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How YourCare Continuum Benefits Providers and Chronically Ill Patients

Nurse talking with an older patient

Patients with chronic conditions depend on our healthcare system. Cardiovascular disease, smoking- and alcohol-related health issues, diabetes, Alzheimer’s disease, cancer, obesity, arthritis, asthma, and stroke are the top 10 villains among a whole host of chronic conditions that cause suffering and expense.

According to the American Hospital Association, 60 million Americans live in a rural region where they are medically underserved. Lack of access to healthcare is part of the issue: Nearly 20 percent of the U.S. population lives in rural areas, but only 9 percent of physicians practice there.

Managing patients with long-term illness is a particular challenge in rural communities, where almost 1 in 4 people (22 percent) suffer from two or three chronic conditions, according to the National Center for Health Statistics.

How can we ensure that patients receive the appropriate level of care—minimizing unnecessary complications—and, at the same time, prevent costly readmissions of those chronically ill patients?

Research shows that chronic disease is worsened by the inefficiencies in care coordination. Most of these issues can be addressed through technology solutions. Inefficient referral  and scheduling systems are one of several health system factors that causes patients with chronic disease to miss appointments, according to a review of 28 research studies.

The consequence for patients with one or more chronic illnesses who are “no shows” can be severe.

“The most worrisome outcome of non‐attendance is a delay in presentation and a lack of monitoring of chronic conditions, predisposing the patient to exacerbations of the disease and disease‐related complications,” according to one study of patients with diabetes who were no-shows for a diabetes clinic.

So, how can technology solve care coordination challenges? According to the Agency for Healthcare Research and Quality technology can help solve for some of these issues:

3 Key Issues Technology Can Solve For:

  1. Confusion Over Next Steps:

    Patients don’t understand why they’re being referred from a primary care physician to a specialist, they are unclear about how to make appointments, and they don’t know what steps to take after seeing a specialist.

  2. Reason for Referrals:

    Specialists, for their part, don’t always know why a referral has been made or don’t have adequate information on lab tests that may have already been performed. Primary care physicians do not typically get information back about the results of a referral to a specialist.

  3. TMI: Too much information to manage:

    Referral staff deal with many different processes and lost information, which means that care is less efficient.

Scheduling systems can be a big part of the solution, helping streamline coordination of care, minimizing time and effort, and meeting the needs for patients and providers. Technology platforms targeted to care coordination should have the ability to fulfill workflows like:

  1. Schedule hospital services and clinic visits

  2. Make surgery scheduling requests

  3. Self-schedule for hospital, clinic, and physician visits

  4. Schedule into a queue for emergency department visits

  5. Physicians to request direct admissions

  6. Enable facility transfers

  7. Create workflows around clinical orders

Knowing better care coordination is effective is crucial to patients who depend on frequent healthcare communication and doctor visits. Research into a population with chronic cardiovascular disease shows that careful attention to patients after an episode of care can result in lower readmissions.

For example, adults who were discharged after hospitalization for heart failure, and who received an outpatient follow-up with a cardiology or general medicine provider within seven days, showed  a lower chance of 30-day readmission.

Rural communities have daunting challenges, but scheduling solutions that address care coordination can help procure better outcomes for chronically ill patients and lower readmissions.

YourCare Continuum® includes a scheduling platform to make care coordination simpler, helping to ease the workflow process for staff and the transition for patients across multiple health systems.

Read on for a deeper dive into how YourCare Continuum® can help rural hospitals and healthcare facilities treat patients managing chronic illness.

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