The barriers to action
There used to be significant resistance and minimal incentive for preventing readmission in many layers of health care. It is now true that there has been more awareness and attention to the problems and issues regarding readmission to acute-care hospital, regardless of location of care such as ambulatory care or SNF. Therefore, it is also true that numerous researches and papers published to solve this issue by various interventions and programs reflect the significance of problems and emergent attention, especially administrative and management level that is more conscious about the potential financial impact from readmissions.
In order to apply this empirical evidence …show more content…
Or it might be true that front line health care providers might not be aware they are stakeholders in terms of preventing readmission.
Therefore, It is tendency for health care providers at acute hospital that readmission from SNFs is due to something suboptimal or wrong with SNF’s care.
Thus it is important for this program to involve administrative support (top-down) as well as “champion” from each disciplines (bottom-up) who are interested in and able to comprehend the proposed changes in process in coordination of care. Based on process mapping about transition in care and coordination of care, there are many processes should have happened in the acute hospital since they are significantly contribute future risk of readmission.
Of course, outside of acute-hospital and SNF, primary care physician who provide follow up visit should be included for this process improvement.
Stake holders and their traditions
All type of comprehensive care coordination will involve many stake holders, such as health care organizations and disciplines in order to provide additional capacity for transition as well as transform the roles and responsibility during the process of coordination of …show more content…
Based on process mapping about transition in care and coordination of care, there are many processes could have happened in the acute hospital, which may be able to contribute the risk reduction for readmission in near future. Of course, main stake holders in terms of health care provider outside of acute-hospital, primary care physicians and their office/ care coordinator, should be included for this process change. However, many disciplines, such as Hospitalist, care coordinators and more in acute-care hospital as well as SNF should be involved and aiming to same outcome