PATH ALONG and the Skilled Nursing Facility

PATH ALONG is an original Wisconsin model that performs a service capable of supporting skilled nursing facilites in the initiative to reduce avoidable hospitalizations.  PATH ALONG is a model that supplements existing staff efforts.  PATH ALONG design is easy access with no changes required of  the operating structure of delivery.

PATH ALONG staff accompany the patient with the hospital stay and back to the skilled nursing facility.  PATH ALONG staff utilze education, supportive strategy, ongoing choice, and track data to evolve best practise and demonstrate evidence of a postive impact. 

A positive impact includes support that maintains access to existing care and continued choice of providers.  The over all goal is to support the CMS initiative to reduce health care spending while assuring needed service. 

The skilled nursing facility population targetted to benefit from this service can be identified through three assessments.

1.  If the patient has a history of hospital readmission PATH ALONG could be beneficial.

2.  If the patient has a chronic disease process (COPD, Diabetes, CHF) and a change in physical function PATH ALONG could be beneficial.

3. If the patient has a chronic disease process (COPD, Diabetes, CHF) and a change in cognitive function PATH ALONG could be beneficial.

PATH ALONG staff maintain a physical presence with the patient during the transition process.  PATH ALONG staff take a collaborative, cooperative approach to communicating with all care delivery participants.  The transition period is recognized as 48 hours prior to hospitalization on to 30 days post discharge.  Evidence based support during the hospitalization and throughout the process.

PATH ALONG is a community based supportive care model (service set) with a design that improves the process of transitioning between inpatient hospitals and skilled nursing facilities.

Check out the site below with free access just point and click
http://www.homecarepath.com/Pages/PATHALONGInpatientAdvocacyReducesReadmissions.aspx