Case management combined with in-home environmental assessment and remediation of environmental triggers reduce asthma-related hospitalizations, emergency department visits, missed school days, and missed parent work days in diverse, low-income urban children with asthma.
Onsite care coordination and support of seniors in affordable housing community leads to fewer falls, reduced hospital admissions, improved nutritional status, and increased levels of physical activity, promoting seniors' ability to remain in their homes as they age.
A Web-based registry assists primary care physicians, pediatricians, and school nurses in managing childhood asthma, leading to significant reductions in inpatient admissions and emergency department visits.
A rehabilitation center's recuperative services unit uses a three-part protocol consisting of standardized assessments, palliative care consults and care plans, and root-cause analysis to reduce readmissions and improve staff morale.
Community-based clinic enhances access to medical care and reduces emergency department visits for chronically ill individuals who have recently been released from prison.
A collaborative telemedicine program between a hospital and 10 nursing homes in rural communities prevents unnecessary transports of residents to the emergency department.
Hospital case managers telephone skilled nursing facility nurses within 48 hours of each heart failure patient's discharge to verify that appropriate care management is being provided, leading to a significant reduction in readmissions and associated cost savings.
A hospital-based program for young victims of penetrating trauma identifies those at risk of future violence, educates them about the need to change behaviors to reduce those risks, and connects them to community-based organizations that can help them in doing so, leading to fewer repeat episodes.
A collaborative medication review process involving physicians, nurses, and pharmacists virtually eliminates medication errors and significantly reduces readmissions in patients discharged to a nursing home.
A Sickle Cell Day Hospital provides an alternative to inpatient care for patients with sickle cell anemia, with the goal of managing their pain and keeping them out of the hospital, resulting in lower inpatient lengths of stay and emergency department utilization.