title: Coordinating care in an integrated delivery system.
abstract: To keep patients from falling through the cracks, each point of service in a healthcare system must understand its role in the patient's overall care and have access to the right information at the right time. Communication and a system's organization play significant roles in making coordinated care work: Some health systems prefer to keep patients with common diagnoses in service lines that take them from preadmission to home care; others set up separate organizational entities to coordinate care for all patients with chronic illness. Regular meetings on patient status, standardized forms and clear job descriptions all help minimize confusion.
authors.forename: M
authors.initials: M
authors.lastname: Darby
mesh_terms: D019090:Case Management; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019468:Disease Management; D004282:Documentation; D006075:Governing Board / Q000458:organization & administration; D006694:Holistic Health; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration / Q000592:standards; D008329:Managed Care Programs / Q000458:organization & administration; D008499:Medical Records; D016344:Medicare Part A; D009937:Organizational Objectives; D010346:Patient Care Management; D011357:Product Line Management; D014481:United States; D014600:Utilization Review