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Innovations
Church-Health System Partnership Facilitates Transitions From Hospital to Home for Urban, Low-Income African Americans, Reducing Mortality, Utilization, and Costs 9/10/2014
A partnership between a large health system and 512 churches supports the transition from the hospital back into the community, leading to lower mortality, health care utilization, and health care costs and to higher satisfaction with hospital care.
Updated Transition Home Program Reduces Readmissions for Heart Failure Patients 9/10/2014
The Transition Home program incorporates a number of components to ensure patients a safe transition to home or another health care setting, leading to fewer readmissions.
Culturally Tailored Chronic Disease Education Program Improves African American Patients' Self-Management Behaviors, Blood Pressure and Blood Glucose Control, and Quality of Life 9/10/2014
A nine-session, culturally tailored program to educate minority populations with diabetes, hypertension, or overweight/obesity about appropriate disease management improves self-care behaviors, leading to improved blood pressure and blood glucose control and better quality of life.
Emergency Department–Based Asthma Clinic Improves Self-Management Behaviors and Reduces Acute Episodes for Low-Income, Inner-City Children and Teenagers 9/10/2014
An asthma clinic located within the emergency department of a children’s hospital provides education, nonurgent medical care, referrals to primary care providers, and followup support to low-income, inner-city children and teenagers, leading to improvements in self-management behaviors, fewer acute asthma episodes, and better quality of life.
Trained Peers Educate and Support Veterans in Self-Management of Hypertension, Leading to Improved Blood Pressure and Weight Loss 9/10/2014
Trained peers educate and support veterans in managing their blood pressure during regularly scheduled monthly meetings at Veterans Service Organizations posts, leading to lower blood pressure, weight loss, and other improvements.
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QualityTools
POWER Program Curriculum 9/10/2014
The POWER Program is an innovative project designed to help participating veterans manage high blood pressure and other chronic conditions.
Self-Management Support Resource Library 9/10/2014
The Self-Management Support Resource Library was developed to help primary care team members learn about self-management support and develop their self-management support skills in working with chronically ill patients. 
4 Steps to Control Your Diabetes. For Life. 8/27/2014
This booklet for consumers provides four steps to help diabetic patients manage their diabetes and live a long and active life.
High Blood Cholesterol: What You Need to Know 8/27/2014
This fact sheet explains the risks of having a high blood cholesterol level and provides guidance on lowering high blood cholesterol.
Low-Income Households and Asthma 8/27/2014
The Low Income Households and Asthma fact sheet provides statistics on low-income households and asthma rates. The fact sheet also provides 10 key tips for controlling and managing asthma.
Other Related Results
ARTICLES
Integrating Behavioral Health With Primary Care 6/18/2014
How Middle Managers Can Influence Innovation Implementation 5/7/2014
Challenges Facing Rural Health Care 3/26/2014
Chronic Disease Management Can Reduce Readmissions 3/26/2014
Improving Access to Specialty Care for Medicaid Patients 3/26/2014
Public- and Private-Sector Initiatives Are Reducing Health Disparities Among Children 3/26/2014
Spreading Innovations To Enhance Care for Older Adults 3/26/2014
Technology Is Improving Patients' Access to Their Health Information 3/26/2014
The State of Accountable Care Organizations 3/26/2014
Wellness and Health Promotion Programs Use Financial Incentives To Motivate Employees 1/15/2014
New Recognition Standards for Specialty Practices Emphasize Coordination With Primary Care 4/17/2013
ISSUES
Quality Improvement in Pediatric Care 10/9/2013
Using Patient-Reported Data To Improve Chronic Disease Care 4/24/2013
HIV Screening and Care for HIV-Positive Patients 4/10/2013
Clinical-Community Linkages to Improve Chronic Disease Care 7/3/2012
Remote Monitoring of Chronic Conditions 2/1/2012
Chronic Disease Management 7/21/2010
Management of Chronic Illnesses 7/7/2008
Managing Chronic Health Conditions 5/26/2008
VIDEOS
Brenner Children’s Hospital BrennerFIT program
Care Management Plus Program: Can This Innovation Be Scaled?
Essentia Heart Failure Program: Can This Innovation Be Scaled?
EVENTS
Chats on Change: Using Social Media To Reduce Childhood Obesity
9/10/2013

Last updated: September 10, 2014.