Promoting preventive health screening through the use of a clinical reminder tool: an accountable care organization quality improvement initiative.

This quality improvement initiative was designed to increase clinical prevention performance rates in 11 Austin Regional Clinic primary care facilities as part of an accountable care initiative. The initiative was conducted between January 2011 and December 2011. The principal interventions included implementation of a care coordinator and care gap summary tool. The care gap summary includes recommended preventive healthcare services and serves as a prompt for healthcare providers. These interventions led to improvement in clinical prevention performance rates as demonstrated by aggregate organizational data. This initiative demonstrates that quality improvement initiatives including care gap summaries, workflow changes, and provider feedback can increase performance rates for clinical preventive services.

A project to reengineer discharges reduces 30-day readmission rates.

A Texas hospital achieves improvement in its readmission rate by implementing Project RED.

A community-wide quality improvement project on patient care transitions reduces 30-day hospital readmissions from home health agencies.

Approximately 1 in 5 Medicare patients are rehospitalized within 30 days of discharge. The Harlingen Hospital Referral Region, an area defined by the Dartmouth Atlas as 35 ZIP codes in South Texas, reduced 30-day hospital readmission rates and associated costs through its participation in the Centers for Medicare & Medicaid Services Care Transitions project. The project emphasized a community-wide focus on 4 quality improvement areas: (a) the problem of rehospitalization, (b) improving cross-setting collaboration, (c) access to performance data, and (d) implementation of best practice interventions to reduce avoidable hospitalizations.