Resilience health perceptions (QOL) stressors and hospital admissions—Observations from the real world of clinical care of unstable health journeys in Monash Watch (MW) Victoria Australia

摘要

Rationale, aims, and objectivesMonash Watch (MW) aims to reduce potentially preventable hospitalisations in a cohort above a risk “threshold” identified by Health Links Chronic Care (HLCC) algorithms using personal, diagnostic, and service data. MW conducted regular patient monitoring through outbound phone calls using the Patient Journey Record System (PaJR). PaJR alerts are intended to act as a self‐reported barometer of stressors, resilience, and health perceptions with more alerts per call indicating greater risk.Aims: To describe predictors of PaJR alerts (self‐reported from outbound phone calls) and predictors of acute admissions based upon a Theoretical Model for Static and Dynamic Indicators of Acute Admissions.