Abstract: A method for monitoring a patient after release from a health care facility includes: monitoring, using a control module, at least one characteristic of the patient in an outpatient setting; based on the one or more characteristics, determining a risk of readmission; and when the risk of readmission is above a certain threshold, automatically generating a notification to a healthcare provider to provide intervention. A system for monitoring the patient includes: a sensor configured to measure at least one characteristic of the patient in an outpatient setting; and a control module in communication with the sensor, the control module configured to: monitor the at least one characteristic via the at least one sensor; based on the one or more characteristics, determine a risk of readmission; and when the risk of readmission is above a certain threshold, automatically generate a notification to a healthcare provider to provide intervention.