Transitions are vulnerable exchange points that expose older adults and individuals with special needs to lapses in quality and safety. Poorly executed care transitions contribute to increased rates of potentially avoidable re-hospitalizations, unnecessarily high rates of health services use and health care spending. Care transitions are central to several initiatives, including the Center for Medicare Medicaid Services Partnership for Patients, and were included as a provision in the Affordable Care Act and the work of the National Quality Forum. The Long-Term Quality Alliance (LTQA) is a broad-based coalition of the nation's leading long- term care, health and consumer advocates, and government agencies, focused on improving the effectiveness and efficiency of care and quality of life of people receiving long-term services and supports. LTQA identified the improvement of care transitions as a priority focus because of its promise for improving quality, consumer experience, and efficiency, as well as reducing costs. LTQA is proposing to host a conference on care transitions of the elderly and younger adults with disabilities who require long-term services and support. The goal of the conference is to disseminate evidence-based models and approaches of care transitions in clinical and community settings. Sessions will be presented on successful approaches of transitional care in nursing home and community-based settings and how to bring to scale transitional care interventions. Sessions will impart knowledge on the educational needs of the workforce to successfully adapt the interventions and maximizing health care reform implementation. Leading Age, on behalf of LTQA and as a member of LTQA, is requesting AHRQ to partially fund (co-sponsor) this conference. This conference approach is directly related to AHRQ's Small Grant Program for Conference Support objective #3 (Dissemination and implementation conferences) and the Patient Safety and Value portfolio areas. Two background papers- measurement of preventable hospitalizations and transitional care measures-will be distributed to attendees and made available on the LTQA website. A white paper on the conference proceedings, a peer-reviewed journal article on the policy implications and research agenda for transitional care, and a catalogue synthesizing evidence-based best practices to improve transitional care will be developed. LTQA will disseminate these reports and resources through the LTQA and 45 committee member organizations communication channels.
Improving care transitions is a crucial issue in health care today and is central to several recent initiatives. This project is to support a national conferenc on care transitions to provide approaches to address the public health goals of providing higher quality care at lower cost.