The Improving Chronic Illness Care project defines care coordination is “the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services.” In this definition, all providers working with a particular patient share important clinical information and have clear, shared expectations about their roles. Equally important, they work together to keep patients and their families informed and to ensure that effective referrals and transitions take place. This resource provides a wealth of knowledge and tools for coordinating chronic care at the community level as part of a patient centered medical neighborhood.
Care Coordination and the Patient Centered Medical Neighborhood
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