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Dr. Mike Kern, Medical Director of the Physician Network, was concerned about chronic care at John Muir. He set out to develop a patient-centered program that provided continuity of care across multiple settings and practitioners. Research led him to such a program, developed by Dr. Eric Coleman at the University of Colorado. Dr. Coleman's Care Transitions Program® is designed to improve the quality and safety of care hand-offs for persons with complex care needs.
Patients who participated in Dr. Coleman's trial program were found to be:- Less likely to be re-admitted for the same condition, and
- More likely to achieve symptom management and functional recovery
Readmission rates at 90 and 180 days after discharge for patients who participated in the pro-gram were found to be almost half that of the patients who did not participate.
Given this strong body of evidence, and with the support of the California Health Care Foundation, Dr. Kern organized a pilot Care Transitions Intervention (CTI) program at John Muir.
For more information on Dr. Coleman's research, click here.
"We believe that this program will be an important first step in improving the coordination of healthcare across all of our organizations, as the hospitals, the Physician Network and the medical practices will all be involved in supporting this initiative."
Dr. Mike Kern
Medical Director of the Physician Network