Vanguard Health System uses follow-up phone calls to patients and health coaches as part of its Transitions in Care program to reduce readmissions at MetroWest Medical Center and Saint Vincent Hospital in Massachusetts. Staff from a Vanguard call center visit and check in with patients at home, and nurse Mary Bottachiari works with those still hospitalized to set up social service referrals and help them with unique needs, such as chair lifts for the home.
Vanguard Health uses coaches, follow-up to reduce readmissions
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