Atrium Health Navicent Expands Congestive Heart Failure and Diabetes Disease Management Programs to Baldwin and Peach Counties
Atrium Health Navicent is expanding its outreach efforts to people with congestive heart failure and diabetes — already proven effective in Macon-Bibb County — to Baldwin and Peach counties.
Data has shown that Atrium Health Navicent, like many hospitals, encounters patients who must be readmitted to the hospital for congestive heart failure and diabetes, two conditions which disproportionately affect Black Americans.
Congestive heart disease and diabetes are progressive conditions, that, without managed care, can lead to an earlier death, said Angeline Doh, manager of Atrium Health Navicent Healthy Communities.
“If we can keep them out of the hospital, we can help them to be able to care for themselves and manage their outcome and keep them out of the hospital, increasing their life expectancy,” Doh said.
How The Program Works
Focusing on the sickest of the sick, Atrium Health Navicent enrolled 640 high risk heart failure patients and 750 high risk diabetes patients in 2022. The management program which includes weekly monitoring — and if necessary — home visits, has lowered the readmission rate by 11.9 percent in heart failure patients and 10.8 percent in diabetes patients.
“Making an impact in this population ultimately, makes an impact on all heart patients and all diabetes patients, and that’s how we can be successful,” Doh said.
The program, which Doh describes as being “extremely hands-on” also allows health providers to discover additional health concerns affecting patients and their families. Doh said health providers encountered one patient and later discovered that every person in their household had diabetes.
“We wondered why when we made home visits that every family member would crowd around and listen,” she said.
The 90-day program includes an individualized treatment plan, education, and assistance in connecting with other available services and resources.
For more information about Atrium Health Navicent Healthy Communities’ health outreach programs, call (478) 633-5623.
