Counseling and Care Coordination for Patients With Advanced Illness Lead to More Patients Completing Advance Directives and Less Use of Inpatient Care
Counseling and care coordination for patients with advanced illnesses improved patient–provider communication and the quality of medical care and decisionmaking support, leading to more patients completing advance directives and lower inpatient care requirements.
Disease Management Programs Improve Adherence to Evidence-Based Processes and Outcomes by Targeting Sickest Patients and Working Closely With Physicians
A hospital-based outpatient disease management program serves patients with asthma, chronic heart failure, and diabetes and offers smoking cessation services to smokers. Unlike traditional disease management programs, this initiative heavily involves physicians in the initial referral and throughout the process and targets services toward the sickest patients (rather than to all patients with the condition).
Health Navigators Support Self-Management With Primary Care Patients, Leading to Improved Behaviors and Lower Utilization
Health navigators help primary care patients access medical and community resources, leading to significant improvements in health-related and self-management behaviors and health outcomes and to meaningful declines in emergency department and inpatient utilization.
Heart Failure Disease Management Improves Outcomes and Reduces Costs
Essentia Health Heart and Vascular Center created a heart failure program combining chronic care and disease management principles to improve outcomes and reduce costs associated with heart failure care.
Outpatient Center Evaluates Stable Patients Experiencing Recent Ministroke, Leading to Timely, Comprehensive Care and Lower Costs
As an alternative to inpatient care, an outpatient center located within a hospital with a stroke center evaluates stable patients who have experienced a recent transient ischemic attack, leading to more timely and comprehensive care, and to significant cost savings through the avoidance of unnecessary admissions.