Congratulations to Jane Brock and CFMC

January 23, 2013 at 7:47 AM Leave a comment

Today in JAMA is an article about transitions of care, and reducing readmissions.  Dr. jane Brock and others demonstrated that with the mobilization of community resources, readmissions decline twice as fast as the background rate:

Jane and I met during this trial, and have been friends ever since.  I chaired the steering committee for Northwest Denver, one of the 14 communities Jane studied.  The stories were remarkable.  Hospitals that are ostensible competitors came together with lots of community agencies to design uniform protocols and tools to make transitions of care more effective, efficient, and safe.  Jane tells stories about another part of Denver that was the alpha test site.  The hospital and nursing home staffs in that project had never met each other prior, even though they had shared hundreds of patients.  When they realized how poor and dangerous their communication had been, people teared up, and apologized to one another.  “I had no idea what I was doing to you.  I am so sorry.”

There is much road to travel before we have safe, reliable, and effective transitions for everyone moving from one site of care to another.  But Jane’s effort began and continues the right way.  It recognized that the experience of care should be continuous, not segmented; that people visit caregivers, but they live in communities; and that few things are as powerful as knowing the people you work with in the common service of your neighbors.  My deepest appreciation goes out to Jane and her team for their vision and hard work to tell the rest of us how much better care can be.

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