In Hong Kong, elderly patients recently discharged from hospital are at
high risk of unplanned readmission, leading to the phenomenon of the
‘revolving door syndrome’. A review of the literature and also studies
conducted locally suggest that a case management approach could be
a useful tool to achieve a more coordinated and better continuum of
care for this group of patients. The case management tool could also
contribute to a more integrated care system for the frail elderly, due to
pooling of expertise and resources from the health and long-term care
sectors. More studies should be encouraged locally to explore a broader
application of this approach as a means of improving elderly care for
the rapidly ageing population of Hong Kong.

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