Suppose our Mrs. Peterson would not have been able to look after herself the first few weeks after surgery. Because hospital care is only for specialized medical and nursing care, she would have had to leave the hospital and go to a nursing home for recovery. Here, another waiting list occurs. Especially for psycho-geriatrics departments within the nursing homes the waiting lists are enormous and can amount to more than half a year. All the time the patient has to stay in the hospital. For patients that should be admitted to a nursing home from the home situation, these waiting lists add to the existing strains on the home care. As long as these patients cannot be admitted to a nursing home, the home care organization has to look after them.
Because I have almost run out of time, I can only introduce the subject of transmural care to you shortly. As I have already explained to you the goal of transmural care is to bridge the gap that exists between general primary care and specialized hospital care. In the words of the Dutch National Council on Health Care transmural care is:
screen 48 (epilogue: transmural care: definitie)
'Care, geared to the needs of the patient, provided on the basis of cooperation and coordination between general and specialized caregivers, with shared responsibility and specification of delegated responsibilities' (NRV 1994)
Transmural care overlaps with the concepts of 'shared care', used in the United Kingdom and 'integrated care delivery', emerging in the United States. Starting in 1990, many transmural initiatives have been taken in which home-based and hospital-based providers work together in project teams to improve quality and efficiency in care delivery. In many cases this results in substituting care from hospital to home care. Therefore, transmural care also enlarges the
