Schneider Institutes for Health Policy
Research Project Summary
| Project Title: | Improving Post-Discharge Care for Surgical Patients: The Challenge of Cross-Organizational Coordination |
| PI: | Gittell JH |
| Team Members: | Kautz C, Lusenhop W, Weinberg D |
| Start Date: | 6/1/2002 |
| End Date: | 6/30/2005 |
| Funder: | Commonwealth Fund |
| Research Area: | Acute and Chronic Health Care |
| Core Competencies: | Organizations, Quality |
| Description This project tests the effect of an intervention – a post-discharge care coordinator who answers patient questions and connects them with other care providers as needed – on the quality and efficiency of post-discharge care. The project is funded by the Commonwealth Fund of New York, and is being carried out at the Brigham and Women’s Hospital in Boston, with the participation of four orthopedic surgeons who conduct high volumes of knee replacement surgery, in conjunction with their staff, their patients, and the post-discharge providers who care for their patients. Our research team is tracking the care of these patients from prior to surgery, starting with the pre-operative clinic, then to surgery, then to the rehabilitation setting, whether a rehab hospital, skilled nursing facility or at home, until one year after surgery has occurred. Functional status, quality of life, perceived quality of care, and the efficiency of care delivery are being measured for each patient throughout this time period. We are also measuring the coordination among care providers for each patient enrolled in the study, to test the hypothesis that the post-discharge care coordinator improves quality and efficiency outcomes by improving coordination among providers. | |
