Transcription of Reducing Care Fragmentation - Improving Chronic Care
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Reducing care Fragmentation A TOOLKIT. FOR COORDINATING care . Reducing care Fragmentation 1. Contents I. Introduction 1. MS. G: A Case Study in Fragmented II. The care Coordination Model 4. care Coordination MS. H: A Case Study in Coordinated III. Change Package and Tools 8. Key Change / Activities #1 KEY CHANGE: Decide as a primary care clinic to improve care #2 KEY CHANGE: Develop a referral/transition tracking Patient #3 KEY CHANGE: Organize the practice team to support patients and families during referrals and Relationships and #4 KEY CHANGE: Identify, develop and maintain relationships with key specialist groups, hospitals and community #5 KEY CHANGE: Develop agreements with these key groups and #6 KEY CHANGE: Develop and implement an information transfer IV.
Reducing Care Fragmentation: A Toolkit for Coordinating Care, is supported by The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The view presented here are those of the authors, and not
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