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OSF deploys care transition program, reduces readmission rate from 29% to 9%
The sophisticated program employing patient monitoring, patient tracking and reporting technologies also has enhanced patient follow-up and engagement and yielded a big win on overall healthcare delivery.
THE PROBLEM
This issue stemmed largely from gaps in continuous care during transitions between these settings. Patients discharged from hospitals often were readmitted due to complications that could have been prevented with better monitoring and more proactive management, said Matt Nieukirk, director of the SNF practice at OSF HealthCare.
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