The McClendon Center Patient Discharge Coordination program (PDC) is a partnership effort between McClendon Center, AmeriHealth Caritas DC, and Beacon Health Options to ensure that these Managed Medicaid Organizations’ members who are admitted to a psychiatric inpatient unit (PIU) experience a seamless transition back into the community.
HOW IT WORKS
During Hospitalization: When a member is first admitted into a PIU, our PDC staff is notified and visits the member within a 24 hour period to complete an assessment and begin care coordination with the inpatient hospital staff. Once the PDC receives the member’s consent to work with them, they begin daily communications with the inpatient treatment team and visits the member at least every other day during their hospitalization.
Preparing for Discharge: When the member is ready to be discharged, our PDC staff will be there to administer a Patient Health Questionnaire, which is used for screening, diagnosing, monitoring, and measuring the severity of depression, and the results are submitted to the Managed Medicaid Organization. Depending on the member’s needs, the PDC team may be asked to continue working with the member post-discharge, and help with coordinating follow-up care with any treatment agency or professional in the community.
Discharge and Post-Discharge: On the day of the member’s discharge, our PDC staff is there to take the member back to their home, picking up any prescribed medications. One of the most important services the PDC provides is educating the member (and their caretaker) about their medication, how to take it, and the importance to adhering to the prescription instructions.
RESULTS AND FUTURE
Over time, we anticipate a significant reduction in the number of days a member is in the hospital for psychiatric inpatient care and in the number of readmissions.