Training, knowledge management
Regulations from the New York State Office of Alcoholism and Substance Abuse Services mandated that all substance abuse treatment facilities in the state become tobacco free and integrate smoking cessation education and therapy into the treatment of other addictions. The regulation resulted in increased access to cessation services and reduced smoking rates among patients and staff as well as some cost savings.
As mandated by State law, the California Department of Health Services requires acute care hospitals to maintain minimum nurse-to-patient staffing ratios and to develop various systems to ensure adequate nurse coverage and quality, leading to more reasonable workloads, lower patient mortality, and higher job satisfaction.
A statewide consortium of community health workers, public agencies, and nonprofits aimed to reduce health disparities by developing a standardized scope of practice, creating a training and certificate program and a stable funding strategy to secure reimbursement from Medicaid. Their work resulted in greater integration for these workers in the health care work force.
A statewide, multipayer pilot program provides technical and financial support to physician practices interested in becoming patient-centered medical homes, leading to all participating practices being recognized as medical homes and to anecdotal reports of better access and higher quality.
Specially trained and certified lay workers known as “Grand-Aides” use illness-specific protocols to ensure that patients receive appropriate treatment in primary care settings and to ease the transition from hospital to home after discharge. The primary care-based program has reduced unnecessary visits and demonstrated the potential to reduce costs. Early data from one hospital program show significant reductions in readmissions.
A medical center uses a standard protocol to improve collection of racial, ethnic, and language data from patients, leading to better interpretation services for patients with limited English proficiency and to more consistent, higher quality care for cardiac patients.
As required by law, hospitals in New York track and report information on select hospital-acquired infections to the State Department of Health, which publicly releases hospital-specific performance data and supports hospitals with quality improvement initiatives; the program has reduced infection rates and generated substantial cost savings.
A partnership among a periodontist, hospitals, state-funded health clinics, and area dentists enhances access to comprehensive dental care and education about oral hygiene to thousands of low-income pregnant women.
Kaiser Permanente Colorado and the Visiting Nurse Association in Denver jointly offer intense, consistent education to elderly heart failure patients discharged from the hospital in need of home-based skilled nursing care, leading to improved knowledge and self-management skills and fewer readmissions.
Emergency department–based case managers at nine Milwaukee hospitals use electronic technologies to schedule and track attendance at follow-up clinic appointments for low-income, uninsured patients who come to the emergency department with nonurgent needs, allowing many such patients to establish a medical home.