Across the country, Colorado is considered a leader when it comes to improving care transitions. Over half of our hospitals are currently committed to efforts to improve the process by which patients are discharged home from the hospital or transferred to a different care setting, thus reducing the rate of potentially avoidable hospital readmissions. In many corners of the state, community-based initiatives are at work to better coordinate patient care after hospitalization. Many of our long-term care providers are working to reduce unnecessary trips to the hospital for frail and elderly residents and improve coordination of care when individuals are transferred into or out of their facilities or programs. Despite all these efforts, there has been little opportunity for those working on care transitions across the state to come together to inform each other of their efforts, identify opportunities for collaboration, and share best practices.
For more than a year, CIVHC has convened a care transitions task force and work groups aimed at building collaboration among several initiatives aimed at improving care transitions across the state, and advancing the integration of patient and family-centered approaches across Colorado’s health care delivery system. The work groups helped CIVHC develop important resources including an inventory of care transitions initiatives across Colorado, and an issue brief defining care transitions and national models being tested across the state. One of the groups focused on workforce identifying clinical roles and responsibilities in care transitions models. With the foundational work complete, the work groups are joining together in 2013 to develop a statewide care transitions campaign that will unify, support and advance current care transitions programs in Colorado communities and will provide resources and tools to launch new initiatives in areas of need.
The ultimate goal of the statewide campaign, scheduled to launch in the summer of 2013, is to improve care transitions for Coloradans by aligning and accelerating existing efforts, creating opportunities for collective impact and sharing best practices. This concept was inspired by campaigns in other states focused specifically on reducing hospital readmissions such as the Minnesota RARE Campaign and the No Place Like Home campaigns implemented in Arizona, Florida, Nevada and California. After reviewing these statewide approaches in September 2012, the care transitions task force agreed to develop a similar campaign for Colorado to further advance the impact of their work across the state.
The stakeholder partners are currently working with CIVHC to develop campaign priorities, objectives, goals, and a work plan to launch the statewide campaign and website by June 2013. A top priority of the campaign is to align the goals and components with work already happening across the state, rather than ask partners to change what they are currently doing to improve care at the local level. The campaign also aims to address care transitions beyond hospital readmissions, seek a broader spectrum of participants beyond the hospitals, and provide a platform to celebrate Colorado successes and encourage collaboration.
We would like to thank each individual and organization on our work groups for their time, expertise and participation in setting the foundation for this campaign. If you are interesting in joining the campaign steering committee, or would like to learn more, please contact Jenny Nate at firstname.lastname@example.org.