Home is the Hub is an initiative launched in 2016 by VHHA's Center for Healthcare Excellence that is focused on reducing preventable hospital readmissions. Through collaboration, strategic use of data, best practice implementation, and the engagement of a nationally recognized expert, this multi-stakeholder effort will focus resources on three primary categories:
- 30-day, all cause, all payer readmissions;
- 30-day readmissions for patients discharged to a post-acute setting such as a skilled nursing facility; and
- 30-day readmissions for multi-visit patients (patients, formerly referred to as high-utilizers, with four or more hospital admissions during a 12-month period)
Home is the Hub is envisioned as an 18-month effort featuring online (see webinar videos below) and in-person programming geared around strategies to reduce readmissions. During this initiative, guidance is being provided by Amy Boutwell, M.D., M.P.P., a nationally recognized expert with experience advising on large-scale collaborative efforts aimed at system redesign to reduce readmissions and improve care settings. Content associated with this initiative includes webinars (see videos below) and in-person workshops. This important work is designed to strengthen connections between hospitals and post-acute care settings, and identify and manage multi-visit patients. Reducing readmissions is a priority for Virginia's hospitals and health systems -- our goal is to reduce hospital readmissions by 20 percent as of 2020. For more information, contact Abraham Segres at firstname.lastname@example.org.
November 15, 2016 Home is the Hub Workshop Materials
In addition to a presentation by Dr. Boutwell Review Dr. Boutwell's Nov. 15 presentation slides, representatives from Bon Secours Virginia Health System, VCU Health System, and Health Quality Innovators (HQI) shared real world experiences with workshop participants.
Review Bon Secours' Nov. 15 presentation slides.
Review VCU Health's Nov. 15 presentation slides.
Review HQI's Nov. 15 presentation slides.
In addition to hospital representatives, stakeholders including representatives from the Jefferson Area Board for Aging, the home health and hospice care provider community, and the Department of Medical Assistance Services attended the Nov. 15 workshop. As the workshop concluded, participants were asked to work on a readmission reduction driver diagram prior to the Dec. 15 webinar. For more information about driver diagrams and Dr. Boutwell's work with the Agency for Healthcare Research and Quality, visit this link to review the AHRQ ASPIRE Guide, and this link to view the ASPIRE Toolbox.