Visiting Nurses Association, a non profit home health provider was having an issue with people being readmitted to the hospital. Their funding was contingent on these people being treated and not being readmitted to the hospital from which they came. An all encompassing policy of longer care wasn’t a viable option. Something was needed to identify who was more likely to readmit and who was a non-issue.
Contemporary Analysis (CAN) built a solution that looked at historical data of patients who had been readmitted previously. Similarities surfaced and the model was able to highlight indicators of re-admittance. As care was being provided and documented the system scrubbed for these indicators. As a patient neared the end of their scheduled care they were scored for possible re- admittance. Patients who scored high were given additional care and screening.