At the 2013 American Medical Directors Association (AMDA) convention in Washington, D.C., speakers from Kindred Healthcare and the Cleveland Clinic presented on acute care to post-acute care relationships. The session highlighted aspects of their own clinical and quality initiatives while giving participants a tutorial in how to get started forming their own collaborations. It is through these types of relationships that health care organizations can work to design and to improve care transitions to meet the challenges of the changing healthcare environment. This is an abridged version of a 3 hour presentation at the conference. To see all of the material, go to http://www.prolibraries.com/amda/?select=session&sessionID=898

1. Success Through Relationships :
A Guide to Initiating Joint Quality Committees
March 21, 2013 (Abridged)

2. “Trap Door” Reality
• 40% of patients experience
multiple transitions
• 4% have 4+
• >400 unique patterns for
1464 post-acute episodes
Coleman EA, Min SJ, Chomiak A, Kramer AM. Posthospital care transitions: patterns, complications,
and risk identification. Health Serv Res. 2004 Oct;39(5):1449-65.

3. 90% of Hospital Readmissions come from patients with 4
or more chronic conditions
Source: HHS Strategic Framework on Multiple Chronic Conditions (MCC), 2012

4. Implementing Joint Quality Committees
Using the PDCA model
4