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Journal of Ambulatory Care Management:
doi: 10.1097/JAC.0000000000000028
Original Articles

Innovative Use of Technologies and Methods to Redesign Care: The Problem of Care Transitions

Richman, Mark MD, MPH; Sklaroff, Laura Myerchin MA; Hoang, Khathy BA; Wasson, Elijah MD; Gross-Schulman, Sandra MD, MPH, RN

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Abstract

Organizations are redesigning models of care in today's rapidly changing health care environment. Using proven innovation techniques maximizes likelihood of effective change. Our safety-net hospital aims to reduce high emergency department visit, admission, and readmission rates, key components to health care cost control. Twenty-five clinical stakeholders participated in mixed-methods innovation exercises to understand stakeholders, frame problems, and explore solutions. We identified existing barriers and means to improve post–emergency department/post–inpatient discharge care coordination/communication among patient-centered medical home care team members, including patients. Physicians and staff preferred automated e-mail notifications, including patient identifiers, medical home/primary care provider information, and relevant clinical documentation, to improve communication efficiency/efficacy.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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