Social Work in Health Care · 2018 · 28 citations · 28 references
NursingHealth Care ManagementSocial WorkHealth Services ResearchPsychosocial CareTransitional CareAmbulatory Care UtilizationCare Transition PlanningInpatient CarePsychosocial AssessmentSocial Care IntegrationTransitions Of Care30-Day ReadmissionCare Transitions InterventionComplex Care TransitionsReadmission RatesSocial Care Needs AssessmentSocial Service IntegrationThirty-day ReadmissionTransitional Care Models
The present study was a retrospective evaluation of a social worker-led transitional care intervention that addresses the medical and social needs of inpatient super utilizers with ≥5 inpatient admissions in a 12-month period. Bivariate analyses revealed significant reductions in the total number of hospital admissions, 30-day readmission rates, number of emergency department visits, average hospital charges per episode, and total hospital charges per person after the intervention. This social work intervention may be of interest to providers and payers, particularly regarding addressing the psychosocial needs of complex patients who account for most of health care costs.
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Comorbidity Measures for Use with Administrative Data
Anne Elixhauser, Claudia Steiner, D.R. Harris et al. · Medical Care · 1998 · 9.9K citations
Education, Health Services Administration, Health Assessment +16
The Care Transitions Intervention
Eric A. Coleman, Carla Parry, Sandra Chalmers et al. · Archives of Internal Medicine · 2006 · 1.9K citations