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Innovations
Hospital at Homesm Care Reduces Costs, Readmissions, and Complications and Enhances Satisfaction for Elderly Patients 4/9/2014
Hospital at Homesm provides hospital-level care in a patient's home as a full substitute for acute hospital care for selected conditions common among seniors.
24-Hour Mobile Mental Health Crisis Team Reduces Hospitalization for Children with Complex Behavioral and Emotional Needs 4/9/2014
A rapid response team defuses crisis situations for children with complex behavioral needs.
Case Managers Remotely Monitor Chronically Ill Medicare Beneficiaries Each Day, Reducing Mortality and Costs 4/9/2014
Case managers remotely monitor Medicare beneficiaries with chronic conditions via a messaging device that asks and records answers to disease-specific and general health questions each day, leading to lower mortality and costs.
Donated Care Program Enhances Access to Ongoing Care for Uninsured Patients, Resulting in Significant Reductions in ED Visits, Hospitalizations, and Costs 4/9/2014
CarePartners, a donated care program, matches uninsured Maine residents with primary care physicians who are willing to care for up to 10 patients for free. Case managers help enrollees obtain needed services, including hospital care, specialist services, and free or low-cost drugs through prescription assistance programs.
Electronic Health Record–Facilitated Care Process Redesign Enhances Access to Care, Reduces Hospitalizations and Costs for Patients With Chronic Illnesses 4/9/2014
The Marshfield Clinic is using electronic tools to facilitate care process redesign for patients with chronic illnesses, leading to enhanced quality and access to care, fewer hospitalizations and adverse events, and lower costs.
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QualityTools
Improving Treatment Decisions for Patients With Community-Acquired Pneumonia 12/18/2013
This report describes two tools developed by the Agency for Healthcare Research and Quality (AHRQ) funded research that help assess the need for hospitalization of patients with community-acquired pneumonia (CAP) and determine the medical stability of patients prior to discharge.
STate Action on Avoidable Rehospitalizations (STAAR) Materials 12/18/2013
The STate Action on Avoidable Rehospitalizations (STAAR) Initiative of the Institute for Healthcare Improvement and The Commonwealth Fund aims to reduce avoidable rehospitalizations. This Web site features guides, presentations, and other tools related to reducing readmissions.
Managing Drug-Seeking Behaviors & Super Users in the Emergency Department 10/23/2013
This guide for emergency department (ED) physicians, nurses, and caregivers includes information and tools for providing pain management care to drug "super users" in the ED.
Medical Respite Tool Kit 10/23/2013
The purpose of the Medical Respite Tool Kit is to provide information and tools to help organizations and advocates plan, develop, and sustain medical respite programs. This tool organizes existing resources developed by the National Health Care for the Homeless Council and other medical respite providers while incorporating new and practical tools.
Coordinated-Transitional Care Toolkit 7/31/2013
The goal of this toolkit is to help hospital systems that serve populations with high rates of patient dispersion, cognitive impairment, and vulnerability improve care coordination and postdischarge outcomes such as reduced medication discrepancies.

Last updated: April 09, 2014.