Care management processes
This toolkit has been designed for patient-centered medical homes aiming to transform how their clinics manage patient referrals and transitions, and its goal is to provide clinical practice resources to support coordinated care. The toolkit introduces four key concepts for enabling change, and offers activities, tools, and case studies to support their implementation.
The toolkit is divided into the following sections:
- The care coordination...
This Web site provides a collection of free, research-based physical education (PE) lesson plans for physical educators and classroom teachers. These lesson plans are based on research supported by the Heart, Lung, and Blood Institute of the National Institutes of Health, and are designed to be more inclusive, active, and fun than traditional PE classes.
Sample lesson plans are available for:
- Early childhood physical activity
- Elementary physical education...
The On-Time Quality Improvement program is a practical approach to quality improvement (QI) in long-term care, embedding QI strategies and best practices into health information technology. This manual is an introduction to the On-Time QI approach. It provides an overview of the tools and process improvements and describes the implementation process. Target users are stakeholders interested in nursing home QI, nursing home leaders responsible for deciding QI priorities, and nursing home...
This series of free, interactive courses provide Healthcare Cost and Utilization Project (HCUP) data users with information about HCUP data and tools, and training on technical methods for conducting research with HCUP data. The online courses are modular, so users can either move through an entire course, or access sections that interest them the most.
The courses include the following:
- HCUP overview course
- Load and check HCUP data
This manual introduces concepts about evidence-based practices to practicing clinicians, behavioral health program leaders, and consumers and families. It provides information, suggests ways of thinking and getting started, and points to additional resources as evolving evidence-based practices become a routine part of service delivery and management.
This second edition is built on the authors’ past experience; the current state of evidence-based practice implementation; feedback...
This tool for physicians and clinical staff provides education surrounding patient/provider communication about medication use and adherence during a visit. It includes an executive summary of the most up-to-date information on delivering preventive services to patients in the context of a clinical visit. It also includes a clinical reference document that provides the evidence to support the tool.
The tool is accompanied by a patient guide that may be shared during a clinic visit and...
This form can help correctional health care professionals effectively manage diseases commonly found in jails, prisons, and juvenile confinement facilities. It is used to follow a patient with a single or multiple chronic diseases. The sheet documents the chronic disease(s) for which the patient is being followed, as well as medications, symptoms, immunizations, test results, and more.
NKEplus is a build on the original Nurse Knowledge Exchange (NKE) designed in 2004. This communication system for nursing units in hospitals supports better care and safety for patients and staff. The tools incorporate strategies to manage bedside care, shift change, and distractions to increase quality of care for all parties. The system, used by the project manager/improvement adviser and unit staff, is adaptable to various stages of care and used when needed within the unit.
This is a communication program for health care provider teams to improve patient care by enhancing interaction and exchange of information when providing care. The references and learning materials can be applied in various health care settings to improve patient outcomes through more effective communication and teamwork.
The Massachusetts Child Psychiatry Access Project (MCPAP) is a system of regional children's mental health consultation teams designed to help primary care providers (PCPs) meet the needs of children with psychiatric problems.
Some of the MassHealth-approved screening tools for children younger than 21 are:
- Primary Care Behavioral Health Toolkit
- CRAFFT Toolkit
- Diagnosis specific screens for:
- Attention Deficit Hyperactivity Disorder