Displaying 1 - 20 of 29

The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial

The reanalysis of a randomized control trial evaluating the effectiveness of a care management program finds increased linkages to ambulatory care.

Peer-Reviewed Article

December 2023

Community-Based Organization Services Evidence Bank

Curated collection of research studies highlights the efficacy of services provided by community-based organizations, with a focus on outcomes relevant to health care partners.

Website/Resource Center

August 2023

Scaling Primary Care Social Needs Screening and Referrals in New York City’s Safety-Net Health System

An overview of NYC Health + Hospital’s implementation of a primary care-based social needs screening and referral program, including key implementation challenges and success factors.

Case Example

June 2023

Community Health Worker Programs

Curates recent evidence behind community health worker programs that support people with complex health and social needs, as well as practical strategies to support effective implementation of these programs.

Collection

April 2023

Community Health Worker Model Best Practice Toolkit for Designing, Implementing and Showing Impact

Toolkit provides best practices and practical tools for designing, implementing, and evaluating the impact of community health workers.

Implementation Tool

March 2023

The Paramedic Will See You Now: Expanding Access to Community-Based Care for People with Complex Needs

Highlighted two community paramedicine programs in New England and rural North Carolina that serve people with complex needs.

Webinar

November 2022

Integrating Spiritual Care in Population Health and Care Management: Two Case Examples

Including spiritual care within care management programs in outpatient, managed care, and population health settings can enhance patient care and support the effectiveness of the interdisciplinary care team.

Case Example

September 2022

Factors Associated with Patient-Centered Medical Home Teams' Use of Resources for Identifying and Approaches for Managing Patients with Complex Needs

Nurses and members of fully staffed interdisciplinary care teams are more likely to use patient identification and care management tools.

Peer-Reviewed Article

July 2022

Defining Case Management Success: A Qualitative Study of Case Manager Perspectives from a Large-Scale Health and Social Needs Support Program

Case managers noted establishing trust, fostering mindset changes, and increasing stability and independence can be measures of success when working with people with complex needs.

Peer-Reviewed Article

June 2022

Impacts of Community-Based Care Program on Health Care Utilization and Cost

Community-based care management programs for patients with complex health and social needs have the potential to reduce hospitalizations and inpatient costs.

Peer-Reviewed Article

April 2022

Patient Perceptions of In-home Urgent Care via Mobile Integrated Health

Patients with complex needs were more satisfied with in-home urgent care delivered by community paramedics than with emergency department urgent care.

Peer-Reviewed Article

April 2022

Trends in Health Service Utilization After Enrollment in an Interdisciplinary Primary Care Clinic for Veterans with Addiction, Social Determinants of Health, or Other Vulnerabilities

Interdisciplinary primary care models can help reduce acute care use for individuals with histories of high emergency department use, homelessness, or substance use disorder.

Peer-Reviewed Article

February 2022

Details of Developing and Implementing an Intensive Interdisciplinary Care Program for High Need, High Cost Patients

Case study of interdisciplinary primary care program for high-risk patients based at an academic health system offers lessons on program design and implementation.

Case Example

June 2021

Community Health Worker Interventions for Older Adults with Complex Health Needs: A Systematic Review

Community health worker-led interventions for older adults with complex needs show evidence of improving participant mood and functional outcomes.

Peer-Reviewed Article

January 2021

Core Competencies for Frontline Complex Care Providers

Describes core competencies that convey the essential knowledge, skills, and attitudes of complex care practitioners and teams to improve care for people with complex needs.

Brief/Report

October 2020

Rural Community Paramedicine Toolkit

Toolkit offers health care stakeholders in rural areas with practical information to support the design, implementation, and evaluation of community paramedicine programs.

Implementation Tool

June 2020

Impact of Complex Care Management on Spending and Utilization for High-Need, High-Cost Medicaid Patients

Complex care management program for high-need, high-cost Medicaid patients demonstrates substantially lower spending and inpatient utilization.

Peer-Reviewed Article

February 2020

Integrating Community Health Workers on Quality Improvement Teams: Lessons from the Field

Tips on integrating community health workers into quality improvement teams to address patients’ social needs.

Implementation Tool

January 2020

A Novel Intervention for High-Need, High-Cost Patients: A Study of ECHO Care

Providing virtual case mentoring to outpatient care teams may reduce unnecessary hospital and emergency department visits for high-need, high-cost patients.

Peer-Reviewed Article

January 2020

ECHO Care: Providing Multidisciplinary Specialty Expertise to Support the Care of Complex Patients

Connecting complex care teams with specialists through videoconferencing can increase their effectiveness in caring for high-need high-cost patients.

Peer-Reviewed Article

January 2020

All Resources

Topics

Populations

Audiences

Content Types

State

The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial

Community-Based Organization Services Evidence Bank

Scaling Primary Care Social Needs Screening and Referrals in New York City’s Safety-Net Health System

Community Health Worker Programs

Community Health Worker Model Best Practice Toolkit for Designing, Implementing and Showing Impact

The Paramedic Will See You Now: Expanding Access to Community-Based Care for People with Complex Needs

Integrating Spiritual Care in Population Health and Care Management: Two Case Examples

Factors Associated with Patient-Centered Medical Home Teams' Use of Resources for Identifying and Approaches for Managing Patients with Complex Needs

Defining Case Management Success: A Qualitative Study of Case Manager Perspectives from a Large-Scale Health and Social Needs Support Program

Impacts of Community-Based Care Program on Health Care Utilization and Cost

Patient Perceptions of In-home Urgent Care via Mobile Integrated Health

Trends in Health Service Utilization After Enrollment in an Interdisciplinary Primary Care Clinic for Veterans with Addiction, Social Determinants of Health, or Other Vulnerabilities

Details of Developing and Implementing an Intensive Interdisciplinary Care Program for High Need, High Cost Patients

Community Health Worker Interventions for Older Adults with Complex Health Needs: A Systematic Review

Core Competencies for Frontline Complex Care Providers

Rural Community Paramedicine Toolkit

Impact of Complex Care Management on Spending and Utilization for High-Need, High-Cost Medicaid Patients

Integrating Community Health Workers on Quality Improvement Teams: Lessons from the Field

A Novel Intervention for High-Need, High-Cost Patients: A Study of ECHO Care

ECHO Care: Providing Multidisciplinary Specialty Expertise to Support the Care of Complex Patients