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Care Transition Strategies

A new study published in the October 2015 edition of P&T takes a look at care transitions and provides strategies for improved communication and reduced readmissions. While many of the comments are geared towards hospitals, there are suggestions for post-acute providers as well that are discharging residents into the community. Some takeaway from “Exploring Transitional Care: Evidence-Based Strategies for Improving Provider Communication and Reducing Readmissions” include:

  • Medication reconciliation continues to be a challenge even though it is a key part of the transition process. This article notes that studies have found that 46%-56% of all med errors occur at a transitional point of care, including omissions, duplications, contraindications and unclear information.
  • The use of standardized forms to disseminate data such as CMS’ Continuity Assessment Records and Evaluation (CARE) item set and AMDA’s Universal Transfer Form can assist with communication during transitions, reduce treatment errors and save caregivers time from needing to call the transitioning provider for more information.
  • Approximately 12% of Americans have a “proficient” level of health literacy, according to the authors. This, coupled with physical deficits such as hearing, vision or cognitive impairments, can make following discharge instructions difficult.

Read the full study on the P&T website.

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