Transitions House Calls
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Transitions House Calls Benefits

The patient, PCP and the acute care facility by providing a teamwork approach through:

  • Continuity of care, by assisting patient reconnect with their PCP in a timely manner
  • Access to a robust network of area specialists
  • Reducing emergency room visits and re-hospitalizations
  • Improving outcomes by seeing the patient within 48 hours of discharge to ensure medical conditions remain stabilized
  • Personalized quality and professional care in the home


Transitions House Call Services Include:

  • Medical evaluation and follow-up are completed 3 to 5 days following discharge from the hospital
  • Post hospitalization medication reconciliation
  • Education of the patient and family members on medications and other wellness factors

Physician recertifications for homebound patients Utilizing Transitions House Calls improves a patients health and quality of life. The physician develops a relationship and understanding of the patient and their care giver. Patients receive regular care and follow up while reducing safety risks and travel time.

The Medical Directors are Internal Medicine or Family Practice board certified physicians with extensive knowledge and experience working with older adult patients who may be medically complex due to multiple diagnosis’s that require monitoring.

Our clinic staff includes a team of Board certified physicians, Nurse practitioners and Physician Assistants.