Too many patients are re-hospitalized

Partnering with other organizations in a regional effort, TMF Health Quality Institute is working with health care providers from across the continuum to reduce readmissions following hospitalization. By facilitating community coalitions in Arkansas, Mississippi, Nebraska, Puerto Rico, Texas and the U.S. Virgin Islands, TMF is leading the effort to meet this ambitious goal.

Funded by the Centers for Medicare & Medicaid Services, these community coalitions seek to connect all comers in communities of directed learning that will successfully reduce avoidable hospital readmissions. Participants include hospitals, rehabilitation hospitals, long-term acute care hospitals, home health agencies, dialysis facilities, skilled nursing facilities, physician offices, inpatient psychiatric facilities, as well as patients, families, payers, community organizations and other motivated individuals.

A big problem with a community solution

Frequent hospital readmissions are not just a hospital problem; they are a community problem with all providers in the community having a role in achieving the high quality, coordinated and patient-centered care that prevents avoidable readmissions.

We know simply raising broad awareness of better practice will not achieve sustainable results, nor will it change behaviors on a large scale. However, a community coalitions of peers and communities willing to share, interact, ask, integrate and implement creates a forceful momentum for change.