Discharge planning: whose responsibility?

The advent of prepaid health plans has resulted in tremendous changes for health care providers. Fierce competition among health care providers is a reality. Concessions must be made and consensus reached. Everyone involved must remain open to new relationships and new methods or systems. As hospitals struggle with how to best adapt to change, the third-party payer struggles with how best to integrate its requirements with the hospitals with which it has formed contracts. It is not an easy time for either. However, this is an opportune time to begin to develop the health care system of tomorrow. We should all be aware that any new system must remain consumer-driven. That is, we must let go of traditional roles and ideas and begin to work within a system that continues to redefine how to best serve the patient. It is to everyone's best interest to cooperate and collaborate on the systems that impact patient care. After all, isn't that why we are in the health care business?

Impact of a case manager program on psychiatric aftercare.

Shifting the locus of aftercare planning from hospital to community can enhance continuity of care. The authors compared chronically mentally ill patients assessed and managed by community-based practitioners trained in psychiatric rehabilitation with patients whose discharge planning was arranged by inpatient staff members. They found significant differences between the two groups in aftercare needs identified, aftercare referrals made, and use of aftercare services. The authors conclude that this approach to psychiatric aftercare is superior to more traditional models if practitioners are carefully trained.