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goals of Thinkcatalyst:
- improve continuity and access to resources for discharged acute care patients (eg. those lacking primary care)
- create and implement technology to improve patient access to specialist care, primary care, and social services resources
- support the monitoring and treatment of chronic diseases and the prompt community based treatment of acute exacerbations
- resource map and navigate existing resources- health & social resources
- develop an ongoing evaluation framework for existing publicly funded programs
Acute Care Transition- workflow
patient discharged from acute care- ER, ward, ICU
↓
patient referred at discharge via secured messaging to a thinkcatalyst Acute Care Transition clinic.
-message containing patient information, clinical course information ...
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- designed for initial assessment of recently discharged patients. Many (60-70%) are discharged within 2 weeks.
phase #1
→
resource mapping
needing primary care +/- social resources
↓
→
existing primary care
- designed for patients requiring longer term follow-up (3-6 months). Alternatively, they could be added long term into one of the disease specific chronic disease clinics.
↓
phase #2
→
resource mapping
needing primary care +/- social resources
from ACT or community
unattached patient
→
→
- patients / clients undergo a process of "tagging" and attribute allocation
- these tags are then compared to a database of available resources eg. family physician's doing obstetrics, geriatrics, naloxone Rx, adolescent mental health, domestic violence etc.
- patients / clients are then added to nearby resources with availability.
A(12)d-f-125C-09p-6t
→
→
appropriate / available primary care
for primary medical issues
Auxillium
for primary social issues