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April 3, 2014
Food, Care Transitions, and Colorado's Project Angel Heart
By: Project Angel Heart
 Like Healthy Transitions Colorado, Project Angel Heart is working to keep people in their homes. We are going about this work in different ways than many Healthy Transitions Colorado partners, but hopefully achieving the same outcome. Healthy Transitions Colorado represents an admirable, comprehensive effort of reducing hospital readmissions. Project Angel Heart's piece of the pie is small but mighty - food - and not just any food, but home-delivered and nutritionally appropriate meals. An astounding 96% of those we serve report that Project Angel Heart's meals help them live independently in their own homes. And for many of those we serve, this includes keeping them healthy and at home following a release from the hospital. 
Treating Hunger as a Health Issue
By: Christopher J. Gearon
From US Health News, 2.13.14
woman-grocery-shopping.jpg Addressing issues like hunger, housing and education can have more of an impact on people's health than the traditional medical services hospitals deliver. Many hospitals and integrated health systems - such as Promedica, Massachusetts General Hospital, and the New Milford Hospital - are beginning to address hunger as a legitimate health issue. 
Is Nutrition the First Step in Addressing Hospital Readmission?
By: Robert Miller
From US Health News, 3.18.14

Hunger and the lack of proper nutrition among our nation's seniors has contributed to an increase in hospital readmission rates among this population causing poorer outcomes for patients and putting undue burden on hospitals and treatment centers. A fresh look at how nutrition is being prescribed in the hospital may yield a simple solution to reducing readmissions, leading to both decreased hospital costs and improved patient care.

Study Ties Hospitalizations to Dip in Food Budgets
By: Sabrina Tavernise
From The New York Times, 1.6.14

A new study detailed in this month's Health Affairs looked at patterns of hospitalizations for diabetic patients and found that hospitalizations among this population, especially low-income diabetics, was tied to declining food access at the end of the month. Causes of admissions are also causes of readmissions and drivers of readmission rates

Nurse patient
Palliative Care Shortens ICU, Hospital Stays, Review Data Show
By: Sherry Boschert
From The Oncology Report 2.12.14

A meta-analysis of palliative care studies shows an overall decrease in ICU and hospital stays. The review found that ICU length of stay decreased in 13 of 21 studies, for a total of 59% of patients in those studies. Hospital length also declined in 57% of those studies and 43% of studied patients. The review showed no impact on mortality and a potential increase in communication and family satisfaction. 

The Town Where Everyone Talks About Death 
By: Chana Joffe-Walt
From NPR 3.5.14
In fact, in La Crosse, Wisconsin, you're unusual if you don't have a plan for your death. Some 96 percent of people who die in La Crosse have an advance directive or similar documentation. Nationally, only about 30 percent of adults have that documentation. 
One Third of Skilled Nursing Patients Harmed in Treatment

By Marshall Allen

From ProPublica 3.32014

One in three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment, according to a recent government report that underscores the widespread nature of the country's patient harm problem. Doctors who reviewed the patients' records determined that 59 percent of the errors and injuries were preventable (Allen, 3/3). 

Program Sustainability Assessment Tool

What keeps effective programs sustained over time? Believe it or not, it takes more than just money! The Sustainability Framework identifies a small set of organizational and contextual domains that can help build the capacity for maintaining a program and develop an action plan to increase the likelihood of sustainability.

Community-Based Programs to Improve Senior Health
The Agency for Healthcare Research and Quality (AHRQ) announces the February 26 issue of the Health Care Innovations Exchange. Three programs are featured, including
  • a collaborative that helped community-dwelling seniors access services so they could remain at home;
  • a health and hygiene program that incorporated diabetes and hypertension screenings for at-risk seniors; and 
  • an initiative that enhanced access to culturally tailored mental health services for elderly minorities. 
The featured QualityTools include a library of resources to help community-based organizations develop and implement evidence-based programs to promote healthy living for older adults.  
Learn More 
The TeamSTEPPS system is an evidence-based team training and implementation toolkit designed for health care professionals that can help improve care delivery and patient safety. AHRQ has recently released two new TeamSTEPPS modules: 
  • Long-Term Care - adapted to the environment of nursing homes and other long-term care settings, such as assisted living and continuing care retirement communities.
  • Patients with Limited English Proficiency - this helps develop a customized approach for patients who don't have a fluent understanding of the English language.

Learn More 

Healthy Transitions Webinars Available 

Recordings and slides of our monthly webinars are located on the Education page of the Healthy Transitions Colorado Website. 

Healthy Transitions Colorado Education Page 

In This Issue
Upcoming Events
Call to action 

HTC is putting together a group to begin work examining medication reconciliation efforts across Colorado. Medication reconciliation  is a critical piece of successful care transitions and we would like to expand the available resources on what is happening in Colorado. This group will be led by Donna Kasuda from Think About It Colorado. Please click here if you are interested in joining this group!

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Healthy Transitions Colorado is a collaborative effort, focused on aligning and accelerating existing efforts to improve transitions of care for Coloradans. Our guiding principles are simple - by working together to break down the silos of health care, we can foster true community care coordination across facilities, specialties, and practices. 



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