

Geriatricians work within a continuum of health services designed to meet the diverse care needs of older adults. They must develop expertise in these care models and be able to guide safe and efficient transitions. This article describes a 9-week educational series designed to review the evidence base and practical […]
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Geriatricians work within a continuum of health services designed to meet the diverse care needs of older adults. They must develop expertise in these care models and be able to guide safe and efficient transitions. This article describes a 9-week educational series designed to review the evidence base and practical aspects of implementing key services that span the continuum of care for older adults. The sessions in the series covered geriatric assessment, ambulatory care, acute hospital, house call, hospital-at-home, Program of All-Inclusive Care for the Elderly, assisted living, inpatient consultation, rehabilitation, nursing home, chronic hospital, and palliative care and hospice. To assess the educational effect of these sessions, evaluations were collected at the end of each session, including one "summative evaluation" after the completion of the entire 9-week series. The vast majority (97%) of survey responses evaluating individual sessions were positive (scores of 4 or 5 on a 5-point Likert scale), and 89% of responses on the summative evaluation were in that range. This educational series efficiently provides a sequential "tour" of health services for older adults, allowing learners to appreciate the continuum of geriatric care models and relationships between services. Feedback from attendees suggests that this format increases knowledge of health services along the continuum of care for older adults and does so in an efficient manner for learners at different levels of training.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2009.02275.x/abstract

August 7, 2019

AHRQ. Patient Safety Network. PSNet.

Agency for Healthcare Research and Quality. Patient Safety Network. PSNet. [Web site]. http://psnet.ahrq.gov/default.aspx . Updated July 30, 2014. Accessed July 30, 2014. This toolkit includes comprehensive information for patients and families to facilitate safe transitions from hospital to follow-up care.
Agency for Healthcare Research and Quality. Patient Safety Network. PSNet. [Web site]. http://psnet.ahrq.gov/default.aspx . Updated July 30, 2014. Accessed July 30, 2014. This toolkit includes comprehensive information for patients and families to facilitate safe transitions from hospital to follow-up care.
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http://psnet.ahrq.gov/default.aspx

August 7, 2019

Tying up loose ends: Discharging patients with unresolved medical issues. Archives of Internal Medicine 167, pp. 1305-1311.

Background: Patients are increasingly being discharged from the hospital with unresolved medical problems requiring outpatient follow-up. This study evaluates the frequency with which hospital physicians recommend outpatient workups to address patients’ unresolved medical problems and the impact that availability of discharge summaries has on workup completion. Methods: We conducted a […]
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Background: Patients are increasingly being discharged from the hospital with unresolved medical problems requiring outpatient follow-up. This study evaluates the frequency with which hospital physicians recommend outpatient workups to address patients' unresolved medical problems and the impact that availability of discharge summaries has on workup completion. Methods: We conducted a retrospective cohort study of patients discharged from the medicine or geriatrics service of a large teaching hospital between June 1, 2002, and December 31, 2003. Each subject's inpatient medical record was reviewed to determine if the hospital physician recommended an outpatient workup. Subjects' outpatient medical records were then reviewed to determine if the workups were completed. Results: Of 693 hospital discharges, 191 discharged patients (27.6%) had 240 outpatient workups recommended by their hospital physicians. The types of workups were diagnostic procedures (47.9%), subspecialty referrals (35.4%), and laboratory tests (16.7%). The most common diagnostic procedures were computed tomographic scans to follow up abnormalities seen on previous radiographic studies and endoscopic procedures to follow up gastrointestinal tract bleeding. Of recommended workups, 35.9% were not completed. Increasing time to the initial postdischarge primary care physician visit decreased the likelihood that a recommended workup was completed (odds ratio, 0.77; P = .002), and availability of a discharge summary documenting the recommended workup increased the likelihood of workup completion (odds ratio, 2.35; P = .007). Conclusions: Noncompletion of recommended outpatient workups after hospital discharge is common. Primary care physicians' access to discharge summaries documenting the recommended workup is associated with better completion of recommendations. Future research should focus on interventions to improve the quality and dissemination of discharge information to primary care physicians.
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http://archinte.ama-assn.org/cgi/content/full/167/12/1305

August 7, 2019

Specialists/subspecialists and the patient-centered medical home

This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices […]
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This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices within the PCMH model is described, with a focus on the potential for these practices to serve as a PCMH for a subgroup of patients or, alternatively, as a PCMH "neighbor" that interfaces effectively with PCMH practices. The authors conclude that the model for effective connections between the PCMH and specialty/subspecialty practices requires further development, including the cross-specialty establishment of guidelines and processes regarding referrals, information flow, transitions in care, and accountability. The efforts of the American College of Physicians' Council of Subspecialty Societies PCMH Workgroup to further develop this model are described. The authors encourage involvement from all interested stakeholders to ensure that the issues and challenges identified are addressed through collaboration and consensus based on available evidence.
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http://journal.publications.chestnet.org/article.aspx?articleid=1086197

August 7, 2019

The hospital discharge: A review of a high risk care transition with highlights of a reengineered discharge process. Journal of Patient Safety 3(2), pp. 97-106.

The hospital discharge is a handoff, ripe embedded structural risks and hazards that can result in passive or active failures among “sharp end” providers. These failures can result in medical errors and an array of postdischarge adverse events. There are now emerging data to suggest that postdischarge-related adverse events and […]
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The hospital discharge is a handoff, ripe embedded structural risks and hazards that can result in passive or active failures among "sharp end" providers. These failures can result in medical errors and an array of postdischarge adverse events. There are now emerging data to suggest that postdischarge-related adverse events and rehospitalizations can be reduced through interventions at the time of hospital discharge. This article reviews the modifiable components of the hospital discharge process related to adverse events and rehospitalizations, including those relating to the characteristics of the hospital, patient, and clinician. Using multimethod analysis, our group described the principles thought to be important to the discharge process and delineated what we now call the reengineered discharge, a set of 11 discrete and mutually reinforcing components that we believe should be consistently part of every hospital discharge. Finally, we discuss the work or the National Quality Forum Consensus Standards Maintenance committee who, in 2006, added the hospital discharge as one of its "safe practices for better healthcare."
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http://journals.lww.com/journalpatientsafety/Abstract/2007/06000/The_Hospital_Discharge__A_Review_of_a_High_Risk.9.aspx

August 7, 2019

AHRQ. Questions To Ask Your Doctor.

Agency for Healthcare Research and Quality. Questions To Ask Your Doctor. [Web Site] Updated September 2012. Accessed July 30, 2014. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html . Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, […]
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Agency for Healthcare Research and Quality. Questions To Ask Your Doctor. [Web Site] Updated September 2012. Accessed July 30, 2014. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html . Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.
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http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

August 7, 2019

Systematically improving physician assignment during in-hospital transitions of care by enhancing a preexisting hospital electronic health record

BACKGROUND: The nationwide expansion of the hospitalist movement brings rapid change in communication and work processes in many hospitals. While our fast-growing hospitalist program has greatly improved length of stay and quality measures, it has also faced complex operational challenges affecting the whole organization rather than just our division: assigning […]
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BACKGROUND: The nationwide expansion of the hospitalist movement brings rapid change in communication and work processes in many hospitals. While our fast-growing hospitalist program has greatly improved length of stay and quality measures, it has also faced complex operational challenges affecting the whole organization rather than just our division: assigning and tracking hospitalist coverage of admitted patients was one of these challenges.
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.401/abstract

August 7, 2019

MedLine Plus: Interactive Health Tutorials

MedlinePlus. Interactive Health Tutorials. [Web site]. http://www.nlm.nih.gov/medlineplus/tutorial.html . Updated April 18, 2012. Accessed July 30, 2015. MedlinePlus presents interactive health tutorials from the Patient Education Institute. Learn about the symptoms, diagnosis and treatment for a variety of diseases and conditions. Also learn about surgeries, prevention and wellness. Each tutorial includes […]
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MedlinePlus. Interactive Health Tutorials. [Web site]. http://www.nlm.nih.gov/medlineplus/tutorial.html . Updated April 18, 2012. Accessed July 30, 2015. MedlinePlus presents interactive health tutorials from the Patient Education Institute. Learn about the symptoms, diagnosis and treatment for a variety of diseases and conditions. Also learn about surgeries, prevention and wellness. Each tutorial includes animated graphics, audio and easy-to-read language.
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http://www.nlm.nih.gov/medlineplus/tutorial.html

August 7, 2019

AHRQ. Navigating the Health Care System: Advice columns from Dr. Carolyn Clancy

AHRQ. Navigating the Health Care System. [Web site]. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/070709.html . Published July 7, 2009. Accessed July 30, 2014. Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, […]
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AHRQ. Navigating the Health Care System. [Web site]. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/070709.html . Published July 7, 2009. Accessed July 30, 2014. Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.
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http://www.ahrq.gov/consumer/cc/cc070709.htm