PATH ALONG staff are taught to focus on the dynamic component of each identified care transition with the hospital discharge process. The dynamic component is the primary aspect required to be completed to effectively reduce readmission to the hospital setting. The dynamic component has been called the supreme mandate, critical script, crucial task, main strength and more. Below is a list of transitions and their dynamic component.
1. in hospital lab (transition) clinic lab
Dynamic component: Have all pending labs reviewed by the hospitalist.
2. hospital pharmacy (transition) home town pharmacy
Dynamic component: Insurance pay for prescribed medication the way MD order written.
3. hospital nursing staff (transition) skilled RN home care
Dynamic component: Nursing complete discharge summary prior to patient leaving hospital.
This breif list of dynamic components gives the reader a sense of how PATH ALONG staff intervene to enhance the integrity of the transition process. The over all goal of reducing hospital readmissions is methodically woven in to the fabric of each individual hospital experience. The characteristics of each dynamic component expands the existing effort to reduce the risk in each individual discharge process for a hospital readmission.
The comprehensive strategy takes a pragmatic approach to existing resources leveraging a more certain benefit to the target population. PATH ALONG staff maintain a physical presence with the patient during the hospital stay. An intermittent application with a measurable long term benefit for the community.
PATH ALONG is an original Wisconsin model that connects inpatient providers to community staff who support the patient during health system transitions. An evidence based model with three defined services to help the hospitalist fulfill their continuity of care role. Focus is on care filled transitions.
Please check out this site with free access
http://www.homecarepath.com/Pages/PRESSRELEASEOriginalWisconsinModelToReduceHospitalReadmissionRates.aspx
Friday, December 28, 2012
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