Care Transitions as a Reform Strategy

A key tenet of the Massachusetts Quality Improvement Initiative is an  efforts to improve the flow of patients – and information – from one health care setting to another.  The state’s broad plan is laid out in it’s recently released “Strategic Plan for Care Transitions.” Care transitions are an obvious choice as it is an area in which data indicate Massachusetts can do better.  The federal AHRQ 2008 state rankings place Massachusetts seventh overall for health system performance, but 33rd in avoidable hospital admissions and costs.    For your consideration:  How can home health care contribute to an improved care transitions infrastructure?  In terms of medication reconciliation?   Chronic care symptom management? Screening for readmission risk?    The state’s attention to this issue, can be home health’s opportunity to shine.  Your comments and ideas are welcome.

Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

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