Improving Care Transitions with Innovative Clinical Models

In this presentation, Dr. Jane A. Driver, MD, MPH, Assistant Professor of Medicine at Harvard Medical School, discusses pilot programs that improve transitions of care for geriatric patients. She describes the lack of appropriate discharge instructions and how this contributes to the issue of re-hospitalization in elderly patients. She discusses the important components of transitional care and the obstacles that institutions face in trying to provide this care.

CME Information

CME Credit Available

You may claim CME credit after watching this activity.

Needs Statement

Faculty and trainees within the Department of Medicine who are involved in the care of patients need to be regularly updated with the recent advances and guidelines in the fields of medicine and quality improvement to increase clinical knowledge. This Grand Rounds series also aims to provide learners with the appropriate skills to implement the advances and guidelines in clinical practice to enhance the quality of patient care and outcomes.

Objectives

At the conclusion of this activity, the participant should be able to:

  • Discuss the “four pillars” of transitional care.
  • Examine the elements of successful transitional care programs by comparing the outcomes of three different models.
  • Evaluate the unmet transitional care needs of patients in one's own healthcare system.

Target Audience

  • Physicians
  • Medical Students
  • Fellows
  • Residents

Accreditation/Credit Designation

Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Program Director

Richard J. Hamill, M.D.
Professor
Department of Medicine
Baylor College of Medicine
Houston, Texas
Disclosure: Nothing to disclose.

Term of Approval

December 1, 2019 through December 31, 2021. Original release date: December 1, 2019.

Disclosure Policy

The Office of Continuing Medical Education (OCME) makes every effort to develop CME activities that are scientifically based, accurate, current, and objectively presented. In accordance with the Accreditation Council for Continuing Medical Education Standards for Commercial SupportSM, Baylor College of Medicine (BCM) has implemented a mechanism requiring everyone in a position to control the content of an educational activity (e.g., directors, planning committee members, contributors, peer reviewers) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships: 1) at the time of the activity or within 12 months prior; and 2) of their spouses/partners.

Baylor College of Medicine does not view the existence of interests or relationships with commercial entities as implying bias or decreasing the value of a presentation. It is up to the participants to determine whether the interests or relationships influence the presenter with regard to exposition or conclusions.

If at any time during this activity you feel that there has been commercial or promotional bias, please inform us by using the commercial bias comments box in the evaluation form. Please answer the questions about balance in the CME activity evaluation candidly.

Disclosures

The following individual(s) has/have reported financial or other relationship(s) with commercial entities whose products/services may relate to the educational content of this activity:

Presenter

  1. Jane A. Driver, M.D., M.P.H. Placeholder Image

    Jane A. Driver, M.D., M.P.H.

    Assistant Professor of Medicine
    Harvard Medical School

    Disclosure:

    Nothing to disclose.