Care coordination and medication safety continue to be highly discussed topics across communities and the healthcare continuum. For the past 4+ years, the Great Plains Quality Innovation Network (QIN) has brought communities together throughout the states in our region to work collaboratively to improve both coordination of care and medication safety.
The goals of Great Plains QIN care coordination efforts are to reduce hospital admissions and avoidable 30-day readmissions, including those caused by high risk medications such as anticoagulants, diabetic agents and opioids. To assist communities in attaining improvement in these areas, Great Plains QIN staff regularly review tools and resources to refresh and update information. Following are some highlights to whet your appetite.
The Quarterly Care Coordination Report for each state contains data for the most current quarter, 1/1/2017-12/31/2017. The report includes 30-day readmissions such as acute care utilization, ED visits and observation stays. Additional data identifies where patients are discharged to and where patients are readmitted from, including home health, skilled nursing facility, home and hospice. The top five DRG bundles are identified for admissions and 30-day readmissions. Of note, sepsis is the number 1 reason for admissions and 30-day readmissions across the Great Plains QIN region. Additionally, admissions, 30-day readmissions, ED visits and observation stays related to anticoagulants, diabetic agents and opioids are identified. The report also provides goals for reducing admissions and 30-day readmissions. Following are links to each state’s report:
Visit our Coordination of Care page to access tools relating to advance care planning, chronic disease management, community organizing, discharge planning, falls/mobility, health literacy, healthcare disparities, patient activation, person/family engagement and social determinants of health.
Because the Great Plains QIN work also focuses on reducing and monitoring ADE rates, we research tools and resources to enhance medication safety efforts of providers, pharmacists and stakeholders in our region.
Tools to address the opioid crisis have recently been added to our webpage, including Federal Resources for Rural Communities to Help Address Substance Use Disorder and Opioid Misuse as well as direct links to Prescription Drug Monitoring Programs in Kansas, Nebraska, North Dakota and South Dakota. You will also find a direct link to sign the Medication Management and Opioid (MMO) Initiative pledge to commit to improving medication management and opioid misuse. Look for the icon in the right-hand column.
Visit our Medication Safety page for tools relating to other topics including: adverse drug events, anticoagulants, diabetic agents, drug take-back, health literacy, medication reconciliation and medication safety.
If you would like to receive information regarding these initiatives or any other Great Plains QIN initiatives, please sign up to become a member of our Learning and Action Network.