Chronic care

Innovations

Specially Trained Paramedics Respond to Nonemergency 911 Calls and Proactively Care for Frequent Callers, Reducing Inappropriate Use of Emergency Services 12/19/14

Community Health Access Program helps patients who call 911with nonemergent needs. The dispatcher sends a specially trained paramedic, known as an advanced practice paramedic, to the scene along with the ambulance to confirm that the patient does not need emergency care and then either provide treatment, schedule an appointment with a primary care provider, or arrange for same-day transport to a health resource center.

Home Telemonitoring Does Not Improve Blood Pressure or Glycemic Control in Diabetes Patients 11/06/14

Home telemonitoring did not improve blood pressure or blood glucose control in diabetes patients with out-of-range values.

Health System–Community Partnership Expands Access to Insurance Coverage, Outpatient Care, Health Education, and Social Support in Low-Income, Minority Communities 11/05/14

A health system–community partnership offers resident-initiated programs that expand access to insurance coverage, outpatient care, health education, social support, healthy foods, and opportunities for physical activity for inner-city, low-income minorities.

Regional Commission Made Up of Diverse Stakeholders Enhances Access to Coverage and Services for Low-Income Residents, Reducing Readmissions and Emergency Department Visits 11/04/14

A regional health commission made up of a diverse group of stakeholders promotes various activities and policies to support the safety-net health system, enhancing access to coverage, medical and dental care, and medical homes, and reducing readmissions and inappropriate use of the emergency department.

Culturally Tailored Chronic Disease Education Program Improves African American Patients' Self-Management Behaviors, Blood Pressure and Blood Glucose Control, and Quality of Life 09/17/14

This culturally tailored program educates minority populations with diabetes, hypertension, or overweight/obesity about appropriate management of these conditions.

Trained Peers Educate and Support Veterans in Self-Management of Hypertension, Leading to Improved Blood Pressure and Weight Loss 09/17/14

Trained peers educate and support veterans in managing their blood pressure during regularly scheduled monthly meetings at Veterans Service Organization posts.

Daily Text Messages and Nurse Followup Improve Self-Management Behaviors in Patients with Diabetes, Leading to Better Glycemic Control and Lower Costs 04/28/14

Daily automated text messages combined with nurse followup improved self-management behaviors among patients with diabetes, leading to significant improvements in glycemic control, fewer doctor visits, lower costs, and high patient satisfaction.

Managed Care Entity Funded By Public Agencies Reduces Institutionalization and Recidivism, and Improves School Attendance and Functional Ability Among Emotionally Disturbed Youth 03/30/14

Funded by and receiving referrals from the various public systems serving at-risk youth, Wraparound Milwaukee pays for and supports the provision of coordinated mental health and support services to children and adolescents with serious emotional and mental health needs, leading to less institutionalization and recidivism, lower costs, increased school attendance, better functioning at home and in school, and high satisfaction.

Community Health Workers Embedded in Inpatient and Outpatient Clinical Teams Enhance Access to Primary Care and Improve Health Outcomes for Low-Income Patients 03/13/14

Community health workers embedded in clinical teams in medical offices and hospitals support low-income patients in setting and achieving health-related goals and accessing needed medical and community-based services, leading to better communication and access to postdischarge primary care, increased patient activation, fewer readmissions and depression-related symptoms, and positive feedback from patients.

State Provides Financial and Technical Support to Underserved Communities Designated as Health Enterprise Zones, Leading to Enhancements in Primary Care Capacity 03/11/14

The State of Maryland provides financial and technical support to five communities designated through a competitive bidding process as health enterprise zones, leading to an expansion of primary care capacity in these areas.

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