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CIMRO of Nebraska > Home > CareTransitions > CTHomeHealth  

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The Home Health Impact

Hospital readmissions are a symptom of a fragmented healthcare system. They are expensive and disruptive to the lives of patients and their families. 

Nebraska providers, partners, advocacy groups and stakeholders are all committing to working together to improve care coordination. Home health agencies have been working to reduce their Acute Care Hospitalization rates.  The national ACH rate is 27 percent; Nebraska’s ACH rate is 25 percent. We are making progress, but there is still work to do. 

Through Nebraska’s care transitions pilot, CareTrek™, community partners in Douglas and Sarpy Counties reduced their readmission rate 16.9 percent in two years.  This proves we can make a difference by working in collaboration with other healthcare and community partners. We plan to build on these recent successes statewide through the CareTrek Learning and Action Network (LAN). As a result of our efforts, we believe patients will receive better care, costs will be reduced and communities will be healthier.

The LAN is an opportunity to:

  • Share successes and challenges with other providers in the community
  • Review and analyze data for admissions and readmissions to acute care hospitals
  • Evaluate patient and family/caregiver education during the episode of care to improve patient activation
  • Evaluate processes for communicating information about the home health episode with the patient’s primary care provider or specialist at discharge


Pledge your commitment to improving care coordination, through the CareTrek LAN.

LAN members will have access to resources, education and tools.







Resources

  AHRQ MATCH Toolkit
  Ask Me 3 Tool - National Patient Safety Foundation
  Care Transitions Program
  CHAMP Program
  Community Care Transitions Toolkit
  Home Health Quality Improvement National Campaign
  HRSA Cultural Competency Video
  HRSA Health Literacy Video
  IHI STAAR Initiative
  National Coordinating Center for Care Transitions
  PREPARE For Your Care
  RWJF Care About Your Care Program
  The Conversation Project

Related Documents

MATCH Toolkit for Med Reconciliation.pdfMATCH Toolkit for Med ReconciliationTool1669 KB
Improving Care Coord-Transitions -Home Health Care.pdfImproving Care Coord-Transitions -Home Health CareInformative brochure549 KB
Dr. Landers Presentation - Reducing Hospital Readmissions and Role of Home Care.pdfDr. Landers Presentation - Reducing Hospital Readmissions and Role of Home CarePresentation and Materials465 KB
CareTrek Project Overview.pdfCareTrek Project OverviewInformative brochure277 KB
Ask Me Three Toolkit.pdfAsk Me Three ToolkitTool2052 KB
AHRQ Health Literacy Resource - Simply Put.pdfAHRQ Health Literacy Resource - Simply PutInformative brochure1915 KB
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