The Cedars is proud to announce it has been selected to receive the John A. Hartford Foundation Support for Diagnostic Excellence-Age Friendly Health Systems Seed Grant, awarded by the Institute for Healthcare Improvement. The Cedars will receive a grant of $75,000 to fund the project titled “Integrating Age-Friendly and Diagnostic Excellence: A Strategic Approach to Reducing SNR Rehospitalizations.” This innovative initiative aims to reduce 30-day unplanned rehospitalization rates among high-risk skilled nursing facility (SNF) patients by implementing a comprehensive rehospitalization prevention program that integrates two evidence-based frameworks: the Age-Friendly Health Systems 4Ms and principles of diagnostic excellence.
The project will focus on three key strategies: early risk identification, culturally responsive interventions, and the application of structured evidence-based practices to address social determinants of health. By combining these strategies, the program seeks to create a more effective system for preventing unnecessary rehospitalizations, all while maintaining patient-centered care. This holistic approach considers both clinical and social factors that contribute to rehospitalization risk, ensuring that patient outcomes are improved, and healthcare resources are used efficiently in the SNF setting. This initiative represents a significant step forward in enhancing the quality of care for aging patients and addressing challenges faced by healthcare systems in managing rehospitalization risks and if successful could have national implications. The project is targeted to start in March 2025.