Continuum care is built on provider relationships.
One of the biggest obstacles to creating truly seamless continuity of care is the difficulty of creating an effective feedback loop from home health care agencies to hospital case managers. The problem is complicated by the number of home health agencies to which most hospitals refer, and by lack of external incentives. Case managers at Children's Hospital of Pittsburgh attempt to get around the feedback problem by communicating with the families of patients receiving high-tech home care, such as infusion therapy. Experts advise that it's easier to establish policies for sharing information and case management tools such as critical pathways when you enter into formal partnerships with high-volume home care agencies.
D019090:Case Management / Q000458:organization & administration*; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D019451:Information Management; D007591:Joint Commission on Accreditation of Healthcare Organizations; D014481:United States