Comprehensive report on patient outcomes and implementation information from national hospital at home initiative.

A machine learning model helped identify primary care patients with major depression who are at high risk of frequent emergency department use and might benefit from collaborative care management.

Mixed outcomes for hospital at home services implemented for North Carolina Medicaid enrollees.

Nurse assessments of discharge readiness for older patients with multiple chronic conditions can help identify patients at high risk for hospital readmission.

Preliminary analysis shows that mortality and readmission rates for disabled and Medicare-Medicaid dually eligible individuals receiving hospital at home services are similar to outcomes for overall Medicare population.

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

A primary care-based integrated care team supports patients with type 1 or type 2 diabetes in reducing A1c levels.

Multidisciplinary integrated practice units may have a greater impact on acute care utilization by focusing on patients who have high utilization of emergency departments and are uninsured.

Secondary analysis of Camden Coalition randomized controlled data found that care management participants who were the most likely to engage with the intervention had significantly lower readmission rates.

An interdisciplinary care management program for Medicare patients at increased risk of hospitalization demonstrates a positive return on investment.

Randomized controlled trial shows that a collaborative dementia care model leads to reduction in costs among a sample of Medicare patients.

An interdisciplinary home-based primary care program for older adults with limited mobility leads to reductions in health care utilization and costs.

Peer recovery coaches in emergency departments (ED) decreased subsequent ED utilization for patients with substance use disorders.

Care coordination services in primary care clinics are shown to reduce avoidable hospitalizations among persons living with dementia.

Insights from patient-level encounter histories can support optimizing care coordination team staffing for high-need patients.

Implementation of a high-dose care management intervention for patients with complex health and social needs can reduce hospitalization rates.

Randomized controlled trial measuring the impact of a community paramedicine model implemented in two rural counties shows reduction in emergency department visits.

Barriers to community social services to address health-related social needs persist despite screening and referral programs in clinical settings.

Screening, brief intervention, and referral to treatment combined with recovery management checkups can connect primary care patients to substance use disorder treatment.

Randomized controlled trial of a person-centered housing intervention for older adults shows improved health outcomes for formerly homeless adults living in permanent supportive housing.