title: Innovative use of technologies and methods to redesign care: the problem of care transitions.
abstract: Organizations are redesigning models of care in today's rapidly changing health care environment. Using proven innovation techniques maximizes likelihood of effective change. Our safety-net hospital aims to reduce high emergency department visit, admission, and readmission rates, key components to health care cost control. Twenty-five clinical stakeholders participated in mixed-methods innovation exercises to understand stakeholders, frame problems, and explore solutions. We identified existing barriers and means to improve post-emergency department/post-inpatient discharge care coordination/communication among patient-centered medical home care team members, including patients. Physicians and staff preferred automated e-mail notifications, including patient identifiers, medical home/primary care provider information, and relevant clinical documentation, to improve communication efficiency/efficacy.
authors.affiliation: David Geffen School of Medicine and University of California (UCLA) (Drs Richman and Wasson), Department of Medicine, Olive View-UCLA Medical Center (Drs Richman and Wasson); Ambulatory Care Network: Research and Innovation (Ms Sklaroff and Dr Gross-Schulman), Los Angeles County Department of Health Services, Sylmar (Drs Richman and Wasson and Gross-Schulman and Ms Sklaroff); Olive View-UCLA Education and Research Institute (Ms Hoang); and The Tseng College (Ms Sklaroff) and Master of Public Health Program, Department of Health Sciences (Ms Hoang), California State University, Northridge.
authors.forename: Mark
authors.initials: M
authors.lastname: Richman
authors.forename: Laura Myerchin
authors.initials: LM
authors.lastname: Sklaroff
authors.forename: Khathy
authors.initials: K
authors.lastname: Hoang
authors.forename: Elijah
authors.initials: E
authors.lastname: Wasson
authors.forename: Sandra
authors.initials: S
authors.lastname: Gross-Schulman
mesh_terms: D002140:California; D003142:Communication; D003144:Communication Barriers; D004059:Diffusion of Innovation; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration; D006751:Hospital Information Systems / Q000592:standards / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge / Q000191:economics / Q000592:standards; D010359:Patient Readmission; D064876:Safety-net Providers