Resources

This resource builds on the seminal Home Alone study, the first national examination at how family caregivers manage medical and nursing tasks. Major findings of this new study include: Today’s...
This resource is a series of four videos (each roughly 12 minutes long) about how to transform care for people with involved disabilities according to the “independent living” model. The first video...
This resource, the Partnership Evaluation Tool, is intended to help organizations assess readiness to engage in successful value-based partnerships. It can be used to assess potential partners or for...
This resource provides an overview of a quality-improvement intervention focused on communication with patients with advanced cancer. High-quality conversations between clinicians and seriously ill...
This resource describes the 7-Day Pledge program to reduce readmissions by increasing access to timely primary care appointments after hospitalization. Previous research suggests the important role of...
This resource offers a variety of materials about “personas” for different segments of the high-need patient population. A persona helps depict the experiences, motivations, and goals of a group of...
Based on a review of the evidence, the Quick Reference Guide to Promising Care Models offers summary information on 28 programs for adults with complex needs, specifically: Target population and...
This resource evaluates the impact of an interprofessional case conference approach in an academic primary care clinic. This study was conducted at a primary care clinic at a VA medical center. The...
This resource provides an evaluation of a health system’s outpatient complex case management (OPCM) program and examines whether OPCM lowers service utilization and health care costs. U.S. health...
This resource assesses the characteristics and health care utilization of high-cost patients and compares high-cost patients across payers and countries, based on a systematic review of studies in...
This resource identifies features of intensive outpatient programs that increase patient engagement. Program leaders and clinicians from 12 intensive outpatient programs responded to a questionnaire...
This resource describes how HBPC practices assess the non-medical social needs of older adults who are homebound and identifies barriers to coordinating home and community-based services (HCBS) for...