(Coleman and Fox, 2004). In addition to performance measurement, the report focuses on aligning financial incentives, ensuring accountability, implementing approaches to information transfer, and supporting patients, caregivers, and clinicians. To date, over 2200 reports have been requested.

The American Academy of Pediatrics (AAP) advocates for a Medical Home for children with special health needs (American Academy of Pediatrics, 2003). Communication of a core set of information and a common shared care plan across settings is a central component of the Medical Home. AAP also realizes that high-quality care for this population must include reimbursed time to review home health care orders for completeness and accuracy and to communicate changes in medications. At present, a comprehensive medication review and communication to involved practitioners can consume approximately 15 minutes which exceeds the time dedicated to a face-to-face visit. Analogous to the care oversight codes allowed under Medicare, pediatricians believe there should be codes for generating the care plan, sharing the information with family and involved clinicians and also communicating with the schools. Documentation of these activities could be a performance measure.

Finally, the JCAHO has deemed status for hospital discharge planning and continuity of care. Under statute, this requires JCAHO to assess the following representative care practices (Box I-2).

Encouraged by its Public Advisory Group, JCAHO has expressed interest in revising and strengthening its accreditation items in this area. To this end, JCAHO measurement leaders have held a series of telephone meetings with researchers from the University of Colorado Health Sciences Center to explore a possible collaboration.

In January 2004, JCAHO implemented a new approach to the survey process, Tracer Methodology (JCAHO, 2004b). This new approach includes the following elements: (a) following the course of care and services provided to a particular patient; (b) assessing relationships among disciplines and important functions; (c) evaluating the performance of relevant processes related to patient care; and (d) identifying potential vulnerabilities in care processes. It is now part of the typical 3-day on-site hospital survey process, and in most instances, a typical team of three surveyors is expected to complete approximately 11 tracers. The Tracer Methodology has not yet been extended beyond the hospital setting but it has potentially important implications for discharge planning and transitions. In particular, this approach can follow a particular patient, assessing how the patient fares along a continuum of care. It can assess how well the hospital staff has ascertained posthospital needs of a particular patient, the planning for discharge that has occurred, and, through patient interviews, assess the patient’s understanding about the postacute care aspects of his or her care.



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