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Care Coordination

When you're an IPC/Senior Care patient who is hospitalized at Swedish Medical Center, Porter Adventist Hospital, or The Medical Center of Aurora, you will receive the highest leveliStock 000027684038Small of coordinated care and service as part of our innovative program. Research tells us that well-planned transitions between care settings (for example, from the hospital to your home or rehab/nursing facility) can make a big difference in improving your recovery and decreasing the chance that you'll have to be re-admitted to the hospital.

We have partnered with Swedish and Porter to provide a team of IPC hospitalists (physicians who specialize in taking care of patients only in the hospital setting) and dedicated Care Coordinators. Care Coordinators are responsible exclusively for following your care and maintaining open lines of communication between you and your family members, your IPC/Senior Care provider, your IPC hospitalist, outside specialists, hospital discharge planners, and others who may be involved in your care. Their job is to ensure a seamless and personalized transition between care settings.

 

 

Your Care Coordinator will meet with you and/or your family to help assess the best possible options available upon discharge from the hospital. They will address:

  • Outpatient Care Options: The Care Coordinator will work with your IPC physician and hospital case manager to assess your individual needs. We may identify an appropriate outpatient facility where a Senior Care provider is available, arrange facility walk-throughs, or schedule a follow-up clinic appointment, as necessary.
  • Transitional Plan: Once your options have been identified (based on a collaborative approach including you/your family and the care team), your Care Coordinator will provide a care plan specific to your next step along the continuum of care (e.g., rehabilitation, skilled nursing, follow-up clinic appointment).
  • Delivery of Care: Many details will be attended to behind the scenes on your behalf. Your Care Coordinator will communicate with the appropriate facilities or clinic to pave the way for a seamless transition from inpatient to outpatient setting.

We plan to expand this important service to additional hospitals in the future. If you have any questions about the program, please call us at 303.306.4321 to inquire.

From outpatient to inpatient and back, we're commited to serving our patients across the Continuum of Care.