Empowering Patients for Success Across a United Continuum of Care

Patients are often poorly prepared to manage acute and chronic conditions following their discharge from the hospital. Care across the continuum is often disjointed, inconsistent or not made available. The aim of this project was to empower patients and caregivers to manage acute and chronic conditions successfully, avoiding relapse and readmission. Through the application of quality improvement principles and techniques and the development of partnerships with physician offices, nursing homes, home health agencies, the local community college, and others, a coordinated approach to care has been established. The hospital continues to work in partnership with a common purpose. As a result, patients are more successful in managing their conditions and readmission rates have declined.

Contact: Jan M Robert, Director Quality Management
Email:Email:jan.robert@hshs.org
Phone:618-526-5454

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)