Iowa Healthcare Collaborative

Background

Coordination of care is a vital component in assuring that patients are able to successfully transition between care teams.  Studies demonstrate that critical patient information for referrals and transitions is often missing.  This becomes frustrating for patients and practitioners alike.

The ability to close the referral loop is the key to attaining effective and timely, bidirectional communication between care teams.  A closed referral loop is necessary for successful care coordination that will improve patient outcomes, increase patient safety, enhance the patient experience, and lower health care costs by reducing duplication of services. 

Goal

Through the use of best practices and performance improvement, the Compass PTN seeks to assist Compass enrolled clinicians to increase the percentage of referral loop closures by 3% by 2019, measured by the number of reports received by the referring provider from the provider to whom the patient was referred.

Best Practice Guide

The Patient-Centered Medical Home Neighbor (PDF) - American College of Physicians (ACP)
The interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices.

 

Coordinating Care in the Medical Neighborhood (PDF) - Agency for Healthcare Research and Quality (AHRQ)
Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms.  Chapter three of this document (PDF) is a great chapter that suggests approaches to overcoming common barriers to closing of the referral loop.  

 

Care Coordination: Reducing Fragmentation in Primary Care (PDF) - Safety Net Medical Home Initiative
An Implementation Guide from the Safety Net Medical Home Initiative. 

 

Primary Care Team Guide for Referral Management (Link) - Improving Primary Care program
An interactive toolkit offered by the Improving Primary Care program.  

 
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