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LAN - Care Transitions Network

Description

Goals:

  • Recruit and educate provider groups and communities
  • Recruit communities to participate in Care Transitions Initiatives
  • Assist communities in developing a Coalition Charter
  • Educate patients through Care Transitions community initiatives
  • Develop a V.I. Community Quality Assessment and Performance Improvement (QAPI) Process
  • Share discharge planning improvement strategies/interventions to improve the discharge process and coordination of hospitals with home health, nursing home, physician office and Federally Qualified Health Centers (FQHCs)


Measure(s):

  • 1. Reduce 30-day readmissions by 20% over three years