Transitions Through the Continuum

Lena J. Weiner, February 24, 2016

In a recent HealthLeaders Media Intelligence Report, most healthcare leaders said the status of their care transitions for care continuum providers or services was sufficiently strong, but indicated that there was room for improvement. HealthLeaders Media Council members discuss where they are finding success in improving care transitions outside of their facility.

This article first appeared in the January/February 2016 issue of HealthLeaders magazine.

 

Mitch Fillhaber
Senior Vice President for Corporate Development and Managed Care
The Shepherd Center
Atlanta, Georgia

Mitch Fillhaber
Mitch Fillhaber

The Shepherd Center is a 152-bed specialty clinic that functions as a rehab hospital with its own ICU. We have one of the youngest rehabilitation populations in the country, and we have a significant MS population who uses our outpatient care facilities. The continuum is a bit different for us than at a typical acute care hospital, and our care transitions are inevitably more complicated.

For many years, we've had a transition-support program that manages the return of high-risk patients and their families to the community, whether it be here in Atlanta, elsewhere in Georgia, or anywhere across the country.

As our patients are discharged, we're assessing the follow-up providers' capability and, if needed, providing education that creates a secure care environment for our patients who are going home. We're also working to provide education to patients and families to make sure they can maintain a positive health status once they've returned home.

Lena J. Weiner

Lena J. Weiner is an associate editor at HealthLeaders Media.

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