IPRO Author Analyzes Effective Care Transitions

IPRO is currently offering technical assistance to communities across New York in an effort to address preventable readmissions of Medicare beneficiaries to acute care hospitals. According to national data, 17.6 percent of Medicare beneficiaries are re-hospitalized within 30 days of discharge from an acute care hospital—with three out of four re-admissions viewed as potentially preventable. Under the three-year Medicare Quality Improvement Organization (QIO) contract that began last summer, IPRO educates providers and communities on key issues affecting re-hospitalization rates. Program experts have identified five essential elements of community-based campaigns to reduce preventable readmissions. These include: (1) assessing patient/caregiver understanding of medications and instructions via the Teach-Back Method; (2) identification and referral of high-risk readmission patients for follow-up care; (3) cross setting medication reconciliation; (4) streamlined, standardized information transfer across settings; and (5) support for patient/caregiver self-care. For more information on IPRO’s activities, read “Integrating Health Care Across the Continuum: Strategies to Support the Move from Silos to Partnerships,” by IPRO Senior Director Sara Butterfield, RN, BSN, CPHQ, which appears in the June 2012 edition of the Home Care Association of New York State’s newsletter, The Educator, now available at: www.hca-nys.org/documents/EducatorVolume3Edition3June2012.pdf