Practices can take steps to improve care transitions

(HealthDay)—Implementation of a rigorous process can improve transitions of care, according to an article published March 10 in Medical Economics.

The author of the article, Elizabeth W. Woodcock, M.B.A., notes that the most frequent failings in the transition of care between settings or providers are poor communication, insufficient engagement by patients and caregivers, and failure of the medical community to demand and designate strict accountability for managing the transition.

Woodcock suggests seven steps a practice can take to improve transitions for its patients: (1) formalize inbound patient referrals, including using an electronic consult form and a timeline to process the data; (2) concentrate on logistics of external referrals, including providing requested information and what information the practice wants back regarding the patient's conditions and treatment; (3) file for payment for the transition of care using two new Current Procedural Terminology codes; (4) collaborate with other health care providers to find common goals; (5) improve performance, including particularly hospital readmissions; (6) identify prevention strategy opportunities; and (7) contemplate participation in a patient-centered medical home.

"Ideally, a care transition is a value-based, patient-centric event that does not disrupt the continuity of care," Woodcock writes.

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