Care Transition - Readmissions
Readmission to the hospital within 30 days of
discharge has become an important measure of
quality of care, and is a major focus in
Medicare’s attempt to control rising healthcare
costs.
Frequent contact with post-discharge patients
invites opportunities to detect early symptom
change, thus earlier intervention. Early
intervention can play a significant role in
simpler, more effective treatment to help prevent
hospital readmission.
The period of time following patient discharge
from hospital often represents a “blind spot” in
the overall coordination of care. Patient
responsibility is often ambiguous. Discharged
patients are often confused about symptoms,
post-discharge instructions and/or medication
regimens, which can result in early readmission.
Effective post-discharge patient monitoring can
facilitate care coordination at this juncture but
such programs can be very costly.
Automated calls based on disease or
condition-specific scripts ensure uniform
adherence to the script. Contact scheduling
requires minimal involvement from hospital IT
departments. Patient responses can be transmitted
in a variety of formats to appropriate staff,
tailored to each hospital’s needs. As a result the
hospital has the opportunity to identify the
patients who indicate trouble before hospital
readmission is necessary. Policy makers and
industry experts in the battle to stem rising
health care costs have made focal points of
hospital readmissions, and specifically heart
failure readmissions.
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| OutcomeAdvantage
Media Center |
| Brochure:
Care
Transitions |
| Enable
safer transitions…increase post-discharge patient
reach. |
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19.6%
of Medicare patients are readmitted to the
hospital within 30 days of discharge.
New England Journal of Medicine
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