A primary care medical home for patients with disabilities and complex, chronic medical conditions emphasizes patient engagement and care coordination among medical specialties and social service providers, leading to enhanced access to care, better self-management skills, more days of good health, fewer hospitalizations, and lower costs.
As an alternative to inpatient care, an outpatient center located within a hospital with a stroke center evaluates stable patients who have experienced a recent transient ischemic attack, leading to more timely and comprehensive care, and to significant cost savings through the avoidance of unnecessary admissions.
Pharmacy residents complete one 24-hour shift at a hospital approximately every 2 weeks, providing an array of services, including consultations and assistance with emergency situations; the program has led to low dosing error rates and to high levels of adherence to recommended guidelines for emergency stroke patients and has helped to produce more confident, capable pharmacists.
A comprehensive initiative to improve stroke care features protocols to facilitate faster evaluation and diagnosis, quick administration of tissue plasminogen activator when indicated, 24-hour access to a neurologist, enhanced discharge planning, improved documentation and data collection, continuous staff training, and community outreach, leading to more timely administration of appropriate diagnostic tests and treatment and to many more eligible patients receiving tissue plasminogen activator.
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.
The Michigan Stroke Network provides on-demand remote consultations to emergency department physicians in 30 hospitals and one freestanding emergency department throughout Michigan. These consultations provide the physicians with access to stroke care specialists within 12 to 15 minutes of the physician making a telephone call.
An interdisciplinary care management program that integrates medical and social care for low-income elderly patients with chronic illnesses reduces care costs and improves self-reported health status.