Phoenix-based John C. Lincoln Health Network announced it is expanding its care transition coaching program to reduce readmissions.
Last year, John C. Lincoln's two hospitals implemented a program that employs former military combat medics and corpsmen as care transition coaches for Medicare patients being discharged from the hospital. The coaches help patients in five main areas:
• Medication self-management
• Physician follow-up
• Personal health records
• Nutrition and home safety
• Awareness of red flags
After one year, the program's readmission rate is one-third the rate it started with, having decreased from 18 percent to 6 percent.
With the help of a two-year, $500,000 grant from the Del E. Webb Foundation, the hospitals will employ 10 more Veterans as transition coaches by July 2014, bringing the total number of coaches to 14, according to the release. The additional coaches will enable the hospitals to provide transition services to "all frail elderly patients being discharged from both hospitals, regardless of Medicare status or membership in John C. Lincoln's accountable care organization," the release stated.
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