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OSF deploys care transition program, reduces readmission rate from 29% to 9%

Healthcare It News

OSF HealthCare, a health system that serves Illinois and Michigan, had a big challenge: Managing the high rate of patient readmissions from hospitals to skilled nursing facilities and eventually to home care. THE PROBLEM This issue stemmed largely from gaps in continuous care during transitions between these settings.

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Digitalization in healthcare empowers patients

Healthcare It News

Analytic expertise is required to help prevent “information overload” and provide healthcare professionals with the tools for integrating and using the data for the betterment of that patient. From a patient´s perspective, digital health applications foster interaction between care teams and patients.

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How Reasoning-Based AI Improves Care Transitions

HIT Consultant

This structured framework ensures that recommendations are practical, easily implementable, and aligned with the workflows of care teams. Applications in Care Transition The three principles of responsible AI use are particularly applicable in care transitions, where managing patient handoffs between different care settings is critical.

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Fixing The Hospital-To-Home Health Care Transition

Home Health Care

“On hospital discharge and transition to the next level of care, older adults continue to face risks such as miscommunication, gaps in care and medication-related issues,” the researchers wrote. Transitional care models are designed to address these challenges with the primary aim of preventing readmissions.”

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3 Ways Post-Acute Placement Solutions Improve Transitions of Care

HIT Consultant

However, workers on both the providing and receiving ends of patient transfers are often overburdened with administrative processes and technological inefficiencies that bog them down and prevent them from doing higher-value clinical work. In the past, care transitions have often come with concerns about risk and uncertainty.

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Streamlining Patient Transitions for Better Outcomes

HIT Consultant

However, workers on both the providing and receiving ends of patient transfers are often overburdened with administrative processes and technological inefficiencies that bog them down and prevent them from doing higher-value clinical work. Prior to that, he held nursing leadership and paramedic positions at West Tennessee Healthcare.

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State Community Health Worker Models

NASHP

ACO Accountable Care Organizations. CBCM Community Based Care Management Program. CDC Centers for Disease Control and Prevention. PH-MCO Physical Health Managed Care Organization. USPSTF United States Preventative Services Task Force. APM Alternative Payment Model. CBO Community Based Organization.

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