Post date: Jul 9, 2014 5:19:13 AM

A Partnership between Hospitals and LTC Providers to Reduce our Community’s Readmission Rates

Thursday, July 10, 2014

9:00 – 11:00 am

Bakersfield Memorial Hospital, The Learning Center Lecture Hall

Framework for Discussion

1. Welcome and self-introductions

Lynne Ashbeck, Hospital Council of Northern and Central California Gina Fleming, Clinical Project Manager, Care Transitions, Health Services Advisory Group of California

2. Meeting objectives and expectations

♦ Shared goals

♦ Shared problem statement…what are we trying to solve? Accomplish?

3. How did we get here? Background on the idea for this Summit (Lynne)

♦ Larger care transitions collaborative/CCTP grant

♦ Lessons from other communities

♦ “Small test of change:” what can hospitals and LTC do together to ‘move the readmissions needle?’

♦ The hospital-LTC hand off is a key piece of the readmissions puzzle…and neither hospitals nor LTC can make significant progress on their own!!

4. What can we learn from the data and from our experiences about the readmission process in our region?

♦ Regional, hospital, and LTC data

5. What are we learning from the CCTP grant experience relative to hospitals, LTC, and readmissions?

6. What is it that we do/don’t understand about each other’s processes, expectations, capabilities that are barriers to improving our readmission rates?

7. What is possible for us to work on together?

♦ Can this smaller group develop a shared goal(s)? What might they be?

♦ What metrics would we use to measure success?

♦ Are there ‘subsets’ of the folks we both care for that we might take a closer look at in terms of their readmission practices (e.g. chronic disease, dialysis, “hospital-dependent” patients, etc.)?

8. Next steps