Care Across Settings

The Aligning Forces for Quality November 2011 National Meeting wash held in Washington DC and was broken up into three distinct tracks: Payment, Care Across Settings, and Cost. View video highlights on discussions and lectures below!
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AF4Q South Central Pennsylvania hosted “Improving the Quality & Value of Health Care,” a summit for employers and providers that showcased innovations in health care delivery. Keynoting the event was Paul Grundy, who spoke about the merits of patient-centered medical homes (PCMH), which are designed to foster close relationships between consumers and their primary care physicians. PCMHs are coming alive in South Central Pennsylvania through the Planned Care Collaborative. Karen Jones, MD, explained the value to patients, providers, and employers. “By tying in the...

The 2012 Heart Failure calendar and companion nurse teaching guide are now available to help heart failure patients to take control of their condition. You Can Live with Heart Failure – Healthy Habits for...
When a patient moves across settings, like from a hospital to a nursing home, they are particularly vulnerable. Lapses in care, miscommunication of information between providers, mixups with medication – all are possible side effects of “handoffs” that are not well coordinated.
AF4Q Alliances have done significant work to improve the quality of care in hospital settings, and are connecting these efforts to improve care across settings. Alliances are working to design care delivery systems that focus on the continuity of care, avoid unnecessary risks in quality and safety, and promote coordination between providers.
Eric Coleman, MD, MPH from the University of Colorado at Denver, is a leader in improving quality and safety during times of “hand offs.” In a conversation with AF4Q communities, Dr. Coleman provides an overview of evidence-based transitional care models that have improved patient outcomes and reduced the cost of care. He showcases the Care Transitions Intervention (CTI)—a 4 week program for patients with complex care needs transitioning from hospital to home and which emphasizes coaching and self-care management. Dr. Coleman described CTI’s impact on achieving higher value health care in an era of reform and shares specific lessons, strategies, and implementation resources for hospitals interested in adopting this model of care.