When a patient is discharged from an acute setting, such as a hospital, nursing home, treatment facility or rehabilitation facility, they can face new challenges. Often, patients require home health services when they’re housebound due to illness, accident or surgery. East Valley Family Medical offeres a patient-centric transitional care program. Our program is designed to ensure that the patient receives safe, effective and coordinated care upon transfer or discharge.
Once engaged, our care team coordinator will manage the patient’s discharge or transfer in a timely manner, address the immediate and long term goals and risks, coordinate the immediate care, and ensure that services are positioned to eliminate the need to return to the acute setting.