Free Clinic 5Each year, over 35,000 patients are discharged from the three hospitals serving greater Glendale.

Some of these patients, particularly those with certain cardiac and pulmonary diagnoses (approximately 20%) are readmitted within 30 days, often for a variety of avoidable reasons. Such readmissions can incur significant costs to the healthcare system and to the patient’s well-being. Consequently, this issue has been one of growing concern in healthcare. Moreover, as the U.S. population ages, hospital readmissions are likely to continue to increase, and with them related costs, both human and financial. In recognition of this challenge, the Center for Medicare and Medicaid Services (CMS) has initiated a major undertaking, the Community Based Care Transitions Program.

Glendale’s three hospitals, acting together, applied for and received funding from CMS Community Transitions funding (CCTP). As a result of this application, Glendale was also identified by HSAG as the first of five communities to model working together with HSAG to reduce readmissions. The collaboration taking place among all three hospitals, coordinated comprehensively across the community’s service organizations, can have a profound effect on care transitions and is a model HSAG expects to see replicated widely. Glendale Adventist Medical Center received further funding from the UniHealth Foundation for its Patient-Centered Healthcare Transitions (PCHT) program, which works in concert with CCTP. Through these efforts, the community of health care providers in greater Glendale is making a concrete and proactive expression of their concern for providing transitional care to discharged patients. Glendale’s transition care effort leads the state in improving community health care.