Telligen Community Connect Call - Oklahoma - Shared screen with speaker view
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keziah koshegee also a Nursing home Administrator for 3yrs
Please enter you name and organization in chat.
Keziah koshegee: Burford Manor
Anthony Waltrip RN Variety Care
Sherry Gfeller, 30 years nursing, Quality for 11 years.
Jen Cushman RN Director of Clinical Compliance for Epworth Villa
Wow, great collective tenure! Thank you for your dedication!
Danielle Burtschi, Grady Memorial hospital
Agree, Meredith. Thank you to all for your dedication and commitment to the beneficiaries and communities you serve!
The presentation slides will be sent via email to all those attending today.The recording for this event will be posted on our website at: www.telligenqinqio.com
We want to hear from you. Chat in your questions or comments and we will address them as we go along.
May is:National Mental Health Awareness Month: https://nami.org/Get-Involved/Awareness-Events/Mental-Health-Awareness-MonthNational Stroke Prevention Month: https://www.heart.org/en/professional/quality-improvement/american-stroke-month-qoraNational Blood Pressure Education Month: https://www.cdc.gov/bloodpressure/communications_kit.htm
Welcome, if you are just joining us please enter your name and organization in chat.
Please explore the Telligen QI Connect Portal:
Portal login: https://portal.telligenqinqio.com/rdc/
Have you had a chance to sign in to the Telligen portal and look around at the resources available to you? Please indicate in chat - Yes, No, or I need assistance - we would be happy to contact you to help.
Interesting that stroke readmissions > 30 days spike in Sept 20. Wondering why?
Great observation and curiosity, Patrice.
Could you please contact me about access to the portal
This will be helpful for our driver diagram conversation to keep in mind....
I think that during this time frame, COVID has a lot to do with discharges to home at 42%, as patients wanted to avoid any increased LOS. Wondering how this 42% d/c to home compare with the previous year?
AHA’s Institute for Diversity and Health Equity (IFDHE)https://ifdhe.aha.org/health-equity-resources
Hi Deborah, sure I will reach out to you later today.
Thank you for your feedback, we will definitely take a deeper dive into this data and share what we find.
You can access the driver diagram here:
What change ideas have you tried or considered implementing at your organization related to continuity of care?
In rural areas, we could continue to utilize FQHC's. Many of the ones in our area are expanding to be in walking distance of patients, they are getting cars to get patients to appts. But patients often don't know about those programs or new clinics
For care transitions and continuity, being able to contact patient is critical. The state HIE or the hospital EMR may have more current phone numbers and addresses for active contact points.
Agreed on the phone and email addresses!
AGREED on updated/accurate contact info!
oops- since EMR's from different health systems do not communicate, keeping current meds up in different systems is challenging. also, patient understanding of their chronic disease- and the PCP's honesty in the chance of improvement (ie: Parkinson's- there is no cure, and maintenance is the goal) is critical
not really. Our HIE hasn't been very useful yet
Yes, it is not complete but has data from major healthcare players in Oklahoma.
MyHealth use of Provider Portal helps filter patient information.
What is status of CMS rule directing hospital to notify primary providers post discharge and sharing of pending lab results.
Do you work directly with the HIE vendors?
There seems to be an issue with closing the referral loop.
Yes, I have a contact at MyHealth and an on the utilizer steering committee.
I found out about a resource to help with this- Unite Us
Anthony, I think it is only a small percentage that has be done for eCQM's.
Unite Us is a free resource for community organizations for referrals.
Do you organizations have care/case managers? How do they track this type of information?
Thank you, Jennifer.
I’m getting more info. Here is my Ok contact info: Kathy Goodingshe/her/hersCommunity Engagement Manager Unite UsDurant, Oklahoma
Great, this is very helpful!
Monthly meetings as this to continue, with updated education.
would like to have something in person at some point. Brainstorming session
I would be interested in break out sessions over specific interventions or tasks
Have the leaders report on what they're doing.
Specific interventions in smaller groups
If possible making sure we get a copy of the tools and forms and copy of the power points.
Have a chance to voice what is going on in different hospitals
There's are at no-cost, feel free to register for any session.
Are the QI training sessions for nursing homes only?
They are offered to all provider types.
National Rural Health Association 2021 Top CAH05-03-21-2021-NRHA-Top-20-CAHs
Wellness Recovery Action Plan https://mentalhealthrecovery.com/wrap-is/
Please feel free to enter your resources in chat. We will add them to the Action and Resource Guide.
GAD - Generalized Anxiety Disorder
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Thank you for letting me participate with you all today, excited for the continued conversation and appreciate all that you do!
Great job Oklahoma!!
Great to see you today!