Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex care needs
Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex care needs
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DOI：
10.1046/j.1532-5415.2003.51185.x
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发表时间：
2003-04-01
影响因子：
6.3
通讯作者：
Coleman, EA
中科院分区：
文献类型：
--
作者：
Coleman, EA
有持续复杂护理需求的人经常需要在多个环境中进行护理。在不同环境之间的过渡期间，这一群体特别容易经历护理质量差和护理分散的问题。尽管这些转变已经变得多么普遍，但改善护理转变的挑战几乎没有受到政策制定者、临床医生和质量改进实体的关注。本文从过渡期护理的定义开始，然后讨论了问题的性质、其流行率、执行不佳的过渡期的表现以及潜在的可补救的障碍。然后提出了有效过渡的必要要素，随后提出了在交付系统、信息技术和国家卫生政策层面上改进质量的有希望的新方向。文章最后提出了一个旨在推进高质量过渡期护理科学的研究议程。
Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, and quality improvement entities. This article begins with a definition of transitional care and then discusses the nature of the problem, its prevalence, manifestations of poorly executed transitions, and potentially remediable barriers. Necessary elements for effective transitions are then presented, followed by promising new directions for quality improvement at the level of the delivery system, information technology, and national health policy. The article concludes with a proposed research agenda designed to advance the science of high-quality transitional care.