Texoma Care Transition Coalition

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Texoma Care Transition Coalition

Texoma Care Transition Coalition Mission

The mission of the Texoma Care Transition Coalition is to enable safe and effective transitions of patients between all settings of care, and empowering patients and their families to manage their health.

The Purpose

  • To improve the health of our community
  • To reduce unnecessary hospital readmissions
  • To be a vehicle for the patient and family voice
  • To activate the partient's ability to self-manage their own health through person-centered and person-directed models of care
  • To foster wise stewardship of limited community resources, reducing redundancy, and waste, and build and sustain a community coalition with a focus on improving tranistions of care for Medicare beneficiaries
  • To improve patient safety during transitions between health care settings
  • To enhance the satisfaction of providers and staff through increased collaboration
  • To collaborate and encourage efforts of organizations with shared visions and advance public policies that furthers the vision

Participation & Collaboration

Participation in the Texoma Care Transition Coalition is open to organizations and individuals interested in fostering the vision by actively engaging in the planning and work of the Coalition.

Charter Member Commitments

  • Share best practices and knowledge
  • Mentor partners and providers
  • Share data and support analyses
  • Promote implementation of evidence-based interventions

Participant Categories

  • Healthcare Providers (Hospitals, Accountable Care Organizations (ACO), Skilled Nursing Facilities (SNF), Physician Practices, Home Health Agencies, Dialysis Facilities, Hospice Organizations, Palliative Care Organizations, etc.)
  • Provider Associations
  • Consumer Advocacy Organizations
  • Government Organizations (Health Department, Area Agency on Aging, etc.)
  • Quality Improvement Organizations
  • Educational Organizations
  • Professionals
  • Consumers
  • Funding Organizations
  • Academics

Coalition Participant Responsibility

Meeting Attendance

Coalition Members agree to attend in person or by teleconference a minimum of fifty (50) percent of scheduled meetings each year with not more than two (2) consecutive unexcused absences.


Coalition Members agree to actively participate in committee work, and are expected to volunteer their services for Coalition projects.

Annual Meeting

There shall be an Annual Meeting of the Coalition, at which time the Coalition will review membership, committee reports, develop annual goals, and other business.

Regular Meetings

Currently the Coalition will meet quarterly on the First Thursday in February, May, August, and November.  Meetings will alternate locations between Texas Presbyterian WNJ, TMC, Carrus, and TCOG. View Upcoming Meetings


No one may profit financially from membership in the Coalition by sales or solicitation at meetings or workshops. Participants will disclose any actual or potential conflicts of interest to QIO or other designee.

Decision Making

In the spirit of the Texoma Care Transition Coalition vision, all Coalition business shall be conducted based on the philosophy of mutual respect. Simple majority rules will apply. Coalition Participants are entitled to one vote per member.


Voting on the business of the Coalition may be conducted by those in attendance at the meeting either in person or by teleconference. Proxy voting via email is permissible.

Anticipated Outcomes

Improvements in Practice
  • Implement improvements to the patient care continuum process and practices resulting in higher quality of patient care, improved access to programs and services, and reduced unnecessary hospital readmissions, thus resulting in reduced costs and improved patient satisfaction
Reduction of Readmission Rates
  • Support our community’s hospitals in their efforts towards the partnership for patients goal of reducing hospital readmission rated by 20% within three years
Promotion of Best Practices
  • Share best practices and knowledge and promote implementation of evidence based interventions
Improved Communication
  • Improving communication between partners and providers by sharing data and support analysis with mutual respect for business-sensitive information.

Useful Documents

Texoma Care Transition Coalition Blog

Useful Links

Links for Risk Assessment for Hospitals

Yale Tool

Other Links

Area Agency on Aging of TexomaTMF QUI