Idea submitted by: Zvi Frankel
There's a plethora of published research establishing the dramatic decrease of re-admissions and complications when patients receive optimal post-discharge rehabilitation. At the same time, the unfortunate reality is that a very high percentage of patients never end up receiving the critical benefits of attending an appropriate post-discharge rehabilitation program.
I propose an idea to break this trend, by creating a portal to bridge the transition period between hospital discharge, and admission to an appropriate in-patient (or outpatient) rehabilitation program.
The development of a user friendly “post-discharge to rehab admission” bridge portal, accessible to the team of treating physicians from the hospital (including the primary physician), the patient, and finally the chosen rehab team, would engage all parties to facilitate admission into an appropriate rehab program. The idea would be to keep all parties continuously engaged and updated, and to “hold the patient’s hand” until the successful admission to an appropriate rehab program. I think that a “physician/patient transition to rehab engagement bridge" concept will dramatically increase the number of patients receiving appropriate post-hospital rehab.
Link leads to: http://archinte.jamanetwork.com/data/Journals/INTEMED/5796/ioi05134_235_241.pdf