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Patient- and Family-Centered Interventions to Prevent Readmissions

Presented by Kyle Ridgeway and Jason R. Falvey

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Ideal care transitions and efforts to reduce hospital readmissions must involve the patient and family/caregivers. This course will introduce general concepts on engaging patients and families in discharge planning, care transitions, and self-management/monitoring post discharge. Concepts from motivational interviewing and therapeutic alliance will be connected to specific subjective information, patient/family goals, and patient education content.

Meet your instructors

Kyle Ridgeway

Kyle J. Ridgeway, PT, DPT, CCS, is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy (CCS). He received his Bachelor of Arts degree in Neuroscience from Pomona College in Claremont, CA and his Doctorate of Physical Therapy (DPT) degree from the University of Colorado, Anschutz Medical…

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Jason R. Falvey

Jason Falvey is a postdoctoral fellow at Yale University. His research training focuses on disability and recovery for older adults after acute hospitalization and how physical function contributes to hospital readmission risk. He received his PhD in rehabilitation science from the University of Colorado, Anschutz Medical…

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Chapters & learning objectives

Engaging Patients and Families

1. Engaging Patients and Families

Discussion of concepts, such as motivational interviewing and therapeutic alliance, that can assist therapists in understanding and engaging patients/families in effective ways. Content will be linked to hospital readmission reduction strategies.

Subjective Interview and Identifying Goals

2. Subjective Interview and Identifying Goals

This chapter provides an explanation and outline of subjective interview content and approach, including identification of patient-centered goals.

Monitoring and Measuring: Physical, Functional, and ADL Red Flags

3. Monitoring and Measuring: Physical, Functional, and ADL Red Flags

This chapter describes important functional red flags as well as how patients and families can monitor and measure physical, functional, and ADL performance.

Q&A

4. Q&A

This chapter is a Q&A session with Jason Falvey about engaging with patients and families as a physical therapist.

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Overview of Hospital Readmission Reduction Programs: Relevance to Rehabilitation Providers

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Physical Function as a Biomarker for Hospital Readmissions

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Care Transitions, Rehabilitation, and Readmission Reduction

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Patient- and Family-Centered Interventions to Prevent Readmissions

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Evidence-Based Rehabilitation to Reduce Readmissions

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