Readmission Reduction

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What if we knew sooner that Hart was in the hospital not once...twice... but three times in the last few months!

Some patient populations have a 10-20% likelihood to be readmitted within 30 days of discharge. But, most organizations don't find out about the hospitalization(s) until it's too late. There are a variety of transition of care workflows that the care team could take when Hart was discharged from the hospital (the first or second time). These include best practices like telephonic outreach within 24-48 hours to ensure receipt of medications, provide education, explain when to call for help, and schedule a face to face visit with a provider within 1-2 weeks, and more.

These workflows can be powered by a work-list of recent hospital discharge alerts that a care manager, nurse or provider can take action on. Particle Health supports this workflow and goes one step further providing critical clinical context to support the outreach by providing discharge summaries, and other details of the hospitalization.

Check with your organization if you are receiving Particle Health's Signal capabilities. The Signal solution enables Value Based Care solutions for providers and Payers with real-time alerting on high-risk patients, supporting care coordination. If a customer uses this product, they may customize these alerts which could include admission, discharge, and transfer (ADT) alerts, and may also include medication-based alerts like when an expected fill is missed, or a new medication is filled. It helps providers deal with data overload by extracting and surfacing the most pertinent events and contextual information needed to quickly take action and provide appropriate treatment. Signal enables providers to focus on priority actions, reduce intervention delays and minimize the likelihood of complications.