Implementing Proper Transitions of Care to Prevent Rehospitalization

In the post-acute care continuum, individuals may utilize multiple types of providers, including individual healthcare providers and healthcare organizations, during the course of an acute illness or chronic disease. Transitions of care among these different providers requires a great deal of care coordination in order to ensure a successful transition. Failure to meet the individual’s needs during a transition have a myriad of effects on the individual’s health as well as the healthcare industry as a whole.

Unfortunately, a survey of hospitals by the Agency for Healthcare Research and Quality showed that less than 50% of hospitals identify that important information is given during transitions, and it’s likely that the same applies to other types of healthcare organizations. Because of the effects that poor transitions have, it’s vital that all healthcare organizations understand appropriate systems to improve care in this area and prevent negative outcomes such as avoidable rehospitalizations.

• 3 negative outcomes that result from poor transitions of care.
• Several factors that contribute to poor transitions of care.
• 3 systems that can improve transitions of care.