A large, multi-site hospital in the Southeast was struggling to lower readmissions for patients who fell into the Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) bundles.
Care Guidance services were provided over the course of each bundle period. On average, care guides completed more than 20 activities, 7.6 interactions (face-to-face or over the phone), and 15.75 surveys per navigated patient.
Navigated patients were 57 percent less likely to readmit than non-navigated patients. Readmissions for COPD fell by 51 percent, and CHF patient readmissions fell by 57 percent.
The Care Guide spoke to the patient’s daughter and learned the patient had mobility issues impacting his daily life and needed a walker. The Care Guide connected the patient to a primary care physician who ordered a walker at very little cost to the patient.