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Guideway Care Success Stories

Reduced Readmissions for Sepsis and Pneumonia

The Challenge

A large, multi-site hospital needed help managing readmission across at-risk patients. The biggest challenges were in preventing avoidable deterioration for sepsis and pneumonia patients.

Guideway’s Solution

Care guidance services were provided within a trial of 208 navigated patients to a portion of pneumonia and sepsis patients across all campuses. Disease-specific outreach included practical barrier resolution, medication adherence, patient education, monitoring, assessments, and other non-clinical interventions identified and addressed.

Results Delivered

Care Guidance reduced the readmission rate for pneumonia patients by 49% and for sepsis patients by 40%, producing a total savings of $2,850 per patient or $576K in total savings within the target population.

Readmission reduction by target condition:

Sepsis: Reduced Readmissions by 40%
Pneumonia: Reduced Readmissions by 49%

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Patient Vignette

Meeting the Patient’s Needs

A patient who was bedridden and struggling with pneumonia was told she had to schedule an in-person visit for her pulmonology follow-up appointment. After speaking with the provider’s office about the patient’s circumstances, the Care Guide rescheduled her appointment to a telehealth session. He also coordinated with the home health agency to ensure that all providers understood the patient’s condition.

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Patient Action.