Long process for credentialing Outreach Coordinator to enter hospitals.
Goal 1: Early discharge, pre-term infant 23-37 weeks. Objective 1: Access to home health, early intervention and social services with care coordination and case management with local hospitals. Objective 2: Provide assessment and teaching of caregivers for the early pre-term infants. Objective 3: To reduce long term health consequences that can occur from premature and/or high risk births.
Liaison to make rounds at participating hospitals on weekly basis and frequent phone contact to determine eligible clients for early discharge. Care coordination arranged with orders for home health services and appointments scheduled with Neonatal clinic. Home health to contact family after order received to schedule visit and arrange services. Coordination (maximum 500 characters): List the State, local health agencies or other organizations involved project and their roles. Nevada, Positively Kids Home Health, PK NEIS, Dr. Abdulla Neopediatric Clinic, PK Social Services and UNLV.
Assessments are done throughout services with patient surveys.