Hospitals aren't known for making house calls. Once patients get their discharge papers, they take their chances with a family doctor or staffers at a clinic who may or may not know what happened inside the hospital's walls. Montefiore Medical Center in the Bronx is pioneering a new model of healthcare delivery, endorsed by the architects of health reform, that promises to radically change the current fragmented system in which the family doctor may have no idea what happens during a hospital stay, or a diabetes patient's endocrinologist, internist, and cardiologist never talk to one another. As an "accountable care organization," or ACO, Montefiore, along with Kaiser Permanente in Oakland, Calif., Intermountain Healthcare in Salt Lake City, the Mayo Clinic in Rochester, MM, and a handful of other medical systems, is experimenting with a novel way to save money and improve patient outcomes by coordinating all of their care, by all of their doctors, whether in the hospital or out.
In a social media landscape shaped by hashtags, algorithms, and viral posts, nurse leaders must decide: Will they let the narrative spiral, or can they adapt and join the conversation?
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