Avera is working to improve patient outcomes by reducing hospital readmission rates.
A hospital readmission is when a patients who had recently been hospitalized needs to go back into a hospital again within 30 days of their discharge.
Avera Holy Family Hospital will be offering this program to their patients beginning Jan. 2, 2013.
When a patient who has a qualifying chronic health condition is discharged from Avera Holy Family Hospital, they will have the option to be enrolled in the care transitions program from Avera. Enrolled patients will receive specialized patient education for their condition, a home visit to assess needs and assist with medications, and weekly post-discharge phone calls for 30 days.
"Our hope is to keep patients well, so they don't need to return to the hospital," said Cathi Scharnberg, Avera Holy Family VP of Patient Care. "Education is the largest component of this program. Avera Holy Family Hospital is proud to be able to offer this education to patients to ensure they feel in control of their health condition."
Patients will receive information about their condition, warning signs to be watchful of, and a 24 hour contact line in case they have questions. People with chronic illnesses such as heart failure and chronic obstructive pulmonary disease, and pneumonia will have the option to be enrolled in the program.