Resources

A telephone-based social needs screening, referral, and navigation program that focused on patients with predicted high utilization within the Kaiser Permanente Southern Cal

Providing supportive housing for individuals experiencing homelessness who are identified as active substance users resulted in lower rates of SUD-related ED visits and hosp

This resource describes a quasi-experimental study evaluating the effect of a transitional care program that involved rapid primary care follow-up

This resource describes a new model that moves high-need patients out of the emergency department and into a network of social supports.

This resource describes the Great Plains Senior Services Collaborative, an initiative to improve health and quality of life for rural seniors.

This resource describes and evaluates a new specialist pharmacy service, called the integrated care clinical pharmacist.

At Northwestern Medical Group in Chicago, a patient-centered transitional care intervention serving patients with complex health needs that lack a usual source of care was f

This resource highlights a variety of prevention-focused programs, initiatives and strategies (plays) focused on the opioid use epidemic.

This resource is a toolkit to help payers and providers understand how home-based primary care (HBPC) improves quality and reduces costs for seriously ill and home-limited o

This resource identifies challenges faced by older adults from racial and ethnic minorities, and proposes several strategies to address them.

This resource provides an example of an approach to caring for different subpopulations of people with dementia. 

This resource describes a randomized controlled trial to evaluate the effects of a case management intervention called V1SAGES (Vulnerable Patients in Primary Care: Nurse Ca