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Formal and Informal Relationships Between Nursing Homes and Hospital Systems are Common but do They Improve Care?

      The most cited explanation for the fragmentation of America's health care system is the lack of information that flows between health care providers.
      • Snow V.
      • Beck D.
      • Budnitz T.
      • et al.
      Transitions of care consensus policy statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine.
      • Coleman E.A.
      Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs.
      • Vognar L.
      • Mujahid N.
      Healthcare transitions of older adults: an overview for the general practitioner.
      Providers in acute care settings often have little knowledge of the care that occurred prior to hospitalization. Likewise, outpatient workups may occur among an assortment of specialists, each potentially working from their own unique perspective within health care networks that may not communicate redundancy and changes with other members of the health care team. As such, each care setting represents its own microenvironment of care with health care transitions, or movement between silos of care, expected to rise in frequency and complexity as the adult population ages.
      • Allen J.
      • Hutchinson A.M.
      • Brown R.
      • Livingston P.M.
      Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review.
      ,
      • Reid R.C.
      • Cummings G.E.
      • Cooper S.L.
      • et al.
      The Older Persons' Transitions in Care (OPTIC) study: pilot testing of the transition tracking tool.
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