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June 2, 2014
FOCUS: CARE TRANSITIONS AND SOCIAL DETERMINANTS OF HEALTH
iCARE and Reducing Readmissions in Rural Colorado
By: Jennifer Dunn, Director of Programs, Colorado Rural Health Center
Hospital readmissions are argued to be one of the leading problems facing the US health care system. This has many looking to identify system level interventions to reduce readmissions. As the Healthy Transitions Colorado initiative has indicated, addressing hospitals avoidable readmissions in Colorado has the potential to save Coloradoans over $80 million in healthcare dollars and collectively help patients avoid an extra 34,000 days in the hospital.  Many care transitions and readmission reduction efforts are ongoing throughout our state, both in urban and rural areas. Rural healthcare facilities face unique challenges due to their unique location and limited resources, yet they are dedicated to providing high quality patient care. The Colorado Rural Health Center's iCARE project works with Critical Access Hospitals (CAHs) and provider based Rural Health Clinics (RHCs) in Colorado to improve communications in transitions of care and reduce readmissions. 
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Can You Afford Your Medicine? Doctors Don't Ask
From The New York Times, May 2014

We know that financial concerns can act as a barrier to accessing care for many Americans, but the high costs of health care can affect people in many ways. In general, providers are not trained to ask about financial concerns that may be affecting care or compliance, but delivering high-quality care depends on more than just identifying illness.   

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Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969-2009 

By: Gopal K. Singh, PhD and Mohammad Siahpush, PhD
From American Journal of Preventive Medicine, February 2014

A study in the American Journal of Preventive Medicine compared life expectancy of rural residents to their urban counterparts. The study revealed stark geographic disparities based on race/ethnicity, gender and socioeconomic status (SES) along the rural-urban continuum. 

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Socioeconomic Status And Readmissions: Evidence From An Urban Teaching Hospital
By: Jianhui Hu, Meredith D. Gonsahn, David R. Nerenz
From Health Affairs, May 2014

The CMS Hospital Readmissions Reduction Program focuses on reducing thirty-day readmissions and factors that affect the risk of readmission. Researchers examined how individual characteristics and neighborhood socioeconomic status affected the risk of readmission. Click here to read the abstract or to purchase the full article in the May issue of Health Affairs.

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Integrated Care for Older Adults in Rural Communities 

By: Eileen Griffin, JD and Andrew Coburn, PhD
From The Maine Rural Health Research Center, May 2014

The Maine Rural Health Research Center looks at the recommendations for integrated health in the Affordable Care Act and how those recommendations could be applied to a rural setting. How easily can current models for integrating care be adapted to a rural context and culture? How well do they account for gaps and variations in local delivery systems, capacity, and infrastructure? Which strategies offer the greatest promise for addressing the needs of rural residents?

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CMS Finalizes a Medicare Prospective
Payment System for Federally Qualified Health Centers 
From The Centers for Medicare & Medicaid Services, April 2014

Federally Qualified Health Centers FQHCs, provide vital primary and preventive care services to millions of patients in or from medically underserved areas. Through 2015, Medicare will be transitioning to a prospective payment system for these Health Centers that will increase reimbursement to FQHC's by almost 32%.

RESOURCES AND INNOVATIONS
Accountable Care Organizations, Explained

ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some of the more common questions about how they work.

Health Care Innovations Exchange focuses on Patient- and Family-Centered Care Innovations

The Agency for Healthcare Research and Quality (AHRQ) announces the April 23 issue of the Health Care Innovations Exchange including:
  • Three programs that integrate patient- and family-centered care into service  delivery, contributing to better outcomes and greater patient satisfaction.
  • A toolbox to assist health care professionals in implementing and meeting patient- and family-centered care goals and more.

Learn More 

Are you interested in expanding your quality improvement knowledge?

If so, take any of these FREE Quality Improvement Continuing Education Modules:

Accreditation is available for both CME and CEU. Each module equates to 1.25 credit hours. 

Frontline Innovators on Providing Patient- and Family-Centered Care

AHRQ announces a new video series, Frontline Innovators on Providing Patient- and Family-Centered Care, which features three brief profiles of health care professionals sharing stories about how they have put the core concepts of patient- and family-centered care into practice.  
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
Untreated Mental Health Issues Key in Helping System's "Frequent Flyers" 
By: Kristin Jones
From Rocky Mountain PBS I-News, May 2014

Mental health problems are significant contributors to readmissions and high health service utilization. Care coordination, pilot programs and targeted interventions can help to a certain degree, but to solve to problem, we have to find a way to break down the silos of mental and physical health.

Read More 

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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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