Peninsula Home Care Reducing Hospital Readmissions by Empowering Patients

Published on - November 11, 2016

PHC Highlights Efforts during National Home Care Month

SALISBURY, MD – The evolving reality of healthcare in the United States is focused on putting a stopper in the revolving door of hospitals. More than 10% of people discharged from the hospital will be readmitted within 30 days or less, and many of the readmissions can be prevented. Prevention and education is a top priority for Peninsula Home Care (PHC), a locally operated home care agency serving Wicomico, Worcester and Somerset counties in Maryland and Sussex and Kent counties in Delaware.

During Home Care Month, PHC is highlighting proof of its success in the agency’s patient outcomes.

PHC reported as of September, 2016, a 30-day patient hospital readmission rate of 8.1%, compared to the state average of 12.5% and National average of 11.7%. Peninsula Home Care credits a comprehensive approach to healthcare for the low readmission rate. Inter-disciplinary team meetings and the transition to electronic medical records has allowed the sharing of health information across all disciplines.

“The movement from a fee-for-service to a fee-for-outcome model is meant to improve quality of care and care coordination in addition to lowering costs,” said Nancy Bagwell, Peninsula Home Care Area Director of Operations. “We are moving from an emphasis on treatment to a patient-empowered approach that prioritizes prevention and education.”

Bagwell added that compliance is also a critical piece of a patient’s plan of care when it comes to achieving positive outcomes. In addition to providing skilled nursing and therapy (physical, occupational and speech), Peninsula Home Care provides individualized education regarding warning signs, the importance of medication management and adherence and scheduling follow up appointments with primary care physicians.

Patients become a significant part of their plan of care and can contribute to their recovery by taking a few important steps including the following:

  • Understand the diagnosis
  • Make follow up appointments with general practitioners and specialists. If transportation is an issue, make a plan to find a family member or friend to transport you to follow up doctor appointments. 
  • Understand any prescribed medications and how to take them
  • Be aware of any physical limitations. Know what exercises/stretches to do on a regular basis and which ones to avoid. 

“It is also important for our team to take a step back from the day-to-day visits and assess the overall health picture for each patient,” added Bagwell. “Anything from a chronic disease diagnosis to frequent readmissions to home care are red flags that need to be addressed immediately in a plan of care.”

The push to lower hospital readmissions makes sense for the patient and all healthcare providers attached to that individual. Smooth care transitions as patients are discharged will ultimately help in avoiding health deterioration that often brings patients back to the hospital.

“Reducing hospital readmissions is about improving patient care,” said Bagwell. “Our numbers show patients are getting better care and as a result, fewer are revolving back through that hospital door.”

About Peninsula Home Care

Providing skilled nursing, physical, occupational and speech therapy for more than 30 years, Peninsula Home Care ensures that all patients are involved in their plan of care and strives to give them every opportunity to maintain their independence in the home. The agency has served more than 50,000 patients in Wicomico, Worcester and Somerset counties in Maryland and Sussex and Kent counties in Delaware. In 2017, PHC and PHCN were designated as Preferred Home Care Provider by Peninsula Regional Medical Center and Nanticoke Health Services.


Serving Sussex County & Lower Kent Counties in Delaware and Wicomico, Worcester & Somerset Counties in Maryland

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