Transcript slides
HealthEast Linkage Committee
Pennie Viggiano
RARE Action Day
November 8, 2012
1
HealthEast Care System St. Paul, Minnesota
Woodwinds
St. Joseph’s
St. John’s
HealthEast Care System
• 4 Hospitals
• 14 Primary Care Clinics
• More than 35 specialty services
• Home Care & Hospice
• Medical Transportation
Hospital Statistics
Licensed Beds:
Employees
Volunteers
Credentialed Physicians
925
7300
1200
1400
Bethesda
Membership
• HealthEast
– St. Johns, St. Josephs, Woodwinds,
Bethesda, Home Care, Medical Care for
Seniors and HealthCare Home, Orthopedics
• Cerenity Care, Care Choice, Episcopal Homes,
Golden Living, Health Dimensions, Good
Samaritan
– Representing Transitional Care, Long-Term Care and
Assisted Living.
– Some also have Home Care, Hospice and Other
services
3
AIM
Improve patient safety, quality and
experience resulting in improved
outcomes in care and reduced
readmissions
4
SCOPE
The scope of the committee lies within the relationship and
cross referrals/transfers related to HealthEast Hospitals,
Home Care, Hospice, Primary Care, Medical Care for
Seniors, Community Care Management, Transitional
Care, Long Term Care and Assisted Living provider
partners. Within this relationship understanding barriers
and opportunities for improvements in care to the
patients we mutually serve.
5
The Focus
•
•
•
•
•
•
Comprehensive discharge planning
Medication Management
Patient & Family Engagement
Transition Care Support
Transition Communications
Forum for cross continuum discussion and
consultation.
6
Improvement Work
• Safe Transitions in Care
• Initial Admission and Re-Admission
Assessment
• Partnership on Direct Admissions
• Care Center to Emergency Department
(ED) transfers
• Assisted Living
• Record Access
7
Measurement
Percent Reported by Care
Centers
RARE 30-Day Return to ED
0.5
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul11
11
12
12
12
12
12
12
12
% Readm 0.119 0.457 0.191 0.258 0.163 0.236 0.119 0.075 0.147
8
2012 and Beyond
• Create quality indicators for partnerships
• Implement cross continuum pathways for
total joint and geriatric hip
• Ongoing review and root cause analysis of
barriers identified by the collaborative
9