Care management processes
Ethica Health and Retirement Communities developed a falls management program, the cornerstone of which is an interdisciplinary “falls team” at each nursing home that regularly assesses residents for risk of falling and develops intervention plans for those found at high risk.
Transitions coaches encourage recently hospitalized Medicare patients with complex care needs to assert a more active role in their posthospital care, leading to fewer readmissions and lower costs.
Community partnerships and provider training increase service capacity and access to long-term treatment for individuals addicted to heroin.
Multidisciplinary teams implemented a comprehensive medication reconciliation program for patient admissions, transfers, and discharge to significantly improve the reconciliation process.
A game to educate health care workers in intensive care units about appropriate hand hygiene increased awareness of and adherence to hand hygiene protocols at a major academic medical center, leading to increased compliance with appropriate hand hygiene protocols from 37 to 53 percent.
As part of a statewide collaborative, hospital-based multidisciplinary teams developed and implemented projects aimed at improving adherence to a set of standardized, evidence-based protocols for the management of acute stroke.
Sentara Healthcare launched a program designed to create a strong culture of safety. The initiative includes an assessment of the existing safety culture, establishment of goals related to improved safety, the development of specific strategies to identify and correct safety problems, and the use of ongoing processes and systems to monitor progress and encourage continued improvement.
A multipronged strategy involving ties between hand hygiene performance and compensation systems, adoption and constant reinforcement of clear hand hygiene protocols, a comprehensive auditing program to review hand hygiene adherence, and other program elements improved adherence to appropriate hand hygiene protocols.
An organizational transformation focused on patient- and family-centered care leads to consistently high levels of patient satisfaction.
A comprehensive medical team training program supported by crew resource management principles adopted from the aviation industry was developed and implemented in 79 Veterans Affairs Medical Centers, resulting in a measurable improvement in communication and patient care in 10 participating facilities that have at least a year's experience with the program.