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Insights Blog

Insights Blog

The Case for Care Continuum Leaders

By Matthew Bates, MPH

Posted September 20, 2018

As consumers are increasingly seeking healthcare outside the four walls of the hospital, an even greater emphasis has been placed on coordinating care. Interestingly, though, most organizations do not have horizontal leaders who are responsible for overseeing coordination between facilities and providers to ensure patient care is seamlessly managed.

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COACHING MINUTE: Care Transitions Calls Remove Barriers to Patient Compliance

Posted June 08, 2018

In this Coaching Minute, Tonia Breckenridge explains why it's so important to consistently complete care transition calls to home health patients.

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COACHING MINUTE: Diagnosing Your Current Care Transitions Process

Posted May 15, 2018

Effective care transitions have been shown to reduce medical errors and readmission rates in key patient populations. In this article, care transitions expert, Diana Topjian, suggests three questions to help diagnose your current process.

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It's Not Just About Discharge: The Other Transitions of Care

By Debbie Caskey, RN Diana Topjian, RN, MSN, DM, C-ENP

Posted June 21, 2017

Often, the focus of transitions of care is solely on the discharge process. While it is important to get that step right, there are other transitions our patients face that require diligence to ensure we give our patients what they need.

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Transitions of Care: Moving from Acute Care to Home with Comprehensive Care Plans

By Debbie Caskey, RN Diana Topjian, RN, MSN, DM, C-ENP

Posted June 21, 2017

Did you know that the scale for responses in the Transitions of Care is different from other HCAHPS domains? Learn the right questions to ask to develop a comprehensive care plan that captures the preferences, understanding and responsibilities of the patient and caregiver after discharge.

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Managing Bundled Payments with Care Transition Calls

Posted April 24, 2017

Learn how care transition calls can help hospitals coordinate patient care and manage the additional accountability that the bundled payment model demands. 

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Two Tactics to Elevate Patient Care and Frontline Staff Coaching

Posted May 11, 2016

In a post-Affordable Care Act environment more patients than ever before are accessing care through the emergency department. According to a May 2015 report by the American College of Emergency Physicians (ACEP), three-quarters of emergency physicians reported a rise in patient volume.1

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Taking Patient Call Manager to the Next Level

Posted April 21, 2016

When Sonora Regional Medical Center, part of Adventist Health, started making care transition calls, they quickly realized the benefit and importance of the information obtained in each patient connection. Through the use of Patient Call ManagerSM: The Clinical Call System (PCM), they have maximized their care transition call process to identify new ways to capture and leverage the information it provides. As a result, they have seen a reduction in readmissions and an increase in HCAHPS performance.

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CG CAHPS: Improving Access and Responsiveness to Patients (Part 2)

By Kim Bass

Posted June 17, 2015

In part one of this two-part insight series, we discussed tips to improve the efficiency and effectiveness of patient phone calls through call tracking and the use of AIDET®. In part two, we will cover the use of pre-and-post visit phone calls and leveraging the Electronic Health Record (EHR) portal as a way to improve access and responsiveness to patients.

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Reducing Readmissions through the Centralized Care Transition Call Model

Posted May 01, 2015

Providing safe and quality patient care remains our primary focus in healthcare. At times, this has become increasingly more complex with the changes and shifts in industry regulations and standards. One area that requires an intense focus is providing care across the continuum. 

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