What is PaJR?
Patient Journey (PaJR) is a telehealth-enabled coaching model designed to anticipate deterioration and provide relational support for people with chronic, complex conditions. Grounded in real-time data and human conversations, it bridges gaps in care to prevent unnecessary hospital visits. What Patient Journey aims to do is have regular conversations with people, semi-structured conversations, and identify people's health trajectory. Sometimes some very obvious needs come up, some of it can be detecting deteriorating trends, improvements can be monitored, including checking on psychosocial vulnerability, and self care. Holistic, whole person tracking, people tell their own stories which are recorded in Patient Journey.
Patient Journey is a method of extending the reach of clinicians and carers, that has been clinically proven in use for over ten years. Patient Journey is implemented by the PaJR Patient Journey records system,
How It Works
Check-Ins.
The Health Care Navigator checks-in with the patient on a regular basis for a chat.
They ask a series of questions and take notes. They may offer assistance if it is required.
Algorithm. The PaJR system records the call details and an inference algorithm scores the survey response and allocates the scores
and alerts to the appropriate categories. This is all recorded for future reference.
Coach. The Health Coach, a clinician, responds to any alerts or other anticicipatory calls to action raised by the Care navigator.
Alerts. Anticipatory alerts and notes are logged against the call for the Navigator and the Health Coach to review.
Who It Helps
- Older Adults
- Carers
- Socially Isolated Patients
- Frail and Disabled
- Rehabilitation Patients
- Patients with Mental Health Conditions
- Patients with Complex Needs
- Patients with Multiple Comorbidities
Patient Journey listens to Patients and provides the neighbourly help and support that people need to get on with their lives. Patient Journey aids carers and clinicians to provide appropriate and timely assistance to patients and clients.
Patient Journey is a cost-efficient method of keeping clinicians, carers and patients on track and reducing the risk of unplanned life events, reducing avoidable hospitalisations and enhancing quality of life.