The hospital partnered with other healthcare organizations in a collaborative designed to find solutions to hospital readmissions. They found four major risk factors: lack of post-discharge follow-up with physicians, poor medication management, lack of patient skills to manage conditions post-discharge and poor coordination of post-hospitalization services.
In order to combat these obstacles, the collaborative also established several solutions intended to reduce the incidence of unnecessary hospital readmissions, including calling to remind patients about appointments, teaching self-care skills and assisting transportation to appointments, according to the report.
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