ABSTRACT
Over the past decade, significant attention and funding have been devoted to reducing readmissions in an attempt to both improve quality and reduce costs. Readmissions are frequently occurring, expensive, and sometimes life-threatening events that can often be attributed to a lack of care coordination, including gaps in care transitions and follow-up care (HRET 2014; Jencks, Mark, and Coleman 2009). Investments in pilot interventions to reduce readmissions have led to some consensus around promising practices that result in better care coordination, reduced readmissions, and better outcomes for patients. This chapter provides a summary of the most successful efforts in care coordination and reducing readmissions, identifies the most effective strategies, and concludes with action steps for clinical leaders to successfully implement those strategies.
