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Clinical Care Coordination and Discharge Planning at UPMC

Our commitment to high quality and safe care also includes when you transfer between inpatient and outpatient care.

To support you, we:

  • Assess your needs and support system.
  • Align resources.
  • Have a discharge plan manager guide you and your family to the next level of care.

We also assign a readmission risk score, which we keep updated. This score helps us detect and respond if you’re at a higher risk of being re-hospitalized for a reason we can avoid.

We can also offer helpful and custom interventions, such as:

  • A home visit from a nurse.
  • Community resource support.
  • Insurance-supported programs and professionals.

Our goal is to support your transition in a way that allows for a positive outcome and a decrease in future admissions.