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Cross-continuum Care Continuity: Achieving Seamless Care and Managing Comorbidities
Carol Boston-Fleischhauer1, Robert Rose, Laurie Hartwig
1Author Affiliations: Chief Nurse Executive, The Advisory Board Company, Washington, DC (Dr Boston-Fleischhauer); and Senior Vice President and System Chief Nursing Officer (Mr Rose) and System Administrative Director of Professional Excellence (Ms Hartwig), Trinity Mother Frances Hospital and Clinics, Tyler, Texas.
Abstract:
As healthcare systems continue to design care models responsive to payment changes and the assumption of clinical and financial risk, the need exists for a comprehensive approach to address cross-continuum care transitions. This article will highlight key learnings from the Nurse Executive Center's research on achieving care continuity. The business case for developing a cross-continuum care transition strategy will be discussed, as well as systemic enablers for the achievement of seamless care. A case study example of 1 system's solution for supporting the multiple comorbid patient population as part of its cross-continuum care transition strategy will be examined.
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