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- Getting Started
- Community Engagement
- Root Cause Analysis
Despite the challenges associated with building, governing, and sustaining a locally based coalition, remember that this structure offers the best opportunities for sustained improvement for your community.
The Centers for Disease Control (CDC) has substantial resources on building and sustaining community coalitions, since they have been essential to public health initiatives such as tobacco control, stroke prevention, and domestic abuse. You will find many resources at www.cdc.gov and perhaps it is useful to start with the tobacco control program’s handbook Coalitions: State and Community Guide at www.cdc.gov/tobacco/stateandcommunity/bp_user_guide/pdfs/user_guide.pdf.
The Institute for Healthcare Improvement (IHI) also has useful resources related to coalition building for collaboration. Start by reading their white paper on ‘Planning for Scale: A Guide for Designing Large-Scale Improvement Initiatives’ (Log-in required for access, free registration: http://www.ihi.org/IHI/Results/WhitePapers/whitepapersindex.htm).
A few guiding points from community-based health care improvement coalitions in the field:
- Keep the door open – laggards may be eager to join later.
- Allow no vetoes – parties that want to try something out are free to do so.
- If there is one party with an overwhelming degree of influence, the meetings might go better with an outside facilitator who can keep things more equal.
- Nursing homes and mental health providers have been “beaten up” so much that their staff are often “beaten down” and resentful of being given second-rate status. Meeting in their setting or talking about what they did for shared patients can help establish respectful relationships.
- Process mapping is a tool that often serves to share a work process efficiently and thereby often illuminates inefficiencies and opportunities, especially regarding transfers where the multiple providers do not know one another’s processes.
- Trading visits or exchange site visits can help all parties to understand one another’s settings to better understand and identify challenges and opportunities.
- An intervention that does not work as initially planned is not a failure, but an opportunity to learn something previously unknown about your system, community, or population.
- It takes time to build trust between providers and partners – allow the relationships to grow slowly, but encourage these entities to start talking and sharing.
In the 9th SOW Care Transitions theme, each QIO applied for funding by identifying a population of Fee-for-Service (FFS) Medicare beneficiaries for which it proposed to reduce hospital readmission rates, and a group of health care providers involved in delivering care to that population. Each target population was defined by zip code of residence, resulting in group of beneficiaries living within a contiguous set of zip codes. The targeted beneficiary population consists of all FFS Medicare beneficiaries living in the selected zip codes.
QIO staff identified providers to target for recruitment by assessing the target population’s claims data for key hospitals involved in delivering care to the population, and through local knowledge of relevant community services and leaders. Each Care Transitions community is therefore defined as a set of contiguous zip codes, and a set of targeted medical services providers.
QIOs were encouraged to select communities of beneficiaries whose hospital care could be largely localized to a finite set of hospitals to ensure creation of manageable intervention communities. Each QIO constructed a final proposed community by optimizing the overlap between beneficiaries living in the selected community, and a group of target hospitals. Project leaders at the Centers for Medicare & Medicaid Services (CMS) selected 14 sites in which to fund the project, including Alabama, Colorado, Florida, Georgia, Indiana, Louisiana, Michigan, Nebraska, New Jersey, New York, Pennsylvania, Rhode Island, Texas, and Washington.
In the 9th Statement of Work, the QIOs undertook various roles, with the most common and prominent being facilitation of interdependent improvement efforts. The QIOs worked to help build trust and reliable interfaces among project participants, including providers across various settings. Additionally, the QIOs were able to share data in aggregate with their providers to help them further understand readmission rates and patterns and opportunities for improvement. Many QIOs developed their own reports for distribution to providers, please see the ‘Tools’ section for examples.
The QIOs also served as a resource for technical assistance and evidence-based information. The QIOs facilitated training and implementation of various interventions utilized by individual providers and the community all throughout the project.
Role of the Patient
It is important to remember to act for the individual and learn for the population. By engaging consumers in our efforts, including patients and their families, we are much more likely to be successful. Remember to consider the patient’s experience as they transition from provider to provider, setting to setting, their voices are quite valuable.
The Obama Administration has launched the Partnership for Patients: Better Care, Lower Costs, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort.
The Partnership focuses in on the patient, to ensure hospital care becomes safer, more reliable, and less costly.
- Join the Partnership for Patients today and learn more information at www.healthcare.gov.
Types of Participants (providers and partners)
While all care transitions initiatives are different, the types of participants involved are often common across communities. Traditional partners include the providers based within your community, such as:
- Skilled Nursing Facilities
- Home Health Agencies
- Hospice organizations
- Palliative care organizations
- Dialysis facilities
It may be helpful to engage other partners in your work to increase spread and sustainability. Examples of these supportive partners may include:
- Adult Day Centers
- Area Agencies on Aging (AAAs) - www.eldercare.gov
- Aging and Disability Resource Centers (ADRCs) - www.aoa.gov/AoARoot/AoA_Programs/HCLTC/ADRC_CareTransitions/index.aspx
- Employers in the community
- Information Technology companies or vendors
- Quality Improvement Organization (QIO)
- Senior Centers
- Trade associations