Maintaining patient health after a hospital stay...
RARE - Reducing Avoidable Readmissions Effectively

RARE Action Learning DayApril 24, 2012

The RARE Action Learning Day was designed for the RARE organizations' working teams and focused on the five key areas for improvement. Teams discussed their strategies and worked on plans, and participated in cross organizational networking.

  1. Agenda (2-page Word doc)
    Stephen Jencks
    Steve Jencks, national consultant in
    health care safety and quality.
  2. Welcome and Campaign Overview, presented by Jennifer Lundblad, President and CEO, Stratis Health, slides (15-slide PowerPoint)
  3. Keynote Presentation: What Progress is Being Made in Reducing Readmissions? Presented by Steve Jencks, Independent Consultant in Healthcare Safety and Quality handout (12-page PDF)
  4. Care Outside the Hospital Walls: Panel Presentation handout (4-page PDF)
    • Primary Care, presented by Robin Hoeg, Director of Inpatient Services, Winona Health
    • Assisted Living/Home Care presented by Anne Major, RN, BSN, Director of Home Care, Knute Nelson Home Care
    • Nursing Homes, presented by Sharon St. Mary, Executive Director, Good Samaritan Society, University Specialty Center
    • AAA/Community, presented by Lori Vrolson, Executive Director, Central MN Council on Aging
    • Skilled Nursing Facilities/Transitional Care Units, presented by Darrell Shreve, Vice President for Health Policy, Aging Services
    • Health Plan Care Management, presented by Karen Kraemer,
      Vice President, Disease & Case Management, HealthPartners
  5. Rapid Fire Presentation Sessions handout (1-page Word doc)
    • How to make the OP visit a good visit. Get the right information to the next provider. Presented by Steven Bergeson MD, Allina Hospitals and Clinics
    • Putting the puzzle pieces together for effective care transitions- the people, the metrics, the technology, the processes, and the patients. Presented by Vicki Weber and Beverly Christie, Fairview Health Services slides (13-page PDF)
    • Leveraging Epic to identify patients at-risk for readmission. Presented by Madeline Emahiser, Park Nicollet
    • Care Plans: an organization-wide, patient-centered way to reduce readmissions and ED visits. Presented by Joshua Brewster and Rosemary Quirk MD, Regions Hospital/HealthPartners
    • Reducing readmissions through improved transitions of care. Presented by Gail Olson and Mary Eisenschenk, St. Cloud Hospital
  6. Patient Panel
    • Kerin Hanson
    • Morris “Fritz” Hanson
    • Kathy Bassett
    • Susan Nelsen
  7. Wrap-Up: Sanne Magnan, President and CEO, Institute for Clinical Systems Improvement


Sharon St. Mary Darrell Shreve Vicki Weber
Sharon St. Mary, Good Samaritan Society, University Specialty Center
Darrell Shreve, Aging Services
Vicki Weber, Fairview Health Services, commented about empowering patients.




Patients and family members
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RARE is a campaign lead by the Institute for Clinical Systems Improvement, the Minnesota Hospital Association, and Stratis Health, which represents Lake Superior Quality Innovation Network in Minnesota.