Referrals

Innovations

Family-Oriented Program Combines Medical Care and Behavioral Counseling, Leading to Health Improvements in Obese Children and Adolescents 10/17/08

Through a 1-year program combining medical care with behavioral counseling and practical strategies, a multidisciplinary team of professionals meets with families on an ongoing basis to emphasize good health habits and address a spectrum of lifestyle issues related to pediatric obesity and its complications.

Family Violence Prevention Program Significantly Improves Ability to Identify and Facilitate Treatment for Patients Affected by Domestic Violence 10/02/08

Kaiser Permanente Northern California's Family Violence Prevention Program seeks to improve the identification, prevention, and treatment of domestic violence through a coordinated “systems model” approach, which includes a supportive environment that encourages disclosure of domestic violence to providers, routine screening of high-risk patients, referrals to onsite and community mental health services, and linkages to community resources.

Nurse-Led Program Increases Provision of Cessation Counseling to Inpatients Who Smoke 09/24/08

With support from a unit-based nurse champion, stroke unit nurses encourage inpatient smokers to quit through bedside counseling, referral to an outpatient counseling program, and followup with the primary care provider.

Postdischarge Telephone Followup With Chronic Disease Patients Reduces Hospitalizations, Emergency Department Visits, and Costs 09/11/08

A chronic care coordination program employs coordinators to provide telephone-based support to recently discharged patients and other high-risk enrollees, leading to fewer hospitalizations and emergency department visits and lower costs.

Hospital Collaborative-Inspired Improvements in Donation and Procurement Processes Lead to Increase in Organ Donors 09/05/08

As part of a collaborative with other hospitals, a health system developed multiple strategies to improve the organ donation request and procurement process, leading to a high conversion rate (the percentage of potential donors who become actual donors); collaborative participants as a group experienced a marked rise in conversion rates and donors.

Culturally Competent Community Health Workers Improve Outcomes and Reduce Inpatient Utilization Among Inner-City HIV/AIDS Patients 09/05/08

The Prevention and Access to Care and Treatment project uses specially trained community health workers to deliver culturally competent, home-based support services to help HIV-positive patients in the inner city.

Parent Consultants Help Families Who Have Children With Special Needs Access Needed Services, Leading to Lower Health Care Utilization and Costs 09/04/08

The Pediatric Practice Enhancement Project places parent consultants in primary care practices to help families with special needs children navigate the health care system and access community-based psychosocial and financial services.

Urban Clinic Provides Free, Bilingual Primary and Specialty Care to the Uninsured and Underserved of Miami-Dade County 09/03/08

The St. John Bosco Clinic provides free, bilingual primary and specialty care, referrals, and patient education to Hispanic immigrants who are generally poor, undocumented, and uninsured.

Provider Team Offers Services and Referrals to Frequent Emergency Department Users in Inner City, Leading to Anecdotal Reports of Lower Utilization 08/25/08

Teams of providers proactively visit homes, shelters, and the streets to locate frequent emergency department visitors and provide them with preventive care and other social services.

Community Referral Liaisons Help Patients Reduce Risky Health Behaviors, Leading to Improvements in Health Status 08/11/08

A community health educator referral liaison receives physician referrals of patients with risky health behaviors; the liaison links patients with community resources, offers counseling and encouragement over the telephone, and provides feedback to the physicians.

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