Agency for Healthcare Research and Quality Advancing Excellence in Health Care So You Think You Can Coordinate Care? Prove It! Session #28 AHRQ Annual Meeting Monday, September 27, 2010

Advancing Excellence in Health Care Presenters Carol VanDeusen Lukas, EdD Carol VanDeusen Lukas, EdD Center for Organization, Leadership, and Management Research, Department of Veteran’s Affairs Boston University School of Public Health Kathryn McDonald, MM Kathryn McDonald, MM Center for Health Policy/Center for Primary Care and Outcomes Research Stanford University

Advancing Excellence in Health Care Care Coordination: Functional Definition The deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Two fundamental objectives of care coordination: – Transferring Information – Transferring Accountability

Advancing Excellence in Health Care Examples of Care Coordination Activities Determine and update care coordination needs Determine and update care coordination needs Create and update a proactive plan of care Create and update a proactive plan of care Communicate: Communicate: – Between healthcare professionals & patients/family – Within teams of healthcare professionals – Across healthcare teams or settings Facilitate transitions Facilitate transitions Connect with community resources Connect with community resources Align resources with population needs Align resources with population needs