Data-Driven Care Transition Management Delivers Action Plans for High-Risk Patients

Sea Girt, NJ, July 22, 2015 --(PR.com)-- A deep data dive by the San Francisco Health Network (SFHN) Care Transitions Task Force triggered the launch of a data dashboard, a hospital discharge database and a host of uniform standards and practices that have enhanced care transitions for SFHN's safety net population.

In Data-Driven Care Transition Management: Action Plans for High-Risk Patients, a new report from the Healthcare Intelligence Network, Dr. Michelle Schneidermann, associate clinical professor of medicine for the division of hospital medicine at the University of California San Francisco/San Francisco General Hospital, describes how a data analysis of readmission rates, vulnerable populations, and pain points within SFHN sparked action plans to standardize patient handoffs and post-discharge follow-up in a diverse patient population.

This 25-page report underscores the philosophy that care transitions responsibility should be spread across the healthcare continuum, and showcases how shared ownership of patient handoffs can inspire pilots, partnerships and interventions to ease the hospital-to-home transition.

Learn more about data-driven care transitions at http://store.hin.com/product.asp?itemid=5054

News Facts: Data-Driven Care Transition Management: Action Plans for High-Risk Patients offers the following insights:

- The task force's inventory and gap analysis of transitions, initiatives and programs across its health network;

- Development of hospital-primary care partnerships to ease patients' discharge to home;

- Clinic-based interventions of telephonic follow-up by a readmission prevention team for patients newly released from the hospital;

- Development of a hospital discharge database to help outpatient clinics efficiently track and target their patients;

- Care transitions standards work completed by three targeted task force sub-groups;

- Defining the SFHN class of patients considered at high risk for readmission to the hospital;

- Scaling of pilot post-discharge interventions across all clinics;

- Templates to standardize post-discharge protocols;

- Future enhancements to Task Force initiatives;

and much more.

Learn more about data-driven care transitions at http://store.hin.com/product.asp?itemid=5054

Report Formats: Data-Driven Care Transition Management: Action Plans for High-Risk Patients is available in Print, Instant PDF Download, Print-PDF set or sharable with an Enterprise Site License.

Quote Attributable to Melanie Matthews, HIN Executive VP and COO:

"With data analyst support, the SFHN Care Transitions Task Force turned a 'black box' of data from more than 60 siloed databases across its health network into cohesive data-driven tools that for the first time tracked newly discharged patients for critical telephonic follow-up. For many physician practices and health systems, this basic communication is frequently the missing piece of the care transition puzzle."

Please contact Patricia Donovan to arrange an interview or to obtain additional quotes. For Melanie Matthews' profile, please visit http://www.hin.com/bios.html#mm

About the Healthcare Intelligence Network — HIN is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare. For more information, contact the Healthcare Intelligence Network, PO Box 1442, Wall Township, NJ 07719-1442, (888) 446-3530, fax (732) 449-4463, e-mail info@hin.com, or visit http://www.hin.com.