The health department in New York City uses subsidies, upfront and ongoing technical support, and quality of care feedback to promote implementation and use of electronic health records by primary care practices in medically underserved areas, leading to better care for patients in these practices.
The Children's Healthcare Access Program offers financial incentives and support services to primary care medical homes serving children covered by Medicaid and their families; the program enhanced access to primary care, increased the percentage of children with asthma action plans, reduced emergency department visits and hospital admissions, increased well-child visits, and reduced costs.
A rural medical practice redesigned its care processes to allow multidisciplinary care teams to use a new electronic health record system that features real-time documentation and information sharing and various tools to facilitate the provision of appropriate care, leading to significant improvements in screening rates and high satisfaction for medically underserved patients in Alaska.
Nurse case managers at a Veterans Affairs hospital provide inhospital and post-discharge, telephone-based support to at-risk, community-dwelling patients and their caregivers, leading to better care transitions, fewer readmissions, and substantial cost savings.
A behavioral health clinic maintains an onsite primary care clinic that provides culturally competent care to low-income Asian Americans with serious mental illness, enhancing access to such care and facilitating modest improvements in physical health.
A hospice offered a dedicated care team trained in culture-specific end-of-life concerns to Hispanic patients and families, and conducted targeted marketing and outreach to Hispanics in the community, leading to greater awareness and acceptance of hospice services.
A State-based, public–private partnership supports quality improvement in pediatric practices, leading to greater adherence to evidence-based care and improved care coordination for children and adolescents, and to higher staff satisfaction in participating practices, and highly rated quality of care for children.
A comprehensive, multi-stakeholder program combines training and higher reimbursement for dental providers with outreach, education, and support to families, leading to enhanced access to dental care, less tooth decay, and lower dental care costs for young, low-income children.
A State-based, public–private partnership adapted its successful primary care medical home model to serve pregnant Medicaid beneficiaries, leading to enhanced access to comprehensive prenatal care (including intensive case management for high-risk pregnancies), better adherence to evidence-based care standards, and reductions in low–birth weight babies and rate of primary Cesarean sections.
A traveling team of certified diabetes educators (including a nurse, pharmacist, and dietitian) regularly visits rural clinics to help coordinate diabetes care with clinicians and educate and coach African-American patients with diabetes, leading to improved glycemic control and the potential for meaningful cost savings.