Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients
This brief describes new ways for health care to address social determinants of health.
Brief/Report
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Displaying 461 - 480 of 532
Leveraging the Social Determinants of Health: What Works?
This literature review assesses the impact of social service interventions.
Peer-Reviewed Article
What Works in Integrated Care Programs for Older Adults with Complex Needs? A Realist Review
A literature review describes the most important success factors for integrated care programs.
Peer-Reviewed Article
The CHRONIC Care Act of 2018: Advancing Care for Adults with Complex Needs
A brief summarizes what you need to know about the new Chronic Care Act.
Brief/Report
Compendium of Five Case Studies: Lessons for Interprofessional Teamwork
The VA shares lessons on workforce learning and development.
Brief/Report
Laying the Groundwork for Trauma-Informed Care
How organizations can transition to trauma-informed care.
Brief/Report
Restoring Dignity for Vulnerable Populations: Changing the System for Complex Patients
The benefits of holistic, team-based care go beyond medical needs.
Case Example
The Case for Hospital Palliative Care
Palliative care is appropriate at any stage of illness and can be provided alongside curative treatment.
Brief/Report
Accountable Care Atlas: A Development Guide for Competency Implementation
This resources describes the competencies organizations need to transition to value-based payment.
Implementation Tool
Competing Health Care Systems and Complex Patients: An Inter-Professional Collaboration
This paper describes competing health care systems can collaborate to improve care for overlapping patient populations.
Peer-Reviewed Article
Complex Care Models to Achieve Accountable Care Readiness: Lessons from Two Community Hospitals
Case studies of two community hospitals show how to advance accountable care.
Case Example
Interventions for Patients with Multimorbidity in Primary Care and Community Settings
A review of the evidence suggests it's difficult to improve outcomes for people with multimorbidity.
Peer-Reviewed Article
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
Disability-Competent Care Self-Assessment Tool
How disability-competent is your organization?
Implementation Tool
Toward a Serious Illness Program Design and Implementation Framework
This framework can help you design programs for patients with serious illnesses.
Peer-Reviewed Article
Nursing Student Coaches for Emergency Department Super Utilizers
Nursing students successfully coach patients with complex needs to avoid ED use.
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
Multiple Chronic Conditions: A Framework for Education and Training
A framework describes how to train the health care workforce to care for people with multiple chronic conditions.
Implementation Tool
Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Annual Report - Year Three
This report presents the findings from the evaluation of Medicaid health homes, created as part of the Affordable Care Act.
Brief/Report
Complex Care Program Development: A New Framework for Design and Evaluation
A new framework outlines four steps to develop care management programs.
Brief/Report