title: Kentucky hospital earns rep for continuum care.
abstract: At Ephraim McDowell Regional Medical Center in Danville, KY, case managers helped implement a group of pathways that span the continuum of care by stressing communication with providers outside the acute care setting. Once patients are referred to a pathway, the admissions nurse and case manager draw up a schedule that they share with representatives from the physician's office, rehabilitation, home health, and related disciplines. At the patient's first scheduled appointment, each discipline comes to the patient to perform an initial assessment. Several disciplines also play an active role in preparing for the patient's discharge, including physicians, social workers, case managers, rehabilitation services, and home health.
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D003299:Cooperative Behavior; D019091:Critical Pathways; D006764:Hospitals, Community / Q000458:organization & administration; D007629:Kentucky; D010353:Patient Education as Topic