To help patients stay healthy after hospital care, the Queen of the Valley Medical Centre, a US medical facility, focussed on reducing re-admissions to hospitals and emergency-room use for low-income adults and older adults. The centre set up a CARE Network (Case Management, Advocacy, Resource/Referral, Education) that employed a team-based approach to ensure that a patient’s needs were being met, coordinating between medical services and other resources. Teams visited homes and addressed iss...

BPIR Categories

1.3.2 Determine & provide customer contact mechanisms
6.1.1 Plan key production & delivery processes
6.4.2 Implement systems for managing the service

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