Accreditation Statement: The American Medical Directors Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
This program will describe national changes in expectations for care coordination, care delivery, and patient outcomes exposed by the Care Transitions literature. The participant will be taught the elements of QAPI literature. This will be applied to the INTERACT program, an evidenced base program that reduces avoidable hospital transfers. AMDA Tools supporting improved care transtions will be explored. Opportunities for PIPs will be identified and the Medical Directors potential role discussed.
Summarize what CMS and major stakeholder organizations have identified related to Care transitions as a key opportunity for improving care coordination and health outcomes for high risk elderly patients
Explain how the Affordable Care act requires nursing homes to integrate QAPI into their care processes and how this will be phased in during 2013 and be required in 2014. Discuss how the Care Transition literature has identified many performance improvement opportunities that could become a part of a facilities ongoing PIPS (Performance Improvement Projects), using the QAPI elements.
Discuss how to apply the 5 elements of QAPI to Care Transition improvement using the INTERACT (Interventions for reducing Avoidable Hospital Transfers) program as well as AMDA’s TOC CPG and Know it All Communication tools.
Examine barriers to improving Care Transitions.
Identify important community partnerships to improve care coordination
Associate Clinical Professor,
University of California, San Francisco
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