Mark Johnson, mandy woodward Brown County NIATx 2017 Mark Johnson, mandy woodward

Big Aim. To increase the number of post hospital contacts for those identified as high risk for readmission

DATA: April-June. 15 individuals under case management who had a readmission. (Total: 27 of 172 admissions. 15.69% readmission rate ) Out of the 15, 9 were placed in either long term care or CBRF setting. 6 were returned to their home with ongoing supports

DATA: July –Sept. 5 readmissions for case management clients. (Total DATA: July –Sept. 5 readmissions for case management clients. (Total.9 of 192 readmissions. 6.25% readmission rate) Out of the 5. 1 person had fled the state and was returned. 1 was an attempt to transition into own apartment after many years in structured settings.

INTERPRETATION OF DATA AND NEXT STEPS Significant decrease ion readmissions during the July-Sept period. 15.69% down to 6.25%. (Total admissions) Not able to find correlation of increased case management as 12 of the 20 individuals were placed in either long term care or cbrf setting.

Review each readmission and collect data on common themes Review each readmission and collect data on common themes. Focus on developing preventable measures that will be addressed in discharge planning.