New England QIN-QIO
Nursing Home INTERACT 2016
Participation Agreement

The New England QIN-QIO is striving to reduce 30-day readmission rates by 20% or more in the State of Connecticut and to improve safe care transitions for all of patients, regardless of payor. Based on this goal, as a nursing home provider in Connecticut, our facility agrees to participate in the INTERACT learning sessions provided by the New England QIN-QIO and understand the expectations listed below.

Approach:

We will help you implement INTERACT evidence-based interventions to improve resident outcomes and decrease avoidable readmissions in your facility. The collaborative framework will include monthly webinars, all-teach, all-learn sharing calls, technical support and access to evidence-based learning materials from across the United States.

Benefits of Participation:

·  Decreased readmission rates by preventing avoidable readmissions in your facility

·  Improved communications among staff members

·  Improved communications during transitions of care

·  Improved patient satisfaction

Expectations:

·  Form an INTERACT team within your facility

·  Engage leadership and medical staff

·  Participate in monthly webinars

·  Complete all assignments prior to monthly webinar

·  Submit monthly data

·  Share best practices and lessons learned

Certificate of Participation:

To receive a certificate of participation at the end of the webinar series from the New England QIN-QIO your facility must complete the following:

·  A signed INTERACT participation agreement with the New England QIN-QIO by April 15, 2016

·  Attendance and active participation in 7 out of the 9 webinars starting on March 30, 2016

·  Submission of at least 4 months of readmission data to the New England QIN-QIO by
January 15, 2017

·  At the end of the series, Administrator completes an INTERACT implementation checklist verifying that INTERACT tools have been implemented.

By signing below, I assert that I have read and understand and agree with the expectations outlined above and have the authority to represent the organization delineated below.

Facility name______

Address______State______Zip Code______

Phone Number______Fax Number ______

Administrator/CEO/COO/Owner______Bus Title______Date______

Email______Signature______

Please make a copy for your records

Complete this form and return it to Florence Johnson at or fax: 860-632-5865