Improving Reliability of Scheduling Post-Acute Follow-Up Care, Implementing One Element of Project RED

Abstract

Background: The New England Journal of Medicine reports that 1 in 5 discharged Medicare patients is readmitted to a hospital within 30 days. Readmissions are costly to hospitals and are a major disruption to a patient’s life, creating financial and emotional strain. Project Re-Engineered Discharge (RED), a nationally recognized program to reduce preventable hospital readmissions, was implemented at Sutter Health’s California Pacific Medical Center (CPMC) beginning in late 2013. The most challenging of the 12 components of the intervention is the coordination and timely completion of follow-up care with a primary care physician after hospital discharge.