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Why do many patients face the crisis of returning to the hospital after discharge? How can transformational care save them?
Every year, many patients face the dilemma of returning to the hospital soon after being discharged from the hospital. Older patients, in particular, often suffer from multiple health conditions at the same time, putting their risk soaring during medical transitions. It’s not just older patients, younger people face the same challenges when transitioning from pediatric to adult care. How to effectively manage the transition of health care and allow patients to smoothly transition to the new environment has become one of the current issues that need to be solved in the medical field.
Transformational care is defined as a set of actions designed to ensure coordination and continuity of care when patients move between settings.
Transitional care is not just a matter of patient transition from hospitalization to other care facilities, but also includes how to effectively coordinate the patient's health management after discharge. According to the definition of the American Geriatrics Society, transitional care includes the effective connection of multiple links from the hospital, rehabilitation facilities to the patient's home.
The necessity of transformational care
According to research, patients face higher risks during care transitions, including medication errors and poor communication of medical information. Incorrect medical management can not only lead to worsening of the condition, but may even lead to long-term disability or death. In addition, readmissions due to poor transitional care are increasing, taking a heavy toll on patients' health, finances, and emotions.
Medical expenditures are rising year by year, which makes patients, medical providers and even policymakers pay more and more attention to reducing unnecessary consumption of medical resources.
Measures to improve the quality of transitional care
One measure of the quality of transitional care is the Care Transitions Measure (CTM), a 15-item survey administered to patients after discharge that can effectively predict the likelihood of patients returning to the ED. sex. The measure, developed by Dr. Eric Coleman and his team at the University of Colorado, has shown promise in improving outcomes for patients during their transition.
The implementation of an exchange of care strategy helps patients receive necessary support and guidance when making care transitions. For example, Care Transitions Intervention (CTI) is a coaching-based approach that helps patients return to self-care after a change in health status. This program is not just short-term support, but will continue to help patients understand how to manage their health in the coming months.
Patients who participated in Care Transitions Intervention had 20% to 40% lower hospitalization rates after 30, 90 and 180 days than other patients.
Improve the coordination of medical processes
Continuity of care is key to improving patient health outcomes. The continuity of medical services can be divided into continuity of information, continuity of personal relationships, and continuity of clinical management. Only by strengthening these three aspects can patients avoid loopholes in the medical process, thereby improving safety and effectiveness.
In a health care environment with blurred boundaries, understanding and enhancing the normal ability to communicate between health care providers is critical. Medical providers need to communicate effectively during the transition process to ensure that patients' medical needs and preferences can be transmitted smoothly in order to provide patients with the best quality of care.
Conclusion
Transitional care is not only crucial for elderly patients, but also has considerable significance for young patients in transition. Healthcare promoters and policymakers are working to improve this process to ensure the safe transfer of patients between different healthcare facilities. As medical needs increase and structures change, how can the strategies and effects of transformational care be further upgraded?
