The Care Transitions Learning Sessions are back in session!
Check out the Learning Sessions page for upcoming calls and recordings of all of the past calls.
Learning Sessions Archive
- December 11, 2008 - Michael P. Silver, MPH - Keeping Patients at
Home – A Home Health Performance Improvement Pilot
Recorded Call | Call Notes - November 20, 2008 - Parish Nurse Ministries of New York Inc. &
Stall Geriatrics, LLC - Niagara University Nursing Program
Recorded Call | Handout 1 | Handout 2 - October 30, 2008: Joanne Lynn, MD - Using Population
Segmentation to provide Better Health Care for All: The " Bridges to
Health" Model
Recorded Call - September, 11, 2008: Mary Perloe, RN, MS, GNP - Improving
Nursing Home Care by Reducing Avoidable Acute Care Hospitalizations.
Handout | Interact Tool Kit | Recorded Call - July 24, 2008: Cheri Lattimer - Coordinating Transition As The
Collaborative Team: Patient, Caregiver & Provider
Handout | Recorded Call - July 17, 2008: Vanessa Flint, MPH, MBA - Discharge Planning
Checklist
Handout | Recorded Call - July 10, 2008: W. Kline Bolton, M.D., FASN and Alvin H. Moss, MD
- End-Stage Renal Disease
Handout | Recorded Call - June 26, 2008: Mary Fermazin, MD, MPA - Improving Care
Transitions, Measuring Progress
Handout | Recorded Call - June 19, 2008: David Goodman, MD MS - Defining Populations and
Providers for Measuring Health Care
Handout | Recorded Call - June 12, 2008: Lori A. Gerhard, CASP, NHA - AAA’s and ADRC’s
Role in Care Transitions
Handout | Recorded Call - June 5, 2008: Lori Nichols, Marc Pierson, MD - Explore the
Shared Care Plan PHMS; Implementation in Your Community; How Does
HealthVault Fit In?
Handout | Recorded Call - May 29, 2008: Michael P. Silver, MPH - Causes of Avoidable
Hospitalization in Home Health Preliminary Results from a Field
Study
Handout | Recorded Call - May 22, 2008: Maulik S. Joshi, Dr.P.H. - Local Action for
National Transformation and Harold D. Miller - Reducing Hospital
Admissions by Transforming Chronic Care
Handout 1 | Handout 2 | Recorded Call - May 15, 2008: Judith Tobin, PT, MBA - CARE (Continuity
Assessment Record & Evaluation) Overview
Handout | Recorded Call - May 8, 2008: Stephen F. Jencks, MD, MPH - Rehospitalization: The
Scope of the Problem
Recorded Call - May 1, 2008: Marc Pierson, MD, Bill Mahoney, PhD, Lori Nichols -
Transitional Care Whatcom County Perspectives
Handout | Recorded Call - April 24, 2008:Gail A. Nielson, BSHCA - Creating an Ideal
Transition Home for Patients with Heart Failure
Handout | Recorded Call - April 17, 2008: Patricia Sodomka, FACHE - Sharing the Patient-
and Family-Centered Care Experience at the Medical College of
Georgia
Handout | Recorded Call - April 10, 2008: Brian Jack, MD, Testing the Re-Engineered
Discharge
Handout | Recorded Call - April 3, 2008: Jennifer L. Wolff, MHS, PhD, Family Involvement
in Transitional Care Among Medicare Beneficiaries
Handout | Recorded Call - March 27, 2008: VALUE Project Final Results (CO and NM)
Handout | Recorded Call - March 20, 2008: VALUE Project Final Results (CA and NJ)
Handout 1 | Handout 2 | Recorded Call - March 13, 2008: Chad Boult, MD, MPH, MBA, The Guided Care
“Medical Home” for High-Risk Beneficiaries
Handout | Recorded Call - March 6, 2008: Joseph G. Ouslander, MD, Improving Nursing Home
Care by Reducing Avoidable Acute Care Hospitalizations and Mary Jane
Koren, MD, MPH, Safely Preventing Hospitalization of NH Residents
Handout 1 | Handout 2 | Recorded Call - February 28, 2008:Nan Holland, PGP Demonstration Project - Factors
Influencing Performance Year 1 Quality & Efficiency Results
Handout | Recorded Call - February 21, 2008: Richard D. Brumley, MD, Palliative Care
Across the Continuum Kaiser Permanente
Handout | Recorded Call - February 14, 2008: Re-Designing Health
Care for Quality: The Case for Investing in System-wide Quality
Improvement, Continued
Handouts are the same as the previous call
Recorded Call - February 7, 2008: Bonnie Brossart, Chief Executive Officer,
Health Quality Council in Saskatchewan, Canada - Re-Designing Health
Care for Quality: The Case for Investing in System-wide Quality
Improvement
Handout 1 | Handout 2 | Handout 3 | Recorded Call - January 31, 2008: Dr. Jane Brock (CFMC) and Mark Gottlieb, PhD (NMMRA)
- Developing Metrics for VALUE
Handout 1 | Handout 2 | Handout 3 | Recorded Call - January 24, 2008: Donald E. Casey Jr., MD, MPH, MBA, FACP -
Findings from the CHP "HF GAP" initiative and Atlantic Health's
Approach to Palliative Care
Handout 1 | Handout 2 | Handout 3 | Handout 4 | Recorded Call - January 17, 2008: Donald M. Berwick, MD, MPP, FRCP - Eating Soup
with a Fork
Handout | Recorded Call - January 10, 2008: Joseph Lau - “Non-pharmacological Peri
Discharge Interventions and Outcomes in Heart Failure (HF)"
Handout | Recorded Call - January 3, 2008: Thomas Edes, MD, MS - VA Home Based Primary
Care
Presentation | Handout 1 | Handout 2 | Recorded Call - December 20, 2007: Eric Coleman MD, MPH - Care Transitions
Intervention
Handout | Recorded Call - December 13, 2007: Shannon Brownlee - "Overtreated"
Handout | Recorded Call - December 6, 2007: Mary Naylor PhD, RN - Transitional Care Model
Handout 1 | Handout 2 | Recorded Call
Article about Brownlee's book, "Overtreated," in The New York Times