Coordination of Care
Lake Superior QIN is bringing together community partners to collaborate, improve transitions of care in the community and reduce readmissions. Communities like ours have already contributed to significant gains made in reducing hospital readmissions. More.
Motivational Interviewing is a goal-oriented, patient-centered counseling style designed to bring about behavior change by helping patients to explore and resolve conflicting reactions, beliefs, or feelings about their health care choices. Hospitals and health care providers are looking for methods to reduce hospitalization rates and improve patient outcomes.
In Fall 2017, Lake Superior QIN presented five full-day Motivational Interviewing workshops across Minnesota. Mary Helgeson, RN, discharge planner at Johnson Memorial Hospital in Dawson, Minnesota, attended the workshop that was presented in St. Cloud. Read what she had to say about what she learned at the workshop, and the potential of Motivational Interviewing to improve patient health in a hospital setting. More.
Medication safety in all health More.is essential to care coordination and the health of Medicare consumers. are a leading cause of preventable patient harm, particularly when multiple providers prescribe high-risk medications like opioids, diabetes drugs and/or anticoagulants.
Take part in collaborations to reduce readmissions and improve care for older adults. We are rallying communities around the shared goal of improving care coordination in their area. More.
Heart failure is one of the top diagnoses involved with readmissions throughout the seven-state region of the Great Plains and Lake Superior Quality Innovation Networks. This recorded series of six webinars is designed to assist communities to improve heart failure care through innovative care, data analysis, and engagement strategies.
Click here to view the webinar series on YouTube.
View more Coordination of Care recorded events and webinars on YouTube.
Discharge Follow-up Tools Designed to Improve Patient and Family Engagement
Glencoe Regional Health Services created a handout to introduce discharge planners and the discharge follow-up call process, and a script for the calls.
Download the sample discharge follow-up handout
Download the sample discharge follow-up phone script
Nurse to Nurse Hand-Off Tool. Developed by the NW MN Community Detroit Lakes COC subgroup, this free-to-adapt and use SBAR-based nurse to nurse hand-off tool.is designed to improve transitions between care settings.
Safe Swallowing Tools and Training. Jefferson County Wis. Care Transitions Coalition’s toolkit to help avoid aspiration pneumonia due to Dysphagia (swallowing difficulty).
Tools for beneficiaries at discharge
Heart Failure Educational Resource. A tool for heart failure patients to track and manage their health and symptoms.
Transitions of Care Transfer Form with Core Safety Elements. This free-to-adapt and use form was developed by Essentia Health Fosston and their partners, now working as part of the North West MN COC Community, to ensure that the core safety elements are included in a transfer form when a patient is discharged from the hospital to a nursing home.
Adverse drug events are a leading cause of preventable patient harm. Learn what you can do to prevent them. More
Communities across MI, MN, and WI are working together to improve coordination of care. See how you can join them. More
LSQIN can help you select evidence-based interventions connected with known causes of readmission. More
Avoidable readmissions often result from poor information transfer or communication between multiple providers in multiple settings. More