There is no dearth of advice on how to be a better patient. It usually pertains to behavior, questioning, and follow-up the outpatient setting, and most often while in the exam-room with the doctor. As medicine changes, however, a new behemoth threatens the health of patients. Called “transitions of care,” these are periods when patients are in transit between providers; whether in the same facility during a shift/service change, between hospitals, or from hospital to primary care clinic; or between health states from curative to palliative/hospice or independent to assisted living.
With the current failure of electronic medical records to efficiently convey this information between providers on behalf of the patient, the patients themselves are left with the responsibility to convey this information, often at times of mental or physical health distress. Besides leading to repeat procedures and increased cost, these patients likely experience worse outcomes as a result.
TRANSITIONS OF CARE refers to the movement of patients between health care locations, providers, or different levels of care within the same location as their conditions and care needs change.
As a medical provider, I believe that patients should take an active role in managing their healthcare. From one perspective, they’re paying for it, so they should be watchful of their resources. From another perspective (and the more important one), patients will always know themselves better than the doctor will. Physicians should help patients optimize their understanding of their health status, especially when facing a care transition.
One effective model of patient-centered transitions of care involves the development of a Personal Health Record (PHR). PHRs contain personal information that is relevant to easing your navigation of the system, including but not limited to:
- Personal identification and emergency contact information
- Contact information for all your physicians
- Health insurance information
- Living wills and medical power of attorney
- Dated list of past illnesses and surgeries
- List of current medications and known allergies
This should be updated at every point of contact with the healthcare system. Nevertheless, this record will remain incomplete as it does not address the interval period during a transition of care. A sample one can be found here courtesy of CMSPulse.
Information like “what to do if [X] happens” is notably absent. To address some of these issues the following intervention activities checklist was developed to facilitate discharge and the interval period prior the patient’s next point of contact in the healthcare system.
You should not leave the hospital until these questions and issues have been sufficiently answered and addressed and you would feel comfortable giving an answer to that question in your own words. And trust me, a medical provider who sees a patient taking this kind of interest in assuring their own health will be happy to spend the time making sure you understand.
As medicine evolves in the United States and transitions of care become commonplace, the onus will continue to be placed on the patient to make smart, informed decisions. Your healthcare providers at all levels are a resource to you to make that a reality. Use them.
