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Tools & Resources

Here you will find tools and resources including presentations and materials from our webinars, in-person meetings and others that we have vetted and believe will be valuable to you!

Do you have any resources that could be helpful for the community? Let us know.

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Current information regarding ARC activities and readmission reduction successes from our engaged hospital partners.
Title & Description Author Date Type
Beyond Hospital Walls: Strategies for Reducing Readmissions
Agenda from "Beyond Hospital Walls"
Christine Muscolo 04/24/13
(pdf)
View/Download
Getting Started and Moving Forward- Building Improvement Capacity
Pat Teske 01/19/11
(pdf)
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Breakout Session Key Discussion Points
"Beyond Hospital Walls" breakout summaries
Sam Spurlock 04/24/13
(pdf)
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ARC Update and Understanding the GAP
January 2011, GAP Analysis
Pat Teske 01/19/11
(pdf)
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California Association for Healthcare Quality
ARC Overview: CAHQ Journal
Pat Teske 01/05/14
(pdf)
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Improving Marketshare by Improving Value
Senior Leadership Dinner
Arnold Milstein MD and Kimberly Brayton MD, JD 04/22/14
(pptx)
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CA Hospital Penalties - Year 4
List of CA hospitals and their Medicare penalties in Year 4
ARC/Cynosure Health 08/05/15
(xlsx)
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California Readmission Summit Report
CARS
ARC 12/01/13
(pdf)
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Title & Description Author Date Type
ARC Update
October 2011
Pat Teske 10/14/11
(pdf)
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ARC Update
February 2012
Pat Teske 02/23/12
(pdf)
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ARC - Where are we now?
June 2011
Pat Teske 06/08/11
(pdf)
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The ARC Journey
April 2013 at "Beyond Hospital Walls"
Pat Teske 04/24/13
(pdf)
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New ARC Program Activities
April 2013 at "Beyond Hospital Walls"
Lisa Ehle 04/24/13
(pdf)
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Hospital Collaborative Reduces Readmissions by 11 Percent
Press release highlighting ARC successes
The Gordon and Betty Moore Foundation 05/23/13
(pdf)
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ARC Update and Understanding the GAP
January 2011, GAP Analysis
Pat Teske 01/19/11
(pdf)
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ARC Overview
November 2010
Pat Teske 11/30/10
(doc)
View/Download

Title & Description Author Date Type
ARC Newsletter 01- June 2013
Lisa Ehle 06/14/13
(pdf)
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ARC Newsletter 02- July 2013
Lisa Ehle 07/17/13
(pdf)
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ARC Newsletter 04- September 2013
Newsletter
Lisa Ehle 09/30/13
(pdf)
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ARC Newsletter 05- October 2013
Newsletter
Lisa Ehle 10/31/13
(pdf)
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ARC Newsletter 06- December 2013
Newsletter
Lisa Ehle 12/31/13
(pdf)
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ARC Newsletter 03- August 2013
Newsletter
Lisa Ehle 08/30/13
(pdf)
View/Download
ARC Newsletter 07- February 2014
ARC Newsletter
Lisa Ehle 02/28/14
(pdf)
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ARC Newsletter 09- July 2014
ARC Newsletter
Lisa Ehle 07/07/14
(pdf)
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ARC Newsletter 08- April 2014
Newsletter
Lisa Ehle 04/15/14
(pdf)
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ARC Newsletter 10- Fall 2014
ARC Newsletter
Lisa Ehle 10/01/14
(pdf)
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ARC Newsletter 11- Winter 2015
Lisa Ehle 02/25/15
(pdf)
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Title & Description Author Date Type
ARC Webinar - Implementation of Physician Orders for Life Sustaining Treatment (POLST)
Approach to end-of-life planning that emphasizes patient wishes.
Dr. Jeff Yee & Dr. Vincent Nguyen 04/03/13
(pdf)
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ARC Webinar - Intermountain Risk Score-Heart Failure and Myocardial Infarction Tool (IMRS-HF and IMRS-MI)
Predicting risk of readmission with IMRS-HF and IMRS-MI tools.
Benjamin D. Horne, PhD, MPH, FACC, FAHA 07/10/13
(pdf)
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ARC Webinar - Leveraging Mobile Care Coordination Technology To Reduce Readmissions
CareInSync's collaboration with Marin General Hospital to build the nation's first 'Mobile Care Transitions Network'.
Susan Cumming, MD & Siva Subramanian, PhD 09/04/13
(pdf)
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ARC Webinar - Palliatative Care in the Emergency Department
Emergency Physician model for providing Palliative Care.
Travis E. DeVader, MD 05/01/13
(pdf)
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ARC Webinar - The ROI in Preventing Avoidable Hospital Readmissions
Key findings that support the business case for readmission reduction efforts.
Siva Subramanian, PhD 11/06/13
(pdf)
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ARC Webinar - An Overview of OutcomesMTM
Patty Kumbera, BSPharm, OutcomesMTM COO 12/04/13
(pdf)
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ARC Webinar - Patient and Family Engagement: Recruiting for Patient Family Advisory Councils & A Review of Engagement Tools
Libby Hoy & Julia Hallisy, DDS 01/08/14
(pptx)
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ARC Webinar - The Conversation Project: National Perspective and Local Implementation
Helping people talk about their wishes for end-of-life care.
Marilyn Ababio & Mandy Ferguson 03/05/14
(pdf)
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ARC Webinar - Pharmacy Efforts to Reduce Readmissions
Pharmacy
Jeanette Cavano, Lynn Deguzman, Jaime Cavanaugh 04/02/14
(pdf)
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ARC Webinar - Grand-Aides USA
Learn about the Grand-Aides program, an innovative post discharge workforce model that delivers personalized care at lower cost and prevents unnecessary hospital readmissions.
Arthur Garson, Jr., MD, MPH 05/14/14
(pdf)
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ARC Webinar- An Overview of University of Pennsylvania Health System's IMPaCT Model
Webinar
Dr. Shreya Kangovi 06/04/14
(pdf)
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Advance Care Planning and Utilization of the Physician Order for Life Sustaining Treatment (POLST) to Improve End of Life Care
Judy Thomas and Vincent Nguyen 03/31/15
(pdf)
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ARC Webinar-Preventing Readmissions for High-Risk Patient Populations
Karen Vanaskie 06/03/15
(pdf)
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Webinar Audio- The Conversation Project
02/25/15
(arf)
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Webinar Audio- Grand Aides
05/14/14
(arf)
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Webinar Audio- An Overview of the IMPact Model
06/04/14
(arf)
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Webinar Audio- Patient and Family Engagement
01/08/14
()
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Webinar Audio- Advance Care Planning and Utilization of the POLST
04/01/15
()
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ARC Webinar- Behavioral Health and Readmissions
11/05/14
(arf)
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Webinar Audio- Preventing Readmissions for High Risk Populations
06/03/15
(arf)
View/Download
RN Care Coordinator-Scottsdale Health Partners Job Description
06/16/15
(pdf)
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Medical Assistant Care Coordinator Job Description- SHP
06/16/15
(pdf)
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LSW Care Coordinator Job Description-SHP
06/16/15
(pdf)
View/Download

Title & Description Author Date Type
Action Network Measurement Plan
Pat Teske 01/19/11
(doc)
View/Download
High Quality Planning Criteria
Pat Teske 11/30/10
(doc)
View/Download
Measurement Overview
Pat Teske 01/19/11
(pdf)
View/Download
Medical Record Review Tool
Pat Teske 01/19/11
(doc)
View/Download
Process Review Tool
Pat Teske 01/19/11
(doc)
View/Download
Provider Assessment Tool
Pat Teske 01/19/11
(doc)
View/Download
Patient/Caregiver Assessment Tool
Pat Teske 01/19/11
(doc)
View/Download
Risk Assessment Formula
Formula
Pat Kearns, MD 10/12/11
(doc)
View/Download
Readmissions Reduction Worksheet
Pat Teske 01/19/11
(doc)
View/Download
RRS Measurement Detail
Pat Teske 02/28/11
(doc)
View/Download
Readmission Formula
Formula
Pat Kearns, MD 10/12/11
(doc)
View/Download
ARC Website 2.0 Tutorial
2013 update
Lisa Ehle 06/14/13
(pdf)
View/Download
MOU for Action Network
11/19/10
(doc)
View/Download
Reasons for Readmissions
Reasons for Readmissions
Shogofa Zamon 01/07/14
(pdf)
View/Download
Bay Area Community Resource Guide
08/28/14
(pdf)
View/Download
Peninsula Circle of Care - Patient Re-admit Form
Peninsula Circle of Care
Yvonne Chane 04/01/14
(pdf)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: CHN-2 Education Registration Form
Congregational Health Network Tool & Resource
09/16/15
(doc)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: ACCN-1 2015 Summary
Dignity Health, St. Joseph's Hospital and Medical Center Tool & Resource
Marisue Garganta 09/16/15
(pdf)
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CommUNITY Collaboration to Reduce Readmissions Guide: ACCN-3 Going Home Guide
Arizona Community of Care Network Tool & Resource
09/16/15
(pdf)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: WCC-1 Liaison Tools
Washington County Community Tool & Resource
09/16/15
(pdf)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: WCC-3 Collaborative Shadow Agenda
Washington County Community Tool & Resource
09/16/15
(doc)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: WCC-5- Rhode Island Nursing Home Guide
Washington County Community Tool & Resource
Healthcentric Advisors 09/16/15
(pdf)
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CommUNITY Collaboration to Reduce Readmissions Guide: WCC-7 Charter
Washington County Community Tool & Resource
09/16/15
(doc)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: SM-2 Day of Transitions Mapping Facilitation Instructions October 2013
San Mateo County Tool & Resource
09/16/15
(docx)
View/Download
Care Transitions Community Convening Summary
San Mateo County
09/16/15
(docx)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: SM-6 Day of Transitions Worksheet March 2015
San Mateo County Tool & Resource
09/16/15
(docx)
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CommUNITY Collaboration to Reduce Readmissions Guide: CHN-1 Partnership Covenant Agreement
Congregational Health Network Tool & Resource
09/16/15
(pdf)
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CommUNITY Collaboration to Reduce Readmissions Guide: SM-8 Verbal Handoff Cue Card
San Mateo County Tool & Resource
09/16/15
(docx)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: CHN-3 Network Liaison Guide
Congregational Health Network Tool & Resource
09/16/15
(doc)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: ACCN-2 Agenda Sample
Arizona Community of Care Network Tool & Resource
09/16/15
(pdf)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: ACCN-4 Tools for Backbone Agency
Arizona Community of Care Network Tool & Resource
09/16/15
(pdf)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: WCC-2 Shadowing Program
Washington County Community Tool & Resource
09/16/15
(ppt)
View/Download
CommUNITY Collaboration to Reduce Readmissions Guide: WCC-4 Nursing Home Collaborative Shadow Program
Washington County Community Tool & Resource
09/16/15
(doc)
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CommUNITY Collaboration to Reduce Readmissions Guide: WCC-6 Medication Management Clinic Brochure
Washington County Community Tool & Resource
09/16/15
(pdf)
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CommUNITY Collaboration to Reduce Readmissions Guide: SM-1 San Mateo Initial Convening Agenda October 2013
San Mateo County Tool & Resource
09/16/15
(docx)
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CommUNITY Collaboration to Reduce Readmissions Guide: SM-3 DoT Sample Worksheet - Hospital to SNF
San Mateo County Tool & Resource
09/16/15
(docx)
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CommUNITY Collaboration to Reduce Readmissions Guide: SM-5 Day of Transitions Mapping Facilitators Instructions March 2015
San Mateo County Tool & Resource
09/16/15
(docx)
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CommUNITY Collaboration to Reduce Readmissions Guide: SM-7 Capabilities Worksheet
San Mateo County Tool & Resource
09/16/15
(doc)
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CommUNITY Collaboration to Reduce Readmissions Guide
Guide of innovative approaches to community collaboration plus tools and resources to reduce readmissions
Pat Teske - ARC/Cynosure Health 09/18/15
(pdf)
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CommUNITY Collaboration to Reduce Readmissions Guide: SM-4 Care Transition Community Convening Summary October 2013
San Mateo Tool & Resource
09/16/15
(docx)
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Community Collaboration to Reduce Readmissions Guide (plus tools & resources)
The complete community collaboration guide, including all tools and resources from the featured organizations.
Pat Teske, RN, MHA, ARC/Cynosure Health 09/19/15
(pdf)
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Bay Area Resource Guide
Bay Area Resource Guide
01/12/16
(pdf)
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The Best of Dignity: Innovative Tools to Prevent Unnecessary Readmissions
Zenobia Collins Johnson, RN BSN MBA CPHIT CLNC, Erica Mares, RN BSN MBA CCM, & Kay Duncan, RN BSN MBA CPHQ CCM 05/06/14
(pdf)
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