Hospital-Based Social Workers Follow Up With Recently Discharged Older Adults to Resolve Transition Problems, Reducing Readmissions and Deaths
Hospital-based social workers support recently discharged older patients and their caregivers in resolving problems related to their transition back home, leading to enhanced patient and caregiver knowledge, better attendance at followup appointments, and fewer readmissions and deaths.
Interdisciplinary Clinic Using Team-Based Approach Improves Outcomes and Reduces Costs for Frail, Vulnerable Elderly
An interdisciplinary, hospital-based outpatient clinic staffed by geriatricians and other health professionals cares for seniors with one or more chronic health conditions, leading to improved outcomes and lower costs.
Social Workers Support Outpatients in Dealing With Psychosocial Issues, Leading to High Patient and Practitioner Satisfaction and Better Patient Self-Management
Master's-level social workers operating out of a centralized department support primary care and specialty clinic patients in dealing with psychosocial and environmental issues, leading to high levels of patient/caregiver and practitioner satisfaction, improvements in patients’ well-being and self-management skills, and reductions in resource use.
Inner-City School Health Center's Comprehensive Reproductive Health Services: Enhancing Access to Screening for Sexually Transmitted Diseases, Prenatal Care, and Contraception
School-based health centers provide comprehensive reproductive and sexual health services to inner-city public school students, leading to enhanced access to contraception, prenatal care, and screening and treatment for sexually transmitted diseases.
Virtual Teams That Coordinate Care for Chronically Ill Geriatric Patients Reduce Emergency Department Visits and Improve Medication Compliance, Referral Patterns, and Patient Outcomes
Primary care physicians and offsite clinicians use communications technology to enhance coordination of care for geriatric patients with chronic health problems, leading to fewer emergency department visits, enhanced patient satisfaction and understanding of medications, and more referrals for needed care.
Virtual Integrated Practice (VIP) Toolkit
The Virtual Integrated Practice (VIP) toolkit is part of the VIP program, which is designed to develop effective team building and ongoing collaboration among health care providers who do not work together in practice in the same locations or even organizations. It replaces the logistical obstacles of having clinicians meet in person to discuss patient cases with a system of communicating and meeting "virtually" using an appropriate variety of readily available technologies.