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New evidence that primary care visits soon after hospitalization are associated with fewer readmissions

January 25, 2019
On left: graphic of blue hand next to "7-Day Pledge" in blue and yellow letters. On right, photo of doctor speaking to two Camden Coalition staff members in clinic room.

By Dawn Wiest, Qiang Yang, Carter Wilson, and Natasha Dravid

As part of the Camden Coalition’s ongoing quality improvement efforts, we evaluated our 7-Day Pledge program to learn about the relationship between timely follow-up appointments with primary care and avoidable readmissions. The results of our analysis were published today in JAMA Network Open. We compared patients who had a primary care follow-up within seven days with patients who had similar clinical and demographic characteristics but who had a later or no follow-up appointment. We found that patients who had primary care appointments within seven days of hospital discharge had a lower number of 30- and 90-day hospital readmissions.

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Medical-Legal Partnership: Integrating court-related advocacy into complex care

January 16, 2019
Consulting Attorney Jeremy Spiegel (right) smiles with Camden Coalition program graduate Charlie Vazquez (left) and Community Health Worker Brian Thompson at Putting Care at the Center 2018 conference

By Amy Yuen

Legal issues like a threatened eviction, a benefits denial, or a utility shut-off have often kept healthcare consumers from meeting their basic needs and staying healthy and stable. That’s why our medical-legal partnership pilot program is playing such an important role in our care coordination work with patients. We’ve achieved some exciting legal successes on a broad range of civil and criminal issues since launching the program with Rutgers Law School in November 2017. It’s also given us insight into how we can enhance the program to provide better care.

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Complex care fellowship: Q&A with Nurse Practitioner Rebecca Shames

January 14, 2019
Complex Health and Social Needs Fellow Rebecca Shames, pictured right, smiles with Kimberly McGuinness (left) and Tina Ahmadinejad (center) at the Putting Care at the Center 2018 conference Beehive event.

By Amy Yuen

Wanting to fully utilize her knowledge and skills as a nurse practitioner to improve patient care, Rebecca Shames applied for the one-year Complex Health and Social Needs Fellowship, a partnership between the Camden Coalition and Crozer-Keystone Health System. She completed the fellowship this month. Recently, The Hotspot sat down with Rebecca to learn more about her experience as a fellow, the insights she’s gained, and her future plans.

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11 recommendations for advancing complex care

January 10, 2019
Blueprint for Complex Care - 11 Opportunities to strengthen the field. 1 develop core competencies 2. develop quality measures.

By Amy Yuen

In urban and rural pockets across the country, healthcare organizations have been pioneering new models to improve care for people with complex health and social needs. Many of these innovations are happening in isolation, with little opportunity for organizations to learn from each other and advance best practices.

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Camden Coalition’s 2018 Year in Review: Five of our top stories

December 12, 2018
Care team member leaves patient's residence after home visit

By Amy Yuen

2018 ushered in exciting developments at the Camden Coalition: the arrival of our new CEO Kathleen Noonan, expanded partnerships across traditionally siloed sectors, new resources for organizations interested in cross-sector data collaboration, and more. Amid these advances, our highest priority remains the same: empowering our patients with the skills and support they need to address their complex health and social needs. With 2019 just around the corner, let’s take a look at five top stories that defined our year at the Camden Coalition.

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