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.