Alliant Health Solutions, a Quality Innovation Network – Quality Improvement Organization (QIN – QIO) contracted with the Centers for Medicare & Medicaid Services (CMS), recently unveiled its Home Health Care Reducing Readmissions Toolkit to assist home health care providers in minimizing hospital readmissions. The toolkit is designed to enhance patients’ understanding of home health care services and equip providers with strategies to mitigate readmission risks. Hospitals and nursing facilities can also utilize some of these resources to improve care transitions to home health. This collaborative effort involved input from HCAF, the Florida Hospital Association, and over a dozen home health agencies across Florida.

The toolkit includes a range of resources for providers, such as a capabilities list to share with referral sources, a referral checklist outlining required information, a communication tool for when admissions encounter challenges, a guide to preemptively identify readmission risks and develop interventions, and a tool for prompt communication among providers regarding any changes in a patient's condition. Additionally, patient resources are provided, including a guide explaining home health services, a tool to help patients identify health care concerns after completing home health services, and a guide to assist patients in deciding whether to remain at home or seek hospital care if their condition changes.

Click here to access the toolkit, or visit HCAF's provider resources webpage for direct access.