Health Care Innovation Awards: Project Profile

UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER

Project Title: "Brookdale Senior Living (BSL) Transitions of Care Program"
Geographic Reach: Colorado, Florida, Kansas, Texas
Funding Amount: $7,329,714
Estimated 3-Year Savings: $9,729,702

Summary

The University of North Texas Health Science Center (UNTHSC), in partnership with Brookdale Senior Living (BSL), is developing and testing the Brookdale Senior Living Transitions of Care Program, which is based on an evidenced-based assessment tool called Interventions to Reduce Acute Care Transfers (INTERACT) for residents living in independent living, assisted living and skilled nursing facilities in Colorado, Florida Kansas and Texas. In addition, community dwelling older adults who receive BSL home health services will be included in the Transitions of Care Program. Over the course of the award the program will expand to other states where BSL communities are located. The program will employ clinical nurse leaders (CNLs) to act as program managers. CNLs will train care transition nurses and other staff on the use of INTERACT and health information technology resources to help them identify, assess, and manage residents' clinical conditions to reduce preventable hospital admissions and readmissions. The goal of the program is to prevent the progress of disease, thereby reducing complications, improving care, and reducing the rate of avoidable hospital admissions for older adults. Over a three-year period, the Brookdale Senior Living Transitions of Care program will train an estimated 10,926 workers and create an estimated 97 jobs for clinical nurse leaders and other health care team members.

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