“High-risk patients are most vulnerable within the first 72 hours after discharge, yet patients are too often discharged from hospitals without follow-ups,” says general surgeon, Dr. Ali Ghazanfari.
Patient transitions from the hospital to the outpatient setting involve not only changes to the physicians providing care but also diet, medications and potentially complex drug therapies, exercise, and social factors. All of these changes make the early post-discharge period a vulnerable phase.
A quick patient assessment call can greatly reduce hospital readmissions. The assessment can catch potential red flags, notify healthcare professionals and initiate rapid intervention to help avoid the need for the re-hospitalization. For example, knowing that the patient is feeling worse, not taking prescribed medications, or just has a question can prompt healthcare provider actions to produce more favorable patient outcomes.
The HealthCollaborate Transitional Care Management Solution includes an automated post-discharge assessment IVR module which contacts patients or patients’ caregivers to quickly assess progress. The assessment determines if the patient needs additional patient education, medication review, or just has a question. The HealthCollaborate BI engine analyzes assessment results and sends notifications to the care team if immediate intervention is required.
Automated post-discharge assessment calls subsequent to a hospital discharge help reduce preventable hospital readmissions, thereby minimizing the considerable costs associated with those readmissions. Furthermore, the automated post-discharge assessment calls help hospitals and service providers to cover more lives with less resources.
Health BI’s HealthCollaborate™ is an end-to-end Transitional Care Management Solution that enables healthcare providers and Health Plans to coordinate, manage and monitor transitions of care for patients from hospitals to multiple post-acute care settings.