Aligning Forces for Quality of South Central Pennsylvania, in partnership with the York County Area Agency on Aging, the Adams County Office for Aging, and other regional organizations, is leading targeted efforts to provide care transitions services to Medicare beneficiaries discharged from York, Hanover, and Gettysburg Acute Care Hospitals. Together, AF4Q and the York-Adams Care Transitions Coalition have formed a strong collaborative body and are creating a community-wide infrastructure for effective care transitions for seniors.
In March 2013, the Centers for Medicare and...
As part of the Aligning Forces for Quality (AF4Q) initiative, the Humboldt County Alliance has developed a two-tiered approach to reducing readmissions. The method incorporates both a traditional strategy to reduce readmissions using Eric Coleman’s Care Transitions Program and a more customized approach targeting high-risk, hard-to-reach patients through its Intensive Transitional Services component. The Alliance’s readmissions efforts are led by the St. Joseph Health System-Humboldt County, a two-hospital provider in the community. “Reducing readmissions requires...
As part of the Aligning Forces for Quality (AF4Q) initiative, the Cleveland Alliance, known as Better Health Greater Cleveland (Better Health), has used a collaborative quality improvement approach to reduce readmissions in its community. Better Health has developed a network of 11 local and regional hospitals that are working together to improve care for heart failure, diabetes and stroke patients in Cleveland. “Everyone’s struggling with a lot of the same things, and the solutions and resources are being freely shared. It’s exciting to see the potential,”said...
St. Joseph Hospital’s Care Transition Program, which was highlighted last week during the Robert Wood Johnson Foundation’s Care About Your Care webcast, has seen avoidable emergency department (ED) readmission rates drop since 2006. The Care Transition Program began with a goal of realizing a 20 percent decrease in readmission rates for heart failure and chronic obstructive pulmonary disease (COPD). For the year ending September 2012, it exceeded the COPD goal by chopping the readmission rate to 8.3 percent and came close to the heart failure goal with a 13.9 percent...
As part of AF4Q, hospitals, ambulatory care providers, community health centers and other state and local agencies are working together to improve quality and reduce costly hospital readmissions. Most of the AF4Q’s 16 Alliances indicated efforts to report readmission rates as one of their key strategies for addressing cost and efficiency. Rates of hospital readmission are important outcome measures for assessing the performance of the health care system. While some hospital readmissions may be necessary and appropriate, many are considered unnecessary or avoidable, and serve as...
In the current health care delivery system, care often seems fragmented, as though various providers and patients are all working in separate silos, with limited communication. The care any one provider delivers may be excellent, but without coordination among everyone involved in the process—and putting the patient and caregiver front and center—important details might be missed.
The results? More than 17 percent of Medicare beneficiaries are re-...
Margie Namie, RN, MPH, CPHQ, divisional vice president of quality at Mercy Health in southwest Ohio, was honored to be named one of 73 Innovation Advisors (IAs) in the first cohort of the Centers for Medicare & Medicaid Services Innovation Center (CCMI). Her participation in the program brought an added bonus: reductions in readmissions and costs.
Read the rest of this AF4Q Bright Spot here.
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On March 29, 2012, the Robert Wood Johnson Foundation held a briefing in Washington, DC to highlight the work of Jeffrey Brenner, MD. Brenner, a local Camden, N.J., physician, spurred a national health discussion with a feature in the New Yorker describing his work improving health care in one of the poorest and most dangerous cities in the country.
At the briefing, Brenner discussed his work identifying "hot spots" in and beyond New Jersey, and colleagues from Maine and Delaware discussed their local efforts to address high-utilizers. The Robert...
The Aligning Forces for Quality November 2011 National Meeting was 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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