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Report Examines Lack of Attention Given to Transitional Care Nationwide
DENVER (September 27, 2004) — One of the most overlooked and significant sources of potentially life threatening medical errors occur when chronically ill or frail patients move from one place of care to another, such as from a nursing home to a hospital, or from a hospital to home care.
In a study to be published Oct. 5 in the Annals of Internal Medicine, Dr. Eric Coleman of the University of Colorado Denver, and Dr. Robert Berenson of the Urban Institute in Washington, D.C., point out that there is more and more knowledge about the problems of transitional care, but that America's healthcare policymakers and practitioners continue to focus only on medical errors that occur while patients are in hospitals or in nursing homes. The serious problems of care between settings remain neglected.
In the article, "Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care," the authors say that while there is a point of responsibility and an incentive to reduce errors in a specific facility, there is no comparable responsibility or incentive to protect the patient when he or she moves from one setting to another.
"The root causes of poor transitional care will continue to become more significant over time," said Coleman, MD, MPH, associate professor of medicine in the division of Health Care Policy and Research at CU-Health Sciences Center. "Take for example the number of physicians who practice in only one setting - those doctors typically won't follow a patient into a hospital or nursing home, creating problems in continuity of care.
"Also, there is a fundamental lack of familiarity among staff of differing facilities of the needs and capabilities of other treatment settings where patients are sent for further care."
The article also points to increasing pressures that encourage facilities to focus on service delivery needs within their own institutions and on the needs of their patients from check-in to check-out only. Finally, the article cites decreased Medicare involvement in hospital discharge planning, which is generally the starting point for many patients in transition.
"The problem of poor transitional care is not limited to hospitals and the discharge process," said Coleman. "Care transition problems and errors flow in all directions in the healthcare system.
"The outcomes for patients and the healthcare system are costly medical errors and poor health outcomes."
"Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care" will be the topic of the National Health Policy Forum session on Thursday, Oct. 7, in Washington, D.C. The discussion will feature Drs. Coleman and Berenson, and Carol Raphael, president and CEO, Visiting Nurse Service of New York. Please visit http://www.nhpf.org/announcements/FS_10-07-04_CareTransitions.pdf for more information.
Additional information on the CU care transition research program can be found at www.caretransitions.org.
The University of Colorado Denver is one of three campuses in the University of Colorado system. Located in Denver and Aurora, Colo., the center includes schools of medicine, nursing, pharmacy, and dentistry, a graduate school and a teaching hospital. For more information, visit the Web site at www.uchsc.edu.