Banner Good Samaritan Introduces Transitional Care Service for Heart Failure Patients
Banner Good Samaritan Medical Center is offering a new transitional care service for heart failure patients to improve patient-centered care and reduce hospital readmission rates.
Dr. Ken Ota is the new Banner Good Samaritan Medical Center Physician Transitionalist. He will offer a short-term (30 days) intervention for heart failure patients leaving the hospital that will supplement community physicians’ care through home-based care.
The goals of the program are to:
- Improve quality of patient care
- Increase patient access to care
- Maintain communication with community primary care physicians/specialists regarding patient’s clinical progress
- Ensure timely follow-up with respective physicians
- Reduce preventable readmissions
- Reduce preventable Emergency department visits
The Transitionalist is equipped with medical supplies. The offered services include:
- Prescription reconciliation
- Outpatient follow-up within 24-72 hours
- Patient education and support
- Direct communication with primary care physicians and specialists
- Timely intervention to prevent ED visits and preventable hospitalizations
- Check system for potential medical/system errors
- Emphasis on PCP/Specialist follow-up
- Patients will have direct telephone access to the Transitionalist during business hours and select on-call evenings
Why should you consider the BGSMC Transitionalist for your hospitalized patients?
- Twenty percent of Medicare patients discharged
from the inpatient setting are rehospitalized
within 30 days
- The transitionalist can optimize care transitions that are often lacking in our current health care system
- Reduce the higher risk for adverse events and
overuse of health care resources that accompany
- Engage specialized care that is centered on your
The BGSMC Transitionalist does not have a clinic, and only provides home care intervention during a 30-day window. Follow-up with PCP and specialists is clearly emphasized, regardless of Transitionalist care. For the introductory phase of this program, the target population is limited to Heart Failure patients.
We hope to expand this care to other high-risk patients in the near future.
Mission Statement: To improve the health of our population by providing outstanding patient-centered care transitions from the hospital to the community.
For more information or to request a Transitional Care consultation, please call Dr. Ken Ota at 602-540-8902 or email: Ken.Ota@bannerhealth.com.