In Support of Family Caregivers: A Snapshot of Five States
Family caregivers are an integral part of health care and the economy, and they need states’ support.
Brief/Report
All Resources
Topics
Populations
Audiences
Content Types
State
Topics
Populations
Audiences
Content Types
State
Displaying 141 - 160 of 171
Time and Effort in Care Coordination for Patients with Complex Health and Social Needs: Lessons From a Community-Based Intervention
Staff time effort in complex care coordination programs is highly variable depending on patients’ health and social needs.
Peer-Reviewed Article
Serious Illness Approaches by ACOs: Facey Medical Group
This case study analyzes a successful example of a medical group partnering with a home health agency to provide community-based palliative care for high-risk members of their accountable care organization.
Case Example
Tools to Support Hospital-Based Addiction Care: Core Components, Values, and Activities of the Improving Addiction Care Team
Details the main elements of a hospital-based addiction care consultation team.
Case Example
The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience
Care model that integrates home-based primary care and palliative care for patients with serious illness reports reduced health care utilization and improved patient care experience.
Peer-Reviewed Article
Integrating Nurses into Complex Care Teams
Explored how nurses can be integrated into complex care teams. This interactive online discussion provided opportunities to share ideas and ask questions.
Webinar
Dedicated to the Mission: Strategies US Department of Veterans Affairs Home-Based Primary Care Teams Apply to Keep Veterans at Home
Fostering a culture of caring for veterans takes interdisciplinary teams focused on comprehensive, trusting and reliable relationships through open and frequent communication and ongoing education.
Peer-Reviewed Article
Integrating Social Workers Into Primary Care Teams
Outlines key opportunities for integrating social workers through a standardized approach derived from evidence-based and promising practices.
Play
October 2018
Geisinger Health System Deploys Community Health Workers to Address Social Determinants of Health
Looks at how the Keystone ACO partnership, serving residents of 41 primarily rural Pennsylvania counties as well as parts of New York, New Jersey and Maryland, is using community health workers to improve the quality and cultural competence of service delivery.
Blog
October 2018
A New Hospitalist Model for Managing High-Cost, High-Need Patients
A hospitalist model for complex care.
Case Example
Are Social Workers Missing from Your Complex Care Teams?
Many studies have highlighted the importance of effective interprofessional care teams to improve health outcomes for people with complex needs. But many programs do not take advantage of the special training of social workers to meet these needs on their primary health care teams.
Blog
June 2018
Impact of a Complex Chronic Care Patient Case Conference on Quality and Utilization
The case conference approach to caring for complex patients.
Peer-Reviewed Article
Integrate Health Coaches into the Care Team
Health coaching can play an especially important role for patients with complex needs, who may struggle to manage multiple conditions, multiple providers, and services outside the health system.
Play
February 2018
Define the Care Management Team
Outlines how to develop a care team that can help control costs by allowing medical providers to work to the top of their license.
Play
November 2017
Community Health Worker Support for Disadvantaged Patients with Multiple Chronic Diseases: A Randomized Clinical Trial
This resource describes the benefits of community health workers for people with multiple chronic conditions.
Peer-Reviewed Article
Compendium of Five Case Studies: Lessons for Interprofessional Teamwork
The VA shares lessons on workforce learning and development.
Brief/Report
Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats
How to improve the cost benefits of case management.
Peer-Reviewed Article
Diffusion of Community Health Workers Within Medicaid Managed Care: A Strategy to Address Social Determinants of Health
New Mexico’s model to deploy community health workers is now replicated in 12 states.
Case Example
The Cost-Effectiveness of Clinical Nurse Specialist–Led Interventions in Palliative Care
Clinical Nurse Specialists are playing a greater role in palliative care, but evidence on their cost-effectiveness is mixed.
Peer-Reviewed Article
Innovative Home Visit Models Associated with Reductions in Costs, Hospitalizations, and Emergency Department Use
Home visits can reach patients with complex needs before a higher level of care is needed
Peer-Reviewed Article