Comprehensive Screening, Guideline-Based Treatment, and Self-Management Support Enhanced Access to Asthma Care, Reduced Hospitalizations and Costs
The Urban Health Plan Asthma Relief Street program provides standardized, comprehensive asthma screening, guideline-based treatment, education, and self-management support, leading to more people being diagnosed and treated, fewer hospitalizations, and overall cost savings.
Disease Management Programs Improve Adherence to Evidence-Based Processes and Outcomes by Targeting Sickest Patients and Working Closely With Physicians
A hospital-based outpatient disease management program serves patients with asthma, chronic heart failure, and diabetes and offers smoking cessation services to smokers. Unlike traditional disease management programs, this initiative heavily involves physicians in the initial referral and throughout the process and targets services toward the sickest patients (rather than to all patients with the condition).
Hospital–Community Organization Partnership Uses Culturally Competent Community Health Workers To Support Latino Families With Asthmatic Children, Reducing Hospitalizations and Emergency Department Visits
In a partnership between a hospital and four community-based organizations, bilingual community health workers help low-income, predominantly Latino families with asthmatic children better manage the disease, leading to fewer asthma-related symptoms, hospitalizations, emergency department visits, and missed school days.
Insurer Provides Financial Incentives, Infrastructure, and Other Support To Stimulate Provider Participation in Quality Improvement Collaborations
A large insurer offers financial incentives and other support to provider-led quality improvement collaborations, leading to high levels of provider participation, higher quality, lower costs, and a positive return on investment.
Medical "Extensivists" Care for High-Acuity Patients Across Settings, Leading to Reduced Hospital Use
A Medicare Advantage plan uses employed "extensivists" who perform traditional hospitalist functions for a smaller-than-average caseload of patients, and then continue to follow and care for these patients after discharge until their condition becomes stabilized, leading to low length of stay and fewer readmissions.
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Managing Drug-Seeking Behaviors & Super Users in the Emergency Department
This guide for emergency department (ED) physicians, nurses, and caregivers includes information and tools for providing pain management care to drug "super users" in the ED.
Medical Respite Tool Kit
The purpose of the Medical Respite Tool Kit is to provide information and tools to help organizations and advocates plan, develop, and sustain medical respite programs. This tool organizes existing resources developed by the National Health Care for the Homeless Council and other medical respite providers while incorporating new and practical tools.
Improving Treatment Decisions for Patients With Community-Acquired Pneumonia
This report describes two tools developed by the Agency for Healthcare Research and Quality (AHRQ) funded research that help assess the need for hospitalization of patients with community-acquired pneumonia (CAP) and determine the medical stability of patients prior to discharge.
Coordinated-Transitional Care Toolkit
The goal of this toolkit is to help hospital systems that serve populations with high rates of patient dispersion, cognitive impairment, and vulnerability improve care coordination and postdischarge outcomes such as reduced medication discrepancies.
Interventions to Reduce Acute Care Transfers (INTERACT) Tools
INTERACT is a quality improvement program designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities. The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital.