Summa Health System's Care Coordination Network strives to ensure smooth transitions between the hospitals and 40 local skilled nursing facilities, leading to fewer readmissions and lower length of stay in the hospital.
Due to the high prevalence of osteoporosis in nursing homes, researchers from the Duke University Center for Aging and Human Development and four other organizations developed and tested a program for fracture and fall prevention for nursing home residents based on established clinical practice guidelines for osteoporosis.
The On-Time Pressure Ulcer Prevention and Treatment program uses standardized documentation data elements and actionable clinical reports that are integrated into practice at nursing homes, leading to a significant reduction in pressure ulcer rates.
The Payne-Phalen Living at Home/Block Nurse Program is a community-based program that provides medical and social services to neighborhood seniors, enabling them to live at home rather than in a nursing home.
The Timeslips program uses group storytelling to enhance the lives of people with Alzheimer's disease and related dementia.
The Hospital Elder Life Program screens all patients aged 70 years and older at admission for the presence of six risk factors for delirium, and then implements targeted interventions to reduce these risks, leading to less cognitive and functional decline and lower costs.
Meadowlark Hills, a retirement community, renovated one of its facilities so residents can live together in group households and become more independent. This led to improved residents' health and a sharp decrease in staff turnover.
Providence Mount St. Vincent (known as “The Mount”) developed and implemented a new model for nursing home care in which most residents live in a “neighborhood” of 20 to 23 residents; neighborhoods contain a cluster of private and semiprivate rooms and a large kitchen/dining area that serves as the central gathering spot for meals and activities. The Mount's approach also focuses on giving residents more independence, autonomy, and dignity than in a traditional nursing home, leading to a greater sense of community and a higher quality of life for residents, as well as a better work environment for employees.
A pediatric center provides comprehensive, coordinated services within a primary care medical home for low-income and immigrant children with special health care needs.
Guided by a university research team, a 136-bed, not-for-profit nursing home in Pennsylvania implemented a quality improvement program to reduce pressure ulcer incidence. The program included three components: education and tools to increase workers' ability to recognize and prevent pressure ulcers; financial incentives for improved performance; and ongoing performance feedback.