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July 16, 2014

Physician Performance–Based Incentive Programs

Traditional compensation systems create little or no incentive for physicians to focus on quality improvement activities or manage costs. Many payment systems for physicians are based on a fee-for-service model that encourages them to perform reimbursable procedures only and use resources without regard to cost. New payment structures are creating incentives for physicians to deliver high-quality rather than volume-driven care.

The featured policy Innovations describe three programs that offered financial incentives to physicians based on their performance in meeting clinical care improvement goals and on various metrics of efficiency and quality.

The featured QualityTools include an interactive tool that helps practitioners determine their payment adjustments and reimbursements for Medicare incentive programs; a resource that provides community collaboratives with practical information and guidance on the design, dissemination, and use of feedback reports on physician performance; and a toolkit for health plans and providers, with step-by-step instructions for implementing a bundled fee payment system covering all patient services related to an illness, condition, or procedure.
July 02, 2014

Medicaid Initiatives To Support Medical Homes

A March 2014 report from the Centers for Medicare & Medicaid Services (CMS) estimates there are 64.6 million individuals enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) across the 49 States that provided enrollment data for March 2014. To improve the quality of care for this population while reducing costs, several States are developing new payment models that support medical homes in providing coordinated and integrated care.

The featured policy Innovations describe three State programs that reimburse medical homes for delivering high-quality, coordinated care to Medicaid beneficiaries, improving outcomes and lowering costs.

The featured QualityTools include a collection of patient management tools to enhance patient conversations with health care professionals, an operational handbook for safety net medical homes, and a library of publicly available resources and tools to help safety net providers understand and implement the patient-centered medical home model of care.
June 18, 2014

Alarm Fatigue in Hospital Settings

Medical devices and monitoring equipment that alert staff to rapid deterioration in patients can be effective in reducing adverse outcomes, but the large number of clinically insignificant alarms that occur in a hospital can lead to alarm fatigue, with staff delaying responses or even ignoring alarms.

The featured Innovations describe two programs that sought to minimize alarm fatigue in hospital settings by implementing changes to alarm systems that reduced audible alarms and rescue events.

The featured QualityTools include a Web site offering guidance and tools to help health care facilities improve their alarm safety; and a clinical toolkit that provides evidence-based strategies, resources, best practices, and change-implementation tools to reduce the impact of environmental alarms.
June 04, 2014

Innovations in Emergency Medical Services

Inappropriate calls to emergency medical services (EMS) providers and unnecessary use of the emergency department (ED) occur frequently. Handling nonemergency calls raises the costs of providing EMS and ED services, diverts valuable resources away from true emergencies, and can result in delayed care, ED crowding, and poor patient outcomes.

The featured Innovations describe two programs that implemented innovative strategies to reduce the use of EMS by frequent 911 callers, leading to major cost savings and increased capacity in area EDs. The third featured profile describes a State policy that banned ambulance diversions to other nearby EDs, resulting in reduced ED length of stay and ambulance turnaround time.

The featured QualityTools include a self-assessment tool for communities to assess the status of their paramedicine programs, resources for hospitals and health systems to improve systems of care in response to cardiac emergencies, and a Web site that describes an EMS information system used in various States to evaluate EMS performance.

May 21, 2014

Towards Affordable Care: Policies To Reduce Price Variability

Hospital pricing for elective procedures can vary significantly across facilities within a given market area, and differences are typically unrelated to variations in quality of care. Under most benefit plans, insured consumers lack incentive to choose hospitals offering a lower price for these services. In addition, prices charged for general hospital care often differ based on patients’ insurance status.

The featured policy Innovations describe a retirement system that incorporated a reference-pricing policy for certain procedures in its benefits design, enabling plan enrollees to select high-value hospitals; and California state legislation that promotes fair hospital pricing.

The featured QualityTools include a tool for consumers to estimate how much providers charge for medical and dental services in their area, a Web site to help patients in California navigate the application process for discounted care from hospitals, and a guide for consumers on the average cost of health care services to support price comparisons.
May 07, 2014

Certified Peer Specialists in Mental Health Care

Mental health conditions are a leading cause of mental and physical disability, particularly for people of low socioeconomic status. Trained and certified individuals who are in recovery from mental illness and/or substance abuse can provide sensitive, practical support to peers because of their shared experiences. Certified peer specialists can help individuals access support and wellness services and improve behavioral and physical health outcomes.

The featured Innovations describe two programs that expanded mental health services through the use of trained and certified peer specialists.

The featured QualityTools include a resource for mental health peer-run programs to cultivate cultural competency and a peer support group model designed to promote wellness and self-management of physical and behavioral health among individuals with mental illness and substance use disorders.
April 23, 2014

Patient- and Family-Centered Care Innovations

Patient- and family-centered care is an approach to health care planning, delivery, and evaluation that encourages patient involvement and partnership among health care providers, patients, and families. Important concepts include respect and dignity, information sharing, participation, and collaboration.

The featured Innovations describe three programs that integrated principles of patient- and family-centered care into the delivery of services, contributing to better outcomes and greater patient satisfaction.

The featured QualityTools include a toolbox to assist health care professionals in implementing and meeting patient- and family-centered care goals, a tool for providers to assess their own ability to integrate patients and family members into the care process, and evidence-based strategies for hospitals to implement patient- and family-centered care practices.
April 09, 2014

Policy Innovations in Long-Term Care

According to a report from the Centers for Disease Control and Prevention, more than 58,000 paid, regulated long-term care (LTC) providers delivered services to approximately 8 million people in the United States in 2012. Policymakers and health care organizations are using innovative approaches and policies to promote quality improvement and enhance care for residents of long-term care facilities.

The featured policy Innovations describe two programs designed to improve the quality of care in LTC facilities—a health system’s initiative to transition vaccination-related policies and processes for LTC facilities to a regional pharmacy, leading to increased influenza vaccination rates among workers; and a State program that used financial incentives to fund nursing home quality improvement projects through a competitive bidding process.

The featured QualityTools include a guide to LTC options for veterans, a toolkit to help LTC facilities enhance the quality of care for elderly residents with Alzheimer’s disease, and a manual for embedding quality improvement strategies in nursing homes.
March 26, 2014

Early Intervention and Support for At-Risk Families

Low-income, pregnant women often do not receive adequate prenatal care, leading to poor outcomes. First-time mothers in low-income communities may also lack necessary support and resources to help care for themselves and their children and to access health care. Connecting at-risk women and families to care and other services in the community before and after a child’s birth can help improve outcomes.

The featured Innovations describe three programs that provided personalized support and education for low-income or at-risk families of newborns. The programs include one that performed in-home risk assessments; another that provided home visits to low-income, first-time mothers to improve pregnancy outcomes and children’s health; and a third that offered women and their families services appropriate for each stage of the childbearing cycle: pregnancy, post partum, early childhood, and between pregnancies.

The featured QualityTools include resources to help States identify families and children at risk; resources to help facilitate the care of premature infants and improve outcomes; and a risk calculator for policymakers to estimate how many young children in their State face selected risk factors associated with poor health, school, and developmental outcomes.
March 12, 2014

Addressing Opioid Misuse

Prescribing of opioid analgesics has increased substantially in recent years, as have the consequences associated with opioid misuse: emergency department (ED) visits, treatment admissions, and overdose-related fatalities. According to Centers for Disease Control and Prevention (CDC) data, unintended deaths caused by prescription opioid overdoses are a leading cause of death by injury in the United States. Health care organizations, community-based agencies, and other stakeholders are implementing innovative policies and strategies to address this major health problem.

The featured Innovations describe three programs aimed at reducing opioid misuse and associated health and safety consequences. The initiatives include a mayoral task force in New York City that developed a series of strategies to combat the problem, an ED that implemented a protocol on the use of controlled substances, and an opioid overdose prevention and education program for potential responders.

The featured QualityTools include a manual on the development of overdose prevention programs, a protocol to help clinicians make treatment decisions for patients who may be abusing opioids, and a guide that supports implementation of overdose prevention and response strategies by potential responders.
February 26, 2014

Community-Based Programs To Improve Senior Health

According to a 2013 report from the Centers for Disease Control and Prevention, two-thirds of older Americans have multiple chronic conditions, and 66% of the Nation’s health care budget is spent treating this population. Community-based initiatives can improve the health of at-risk seniors and reduce costs by providing services such as screening and care coordination.

The featured Innovations describe three community-based programs designed to improve senior health. The projects include a collaborative that helped community-dwelling seniors access services so they could remain at home; a health and hygiene program that incorporated diabetes and hypertension screenings for at-risk seniors; and an initiative that enhanced access to culturally tailored mental health services for elderly minorities.

The featured QualityTools include a library of resources to help community-based organizations (CBOs) develop and implement evidence-based programs to promote healthy living for older adults; a tool to help senior-serving CBOs identify community resources to support seniors; and a toolkit to give State and local coalitions strategies, tools, and resources to prevent falls among older adults.
February 12, 2014

Community-Wide Initiatives To Enhance Access for Vulnerable Populations

Low-income and other vulnerable populations often lack adequate medical insurance or have limited access to health services and may wait until a health crisis occurs to seek care in an emergency department. Community agencies and stakeholders are collaborating with clinical organizations to improve access to care for these populations.

The featured Innovations describe three community-wide initiatives that seek to increase access to health care for vulnerable populations. The programs include a community collaborative that opened a free clinic for uninsured children and implemented targeted interventions for patients with sickle cell anemia and substance abuse issues; a community-funded, nonprofit organization that matches eligible uninsured and underinsured patients with providers who agree to serve them at a discounted rate; and a school-based, collaborative, community-wide program that provides mental health and other support services to students and their families living in neighborhoods plagued by poverty and crime.

The featured QualityTools include a program to help dentists join with others in their community to provide dental services to underserved children; a community-funded, nonprofit organization that helps underserved children, adults, and families receive needed medical attention; and a Web site with tools and resources that can help clinicians and community health centers provide quality health care to underserved patients.
January 29, 2014

Using Actionable Data To Improve Quality and Reduce Costs

Lack of adequate, timely information poses a challenge for health care organizations and frontline providers in their quality improvement efforts. Access to useful data on health care utilization and performance can help organizations identify and address problem areas, target resources effectively, and improve care.

The featured Innovations describe three organizations that analyzed and provided specific, actionable data to health plans and providers in support of quality improvement efforts, leading to better care and lower costs.

The featured QualityTools include a guide on how to use predictive modeling tools to identify patients who are good candidates for care management and a Web site that offers resources for health care professionals interested in tracking performance on measures of health care quality.
January 15, 2014

Employee Wellness and Health Promotion Programs

Employees with multiple health risk factors tend to use more health care resources, miss more days of work, and perform at less-than-optimal levels of efficiency and productivity. Well-constructed employee health and wellness programs can be effective in reducing risk factors and improving employee health, resulting in benefits for both employers and employees.

The featured Innovations describe three different programs designed to promote employee health and wellness and reduce health care costs. The programs include an incentive plan offered by the state of Connecticut that improved screening and medication adherence, increased use of primary care services, and reduced specialty and emergency department visits; a multinational health care corporation's wellness program that significantly reduced risk factors; and a large employer's comprehensive wellness program that attracted broad participation and reduced overall health care costs.

The featured QualityTools include a Web site that offers interactive tools and evidence-based strategies to design effective worksite obesity prevention and control programs; a scorecard that assesses how evidence-based health promotion strategies are implemented at a worksite; and a toolkit that provides employers guidance on how to implement a smoke-free workplace policy.
December 18, 2013

End-of-Life Care Issues

Seriously ill or very elderly patients often cannot express their wishes because of limited mental or physical capabilities, leading to health care decisions that may be inconsistent with their wishes. Although advance care planning—a shared decisionmaking process about future health care choices—can help, many patients fail to engage in such planning; this may be true more often in minority populations. In addition, State policies can either facilitate or hinder the provision of effective, compassionate end-of-life care.

The featured Innovations describe three programs that aimed to increase rates of advance care planning. The programs include one that provided education and trained nonphysician facilitators to guide patients and their families in advance care planning; another in which a State-mandated council focused on end-of-life policy issues; and third in which care coordinators used a culturally sensitive, tailored approach to discuss advance care directives with seniors.

The featured QualityTools include a program and a Web site that offer resources to help people make informed decisions about end-of-life care and services, as well as a program that offers health care professionals the tools, training, and technical assistance necessary to start successful palliative care programs.
December 04, 2013

Mental Health Care in Rural Settings

Rural populations face multiple challenges that contribute to disparities in mental health care. Barriers to accessing high-quality care in rural settings include shortages of mental health professionals, limited or lack of inpatient and emergency psychiatric services, and the need to travel long distances to receive care.

This issue’s featured Innovations describe two programs that used telemedicine to increase access to mental health services for individuals in rural areas and one program that used a multifaceted approach to improve diagnosis and treatment of depression among older adults in rural primary care settings.

The featured QualityTools include a guide to improving rural behavioral health programs; a toolkit to assist rural primary care providers in suicide prevention; and a guide for developing, implementing, and sustaining a telemental health program.
November 20, 2013

Identifying At-Risk Patients in the ED

According to data from the Centers for Disease Control and Prevention, in 2010 there were approximately 130 million visits to emergency departments (EDs) in the United States. In addition to providing emergent care, staff at EDs can help identify patients at risk for mental and behavioral health issues and other conditions that may require treatment or referral for services provided by other organizations.

The featured Innovations describe three programs that promoted screening of patients in the ED to identify individuals at risk for specific conditions. The programs include an intervention that enhanced access to mental health services for veterans at risk of suicide, an ED screening procedure that identified patients with potential eating disorders in order to facilitate treatment, and a hospital process that connected young victims of violence with community-based support to prevent repeat episodes.

The featured QualityTools include a screening tool for ED staff to help identify youth at risk for suicide, and a guide for ED staff and clinicians to promote recognition and prevention of morbidity and mortality associated with eating disorders.
November 06, 2013

Better Access Through Virtual Visits

Patients with minor health problems generally must schedule an appointment and travel to a health care provider’s office or clinic for care, often having to wait a day or more and take time away from work or other activities to attend the visit. Virtual visits can reduce wait times by allowing off-hours consultations and allow providers to safely diagnose and treat patients in remote locations and quickly identify more serious or ambiguous cases in which inperson care is required.

The featured Innovations describe three programs that used virtual visits to increase patient access to health care. The programs include one in which a solo practitioner provided year-round, 24-hour-a-day access to care for her patients through liberal use of "virtual" or e-mail visits and telephone calls; another that used an online clinic to diagnose and treat minor health problems with a protocol-based treatment plan; and one that allowed patients with skin conditions to submit their medical history and photographs through secure, Web-based applications for review by a dermatologist.

The featured QualityTools include a Web site that offers resources on using technology to assist care coordination and improve the independence of older adults, a guide for developing a remote diabetic retinopathy screening program, and a toolkit for developing telehealth activities.
October 23, 2013

Strategies To Address Frequent Emergency Department Use

In many hospital emergency departments (EDs), a small percentage of patients account for a disproportionate share of visits and resources. Sometimes referred to as ED “super users,” these individuals often lack a regular source of care and typically present to the ED with non-urgent conditions, often with a variety of underlying medical, behavioral, and psychosocial needs that cannot be addressed in the ED.

The featured Innovations describe three programs that implemented various strategies to provide, manage, and coordinate care and social services for individuals who are frequent ED users, leading to improved outcomes and reductions in ED use.

The featured QualityTools include a campaign in Washington State to help reduce preventable emergency room visits and redirect care to the most appropriate setting, information and tools for ED staff in managing care for specific groups of ED super users, and a toolkit to help organizations and advocates plan, develop, and sustain medical respite programs.
October 09, 2013

Quality Improvement in Pediatric Care

Advancements in health information technology and the increasing use of health care data are providing new opportunities for quality improvement in pediatric care. Innovative approaches to collecting, analyzing, and sharing data can improve the delivery of preventive services, support the delivery of evidence-based care, and facilitate care coordination among pediatric health care providers and practices.

The featured Innovations describe a children's hospital that used an enterprise data warehouse to improve adherence to evidence-based guidelines, a childhood asthma registry that reduced inpatient admissions and emergency department visits, and a State partnership that supported quality improvement projects for preventive services and chronic condition management.

The featured QualityTools include a national health promotion and disease prevention initiative that addresses children's health needs in the context of family and community, a guide to developing regional collaborations of public and private partners to improve the quality of children‘s health care, and a Web site that provides tools and resources to support quality improvement projects.
September 25, 2013

Policies To Reduce Health Care Disparities

According to AHRQ’s 2012 National Healthcare Disparities Report, “differences in access to care, social determinants, provider biases, poor provider–patient communication, and poor health literacy” are among the factors that contribute to disparities in care received by racial and ethnic minorities and disadvantaged populations. For example, recent data indicate that poor and low-income people received worse care than high-income people for about 60 percent of quality measures.

The featured Innovations describe three programs that implemented policies to help reduce health care disparities and ensure that vulnerable populations receive equitable health care. The programs include one that subsidized the costs of electronic health record implementation for primary care practices in underserved areas and another in which a Medicaid plan collected and verified patient race, ethnicity, and language data to help identify and address disparities; as well as State legislation in California requiring that cultural competency curricula be included in continuing medical education.

The featured QualityTools include the 2012 National Healthcare Disparities Report, which identifies and tracks the ways that some populations receive poor or worse care than others; a toolkit to help physicians and health care teams redesign office practices to provide the highest quality care possible to patients with limited English skills; and a guide to help hospital leaders identify and address disparities in order to achieve equitable care for patients.
September 11, 2013

Innovations in Medicaid Policy

On January 1, 2014, Medicaid expansion will take effect as part of the Patient Protection and Affordable Care Act, expanding coverage to millions of low-income Americans. In preparation, several States have begun to implement changes in Medicaid policies and programs that facilitate enrollment and access to services.

The featured Innovations describe a pay-for-performance program in New York that improved immunization rates and diabetes care, an initiative in Oklahoma that facilitated Medicaid enrollment while reducing operating costs, and an Oregon plan that increased screening and access to care for children at risk for developmental disabilities.

The featured QualityTools include a toolbox for Medicaid and CHIP learning collaboratives, a fact sheet describing dual eligible status and its implications, and a toolkit to improve Medicaid managed care service delivery for youth with serious behavioral health needs.
August 28, 2013

Using Decision Aids in Shared Decisionmaking

In shared decisionmaking, patients and clinicians jointly make treatment-related decisions based on available evidence, patient preferences, and personal values. The use of decision aids including video-based, electronic, and paper-based tools can support this process and help patients understand available treatment options.

The featured Innovations describe legislative efforts in the state of Washington that support the routine use of shared decisionmaking in care delivery, as well as two programs that promoted it through the use of decision aids.

The featured QualityTools include decision aids for patients on particular health topics and resources for providers on the process, use, and evaluation of decision aids in shared decisionmaking.
August 14, 2013

Culturally Appropriate Care and Health Education

The United States continues to be a melting pot of people with diverse cultures and languages; in some cases, cultural and linguistic differences can present barriers to health care delivery. It is increasingly important for health care providers to understand and respond effectively to the cultural and linguistic needs of their patients to ensure that patients understand their health care issues, medications, and self-care requirements.

The featured Innovations describe three programs that provided culturally and linguistically appropriate health care and education to specific target populations. The programs include one that delivered a community-based, culturally tailored education program to low-income, predominantly elderly Korean immigrants with type 2 diabetes to improve self-management; another that increased awareness of, attitudes about, and willingness to accept hospice services in a local Hispanic community; and a third that provided culturally sensitive mental health screening for arriving refugees.

The featured QualityTools include a cancer education tool geared toward Asians and Pacific Islanders, a screener to help assess the emotional distress of refugees, and a toolkit to help mental health clinicians and agency administrators evaluate evidence-based practices for possible modification for cultural groups.
July 31, 2013

Improving Health Through Clinical–Community Collaboration

Developing, strengthening, and sustaining effective collaboration among clinical providers and community organizations can help achieve the common goal of improving the health of people and the communities in which they live. Clinical–community collaboration can bring preventive and primary health care to underserved populations, spur employers to promote health-related initiatives, and help patients take control of their health.

The featured Innovations describe three programs that provide successful examples of clinical–community collaboration to improve health. One program provided free primary care, support services, and educational programs for men in African-American communities; another coordinated outreach workers, or promotoras, to help Mexican farm workers navigate the health care system and improve their health; and a third initiative supported the development of programs to improve blood pressure control among a local population.

The featured QualityTools include a resource to assist in research and evaluation of clinical-community relationships, a toolkit to help clinicians learn about community partnerships and share what they know with others, and a set of tools for building clinical-community collaboration focused on chronic disease care and management.
July 17, 2013

Access to Specialty Care in Federally Qualified Health Centers

Federally qualified health centers (FQHCs) provide access to primary care for medically underserved populations including those that are uninsured or covered by Medicaid. According to the Health Resources and Services Administration, FQHCs that received federal grant funding served 18.8 million individuals in 2009. While there is an emphasis on comprehensive, coordinated care, patients at FQHCs often face challenges accessing specialty care due to insurance status, inefficient referral systems, or long wait times.

The featured Innovations describe three programs that improved access to specialty care in federally qualified health centers. These programs include an electronic consultation system that reduced wait times and unnecessary specialty referrals; a formalized referral process that used information technology to enhance access to specialty care; and a telemedicine program that provided retinopathy screening to patients with diabetes served by FQHCs.

The featured QualityTools include a business planning guide and toolkit designed to assist community clinics and health centers in developing networks to share specialty services, and a guide for developing a remote diabetic retinopathy screening program.
July 03, 2013

Value-Based Reimbursement Structures

Value-based reimbursement models aim to improve quality and reduce costs by creating incentives for providers to deliver high-quality rather than volume-driven care. Federal and State programs are implementing policies and payment structures that reflect a movement away from the traditional fee-for-service system.

The featured Innovations describe three programs that implemented value-based reimbursement policies at the State level. One program offered health plans a capitated fee to deliver health care and social services to Medicare/Medicaid dual eligibles; a second adjusted individual hospital payment rates based on specific performance metrics; and a third program rewarded individual hospitals for reducing hospital-acquired conditions.

The featured QualityTools provide resources that help health care administrators and providers prepare for performance measurement and reporting to the Centers for Medicare & Medicaid Services, as well as a toolkit that offers guidance for implementing health care-associated infection prevention programs.
June 19, 2013

Integrating Behavioral Health and Primary Care

The integration of behavioral health services−including the identification and assessment of mental health and substance abuse issues−with primary care can help ensure patients receive needed services, leading to improved health outcomes and cost savings.

The featured Innovations describe three programs that took various approaches to providing integrated primary care. One program offered onsite primary care for patients with mental illness, another implemented an innovative payment model to reimburse primary care clinics for mental health services, and a third supported providers in identifying and addressing behavioral health issues in the primary care setting.

The featured QualityTools provide clinicians and other stakeholders with resources and tools to facilitate behavioral health and primary care integration in various health settings.
June 05, 2013

Health Information Exchanges

In today's health care system, patients often interact with multiple providers, posing a challenge for care coordination across settings. Under the Patient Protection and Affordable Care Act, State and local health care systems are given incentives to implement health information exchanges (HIEs), which connect different health care providers and organizations through the exchange of electronic health information. HIEs can facilitate care coordination among providers, reduce redundancies, and enhance patient-centered care.

The featured Innovations describe two HIE systems that have been implemented effectively. One program—the nation's first operational statewide HIE—has a 97-percent participation rate among providers, allowing them to share millions of clinical results and reports annually. The other program provides pharmacists, regulatory boards, and law enforcement agencies in different states access to information about controlled substance prescriptions to help identify cases of misuse.

The featured QualityTools include a toolkit to help health care leaders establish and maintain an HIE, a Web site that offers three HIE toolkits for use in various settings, and an HIE toolkit with resources for rural providers.
May 22, 2013

Improving Care for Frontier Populations

The National Rural Health Association defines frontier communities as having fewer than seven people per square mile and being farther than 30 miles or 30 minutes from a primary care facility. In frontier settings in the United States, weather and distance can hinder patients' access to dental and medical care. Providers in these remote areas often work in innovative ways to increase access to health care services.

The featured Innovations describe three programs that used innovative approaches to overcome barriers to health care access in frontier settings. One program used dental health aides to provide routine dental care, another implemented an innovative policy that extended hours for patients who need round-the-clock care in remote settings, and a third used electronic health records to bring preventive care services to isolated villages.

The featured QualityTools include a toolkit to help small and critical-care hospitals plan for and implement telehealth, health information exchanges, and personal health records; a tool to help rural facilities assess the status of their paramedicine program; and a rural resource center with more than 2,500 links to such topics as dental and emergency medical services, insurance and managed care, mental health, and substance abuse.
May 08, 2013

Accountable Care Organizations

The accountable care organization (ACO) concept represents a new payment and delivery model in which a group of coordinated health care providers—primary care physicians, specialists, and hospitals—are collectively accountable for the quality and cost of care delivered to a defined group of patients. By incentivizing the delivery of cost-effective, coordinated care, ACOs have the potential to generate better quality care at a lower cost, resulting in improved health outcomes and shared savings.

The featured Innovations describe two ACOs that used financial risk sharing and various improvement initiatives to reduce health care utilization and costs for defined patient populations—one that operates under an annual global budget for individuals covered by the California Public Employees Retirement System, and a county-based ACO in Minnesota that serves Medicaid beneficiaries.

The featured QualityTools include a tool for safety net providers to assess their capabilities and readiness to become ACOs and a toolkit for physicians that provides information about essential elements of a successful ACO and step-by-step implementation guidance.
April 24, 2013

Using Patient-Reported Data To Improve Chronic Disease Care

According to a Centers for Disease Control and Prevention report, chronic diseases are responsible for 70% of deaths in America each year, and 75% of the nation's health care spending focuses on chronic conditions. Using patient-reported data to help manage chronic disease care and reduce costs is a strategy that many health care providers are now exploring.

The featured Innovations describe a tool that uses self-reports from patients with diabetes to generate intervention options, a self-assessment for patients with mental illness that improves communication with providers, and a smartphone application that allows patients with Crohn's disease to track health information and share it with providers.

The featured QualityTools include a pre-visit questionnaire for asthma patients, a quality-of-life assessment for diabetes patients, and a tool to help patients track and monitor their blood pressure, cholesterol, blood glucose, diet, and physical activity.
April 10, 2013

HIV Screening and Care for HIV-Positive Patients

The Centers for Disease Control and Prevention estimates that 50,000 people in the United States become infected each year with HIV, yet many are unaware of their HIV status because they have not been tested. Easily accessible testing for HIV and other related health risks can ensure that those who need it receive treatment in a timely way.

The featured Innovations describe a program that integrates HIV screening into routine care at community health centers, a New York State law that promotes HIV testing in routine care, and a program that provides proactive anal cancer screening to HIV-positive patients, who are at high risk of anal cancer.

The featured QualityTools include information, intake forms, and educational materials for HIV-related health care, housing, and supportive service providers; and resources for use by State health departments to increase HIV testing on a statewide level.
March 27, 2013

School-Based Health Programs for At-Risk Youth

Many adolescents, particularly those in minority and low-income communities, lack access to health information, preventive care, and clinical services, leaving them at-risk for untreated physical and mental health issues. School-based health care delivery can improve access to care and address the needs of this vulnerable population.

The featured Innovations describe a school-based program to reduce type 2 diabetes risk factors for at-risk youth, an inner city school district's reproductive health services model, and a school-based health center that enhanced access to mental health services, particularly for minorities.

The featured QualityTools include resources to support HIV and STD prevention programs in schools and tools to facilitate school-based preventive, mental health, nutrition, and oral health services.
March 13, 2013

Alternative Care Settings To Reduce Hospital Use

When appropriate for particular patients, the delivery of health care services on an outpatient basis or in non-hospital settings can reduce costly use of hospital emergency departments and inpatient admissions.

The featured Innovations describe one program that decreased emergency department visits and two programs that reduced hospital inpatient utilization by providing health care services to specific patient populations in various outpatient settings.

The featured QualityTools include two patient assessment tools that supplement the featured innovations, as well as resources from a State campaign that aims to reduce emergency department use and redirect care to the most appropriate setting.
February 27, 2013

Dental Health Programs for Underserved Populations

According to the most recent National Health and Nutrition Examination Survey External Web Site Policy (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software External Web Site Policy.), approximately 25% of children aged 3 to 9 years and living in poverty had untreated dental caries. Also at risk in this area of health care are people who are uninsured, those living with HIV/AIDS, low-income pregnant women, and individuals who are homeless.

The featured Innovations describe three programs that used innovative strategies to provide needed dental care to underserved populations.

The featured QualityTools include a toolkit to help dentists provide dental care to underserved children in their community, a guide to establishing dental homes and providing education to at-risk children, and a comprehensive oral health curriculum for providers.
February 13, 2013

Innovative Strategies To Increase Cancer Screening

According to a 2010 study by the Centers for Disease Control and Prevention and the National Cancer Institute, overall cancer screening rates in the United States remain below national targets and disparities persist among racial and ethnic groups. Efforts to increase screening can help identify early treatable cancers and reduce morbidity and mortality due to cancer.

The featured Innovations describe three programs that used innovative strategies to increase colorectal, cervical, and skin cancer screening rates among specific target populations.

The featured QualityTools include a toolkit to help health care professionals improve cancer screening rates in their practice and resources for health care consumers and communities to promote screening.
January 30, 2013

Medical Home Models for Specialty Care

Use of the patient-centered medical home model in primary care settings can improve quality, reduce costs, and increase accessibility of health care. Providers are now applying principles of the medical home to the delivery of specialty care in an effort to provide comprehensive, coordinated care and improve health outcomes.

The featured Innovations examine how three different providers adapted the primary care medical home model to specialty care, including a community-based oncology practice that redesigned its care delivery processes, a pediatric center serving children with special health care needs, and a statewide medical home program that improved access to comprehensive pregnancy care for Medicaid beneficiaries.

The featured QualityTools provide resources to support the integration of the patient-centered medical home model into specialty care.
January 16, 2013

Patient-Centered Hospital Design

Patient-centered hospital design can improve patient care and satisfaction, as well as quality of services, safety, and employee retention. Studies have found links between improved design and reductions in medication errors, patient falls, and hospital-acquired infections. Institutions are finding that patient-centered hospital design improves their bottom line at the same time that it raises patient satisfaction.

The featured Innovations showcase efforts to implement patient-centered hospital design. One hospital used playful room design and distraction techniques to help pediatric patients through radiology treatments without sedation; a second used natural light, soft colors, plants, art, and music to help patients feel comfortable and heal faster. An infusion center based its patient-centered redesign on the results of a patient survey, which highlighted the need for more comfortable furniture; softer lighting; natural, warm wall colors; spacious and warm waiting areas; and happy, nature-inspired artwork.

The featured QualityTools provide guidance and the rationale for designing patient-centered hospitals and tools to help improve patient-centered care.
December 19, 2012

Reducing Health Disparities Among Children

Low-income, urban, and minority children often have poor access to appropriate health care and experience higher rates of asthma, obesity, and other chronic health conditions. In addition to lack of adequate health insurance, cultural and linguistic barriers prevent many children from receiving equal care.

The featured innovations describe efforts to reduce health disparities among children, including a program that provided culturally competent asthma care to Latino families, a state policy that increased access to Medicaid coverage for uninsured children, and a medical center’s use of text messaging to increase vaccination rates among low-income minority children.

The featured QualityTools present resources and information to help health care providers and other organizations deliver culturally appropriate services and improve care for at-risk children.
December 05, 2012

Using Information Systems To Promote Prevention

Many Americans do not receive recommended preventive care services, and lack of preventive care can affect health outcomes and lead to increased use of health care services.

The featured Innovations describe ways that health information technologies can be used to enhance provision of preventive services, including a program that enables standing orders for vaccinations and screenings, a system that encourages Medicare patients to schedule their Annual Wellness Visit, and an interactive preventive health record that identifies specific care needs for patients.

The featured QualityTools include a smartphone application to promote healthy weight and tools to improve adherence to guidelines for electronic and interactive preventive health records.
November 21, 2012

Reducing Inappropriate Antibiotic Use

Inappropriate prescribing leads to increased resistance to and reduced effectiveness of antibiotic medications. Physicians and patients may be unaware of guidelines on the use of antibiotics for viral infections, and patients and parents may not realize that their inappropriate use can be ineffective and can cause harm.

The featured Innovations describe efforts to reduce inappropriate antibiotic prescribing, including a health plan that provided regular performance feedback to physicians, a telemedicine-based antimicrobial stewardship program, and an educational program designed to support physicians employing shared decisionmaking with patients.

The featured QualityTools provide information and resources that can help clinicians reduce inappropriate antibiotic use.
November 07, 2012

Health Care for Underserved Populations

Individuals that lack adequate health insurance, are low-income, or reside in rural areas often cannot access preventive and primary care services and do not have a regular source of care. As a result, health problems may go undiagnosed and/or untreated, increasing the long-term risk of serious illness and death among the medically underserved.

The featured Innovations describe three programs that provided medical care and patient education to persons with limited means of accessing such services, thereby improving their health status and facilitating access to follow up care.

The featured QualityTools provide information and resources that address disparities in medically underserved communities.
October 24, 2012

Integrated End-of-Life Care

The aging of baby boomers and an increased need to contain hospital costs in the United States has led many organizations to fine tune their services for patients who are in need of palliative care. Most patients prefer to remain in their home at this time of their life; palliative and coordinated care can help them maintain control of their care choices, avoid inpatient and emergency department costs, and increase their satisfaction with their end-of-life care.

The featured Innovations describe two programs that used palliative care to help elderly and terminally ill patients make greater use of hospice and home care services. A third program coordinated care for Medicare patients and their families, allowing them to define their wishes and options for end-of-life care, increase their use of hospice services, and reduce the incidence of inpatient stays.

The featured QualityTools provide educational, clinical, and organizational resources and information to help ensure better care for patients and their families as they face end-of-life issues.
October 10, 2012

Increasing Patient Involvement in Health Care

An increasing number of health care systems and providers offer services and tools that encourage and empower patients to take an active role in their own health care. The ability to access medical records, test results, and other health information online can increase patient involvement and facilitate patient—provider communication.

The featured Innovations describe two programs that provided patient access to online medical records via secure patient portals and a program that offered patients access to routine laboratory tests between visits, enhancing patient engagement and satisfaction.

The featured QualityTools provide resources and information to help patients and consumers make health care decisions and communicate effectively with providers.
September 26, 2012

State Health Care Legislation and Statewide Initiatives

State legislative initiatives play an important role in efforts to improve health care services and patient outcomes. Statewide programs that demonstrate the value of health care innovation can provide models for other states seeking to achieve similar goals.

The featured policy Innovations describe four different state programs- one that reduced hospital-acquired infection rates in New York, one that boosted hospital nurse staffing in California, one that supported development of patient-centered medical homes in Maryland, and a program that improved services for persons with mental illness in Florida.

The featured QualityTools include a toolkit for state health care reform, materials to support state efforts in reducing avoidable rehospitalizations, and an online dashboard about state initiatives in health information technology.
September 12, 2012

Workforce Development and the Role of Community Health Workers

The composition of the health care workforce continues to evolve to meet the needs of patients within a changing health care environment. Policies and programs designed to leverage the unique skill sets of community members and health workers can play an important role in the development and expansion of the health care workforce.

The featured Innovations describe the development of a new staff position for community members who assist health care teams in primary care settings and after hospital discharge, and a consortium in Minnesota that developed a scope of practice, a statewide curriculum, and a certificate program for community health workers.

The featured QualityTools include a toolkit to help rural communities evaluate opportunities for developing a community health worker program, and an instruction manual for training community health workers.
August 29, 2012

Enhancing Primary Care Access After Emergency Department Visits

Visits to the emergency department (ED) for nonemergent conditions result in unnecessary health costs and overcrowding, and often indicate poor primary care access for those who can least afford to pay for health care.

This issue’s featured Innovations describe a public-private consortium and a partnership between an academic medical center and community-based clinics that reduced nonemergent ED visits and increased access to primary care for Medicaid, uninsured, and underinsured patients, resulting in health care savings.

The featured QualityTools include a series of outreach materials used in a Washington State campaign and a guide for providers aimed at reducing avoidable ED visits.
August 15, 2012

Innovative Payment Policies

Traditional models of health care financing and delivery can lead to inefficient care and often lack incentives to control high health care costs and improve quality.

This issue’s featured policy Innovations describe an insurer’s contracting program and a medical center’s accountable care organization approach to reduce health care costs and improve quality, in addition to a multispecialty center’s use of innovative policies to enhance access to care among low-income patients.

The featured QualityTools include a decision guide about pay-for-performance for purchasers of health care services and a toolkit designed to assist health plans and providers in implementing a bundled fee payment model.
August 01, 2012

Sepsis Management

Sepsis is a common complication of infection that often leads to lengthy hospitalizations and a high risk of death. Early diagnosis of sepsis and prompt treatment with antibiotics can reduce mortality and support improved outcomes.

The featured Innovations describe two programs in California and Delaware that achieved significant reductions in sepsis mortality by supporting timely identification and treatment of patients with the condition.

The featured QualityTools describe two toolkits designed to improve clinical management and reduce mortality in patients with sepsis.
July 18, 2012

Reducing Disparities Through Peer Support

According to the 2011 AHRQ National Healthcare Disparities Report, disparities still exist and health care quality and access are suboptimal. While there is not a simple solution to eliminating disparities, leveraging peer networks and the power of peer-to-peer interactions has the potential to improve care and outcomes for vulnerable populations.

The featured Innovations describe a mentor program for African-American veterans with diabetes that improved blood glucose control and an interactive education class for kidney transplant candidates that increased the percentage of African-American patients and people of lower socioeconomic status, who completed the transplant evaluation process.

The featured QualityTools include a toolkit to help organizations and communities work with peers to engage people living with HIV/AIDS in care and treatment, and a guide to assess and promote cultural competency in mental health peer-run programs.
July 03, 2012

Clinical-Community Linkages to Improve Chronic Disease Care

Managing chronic diseases such as diabetes, asthma, and cardiovascular disease presents challenges both for maintaining optimal patient health and keeping health care costs in check. Partnerships between clinical practices, health departments, and community organizations can promote the delivery of high-quality health care and improve chronic disease management while controlling costs.

The featured Innovations describe a community-level partnership that used lay health advisers and a public-private initiative that leveraged community health teams to improve chronic disease care.

The featured QualityTools include a toolkit to help communities develop asthma management programs and a toolkit designed to support providers of self-management education programs focused on chronic conditions.
June 20, 2012

Support Following Unexpected Clinical Events

Many patients and family members experience an unexpected death or an unexpected clinical event, leading to difficulty understanding and coping with the event. When health care professionals deny and defend their actions and limit communications, patients and/or their family members tend to feel angry and guilty, and want to blame someone.

The featured Innovations describe one hospital program that provides multidisciplinary team support to patients and families who experience an unexpected clinical event, and another program that provides support to clinicians who are the "secondary victims" of unexpected events.

The featured QualityTools describe a toolkit and self-assessment to help health care organizations support and communicate with patients and families around adverse events. Another tool guides health care facilities in organizing institution-wide support for clinicians following adverse events.
June 06, 2012

Health Care Policy Innovations

With this biweekly issue, the AHRQ Health Care Innovations Exchange expands its scope to include health care policy innovations in addition to its current focus on health care service delivery innovations.

Health care policy innovation profiles will describe creative implementations of new or altered governmental or private initiatives that aim to improve health care quality by changing behavior through regulatory mechanisms, incentives, or other means to ensure accountability. We look for policies that are innovative in the context of their setting or target population, and that have important implications for the delivery of patient care.

View the complete inclusion criteria for health care policy innovations or the combined inclusion criteria for health care service delivery and policy innovations.

This issue’s featured Innovations describe an insurer’s incentive and support structure to stimulate quality improvement, a health care policy initiative implemented by the State of Connecticut, and a California state program that supports health care facilities in meeting a legislative mandate.

The featured QualityTools include a legislative toolkit to assist policymakers with the design of health insurance exchanges and resources to support States in developing or improving adverse event reporting systems.
May 23, 2012

Coordinating Community Care for Seniors

An increasing number of older adults have physical and mental problems that require assistance with daily living. Most seniors prefer to live independently for as long as possible in their homes. Outreach workers, who know their communities and can connect seniors to available health care and social services, play an important role in helping seniors maintain their independence.

The Featured Innovations describe two programs that provide seniors with care coordination and support, which reduced hospital and nursing home admissions, and a third program that provides care coordination to adults with serious mental illness, which reduced emergency department visits.

The Featured QualityTools provide resources for health care professionals to collaborate with community organizations and to identify services and supports that can be provided at home.
May 09, 2012

Pediatric Asthma Care

Pediatric asthma affects nearly 6 million children in the United States, reducing quality of life and often leading to costly emergency department visits and inpatient admissions. Low-income, urban children experience higher asthma-related morbidity due to environmental factors and poor access to appropriate care. Managing pediatric asthma according to existing guidelines can help minimize the potential for negative outcomes.

The featured Innovations describe one program that provided services to urban preschool children in an effort to improve asthma-related outcomes, and two programs that improved pediatric asthma care by increasing adherence to well-established care guidelines.

The featured QualityTools provide parents and health care practitioners with resources to help manage pediatric asthma and improve quality of life.
April 25, 2012

Improving the Diet of Low-Income Families

Low-income families face multiple challenges related to eating healthfully, including the relatively high cost of healthy foods, the lack of healthful choices in urban neighborhoods, and limited knowledge on how to prepare nutritious meals. Family-focused interventions can help overcome such barriers and promote healthy diets among low-income populations.

The featured Innovations describe two hospital-based programs— one that enhanced access to healthy foods and another that provided support to parents— aimed at improving the diet and overall health of low-income families.

The featured QualityTools provide information and tools for families, educators, and community leaders related to nutrition and the prevention of childhood overweight and obesity.
April 11, 2012

Patient-Centered Care

Recognized by the Institute of Medicine (IOM) as one of the six major domains of quality, patient-centeredness encompasses respect for and responsiveness to the needs, preferences, values, and cultural traditions of the individual patient, in addition to involving patients and families in clinical decisionmaking.

The featured Innovations describe two programs that delivered patient-centered care to vulnerable populations, thereby improving the patient experience and enhancing access to appropriate care.

The featured QualityTools provide clinicians and other stakeholders with resource guides that support a patient-centered approach to medication management.
March 28, 2012

Spreading Innovations for Cardiovascular Health

The goal of AHRQ's Health Care Innovations Exchange is to speed the implementation of innovative ways to improve and deliver health care. This issue focuses on cardiovascular health and the spread of innovations, from the infrastructure needed to dissemination strategies.

The Featured Innovations describe programs that developed improvements in the management of cardiovascular disease and chronic conditions.

The Featured QualityTools provide resources that consumers can use to assess their cardiovascular health and health care professionals can use to spread innovations.
March 14, 2012

Improving Health of Urban, Low-Income Populations

Residents of urban, low-income communities often face multiple barriers to accessing preventive health care services and specialty care for chronic conditions, which can contribute to health disparities.

The featured Innovations describe three programs that used different community-based approaches to enhance access to care and improve health status of urban, low-income populations.

The featured QualityTools provide information and resources that address the needs of economically disadvantaged individuals.
February 29, 2012

Caregiver Support

Nearly 65 million Americans care for an aging, seriously ill or disabled family member or friend. Caregivers, who tend to be women, are often overwhelmed by managing the daily needs of patients with dementia, which takes a toll on their emotional and physical health. 

The featured innovations describe three programs that use group and/or individual sessions to provide education, coaching and/or support to patients with dementia and their caregivers.

The featured QualityTools provide resources for health care professionals to address the many challenges that caregivers face.
February 15, 2012

Mental Health Care for Underserved Populations

Underserved populations face multiple barriers to accessing mental health care, often lacking regular, high quality treatment and support. Intensive care coordination for underserved individuals in need of mental health services can address barriers to care and reduce disparities.

The featured Innovations describe three programs that enhanced access to necessary services and provided care coordination to improve mental health outcomes among underserved populations.

The featured QualityTools contain resources and tools that aim to increase cultural competence in providing mental health care services to specific communities.
February 01, 2012

Remote Monitoring of Chronic Conditions

Ongoing monitoring of chronically ill individuals, especially older patients, can allow providers to intervene in a timely fashion, helping to prevent exacerbations and complications, reduce care costs, and keep patients in their homes. However, relatively few health systems have the capacity to monitor chronically ill individuals who live in the community.

The featured Innovations describe three programs that used remote monitoring devices or equipment to track patients' health conditions in community settings.

The featured QualityTools provide resources designed to set up remote health care programs, including retinopathy screening and telehealth centers.
January 18, 2012

Culturally Tailored Programs

Health interventions that are culturally tailored take into account the beliefs, values, and circumstances of specific cultural groups. Developing programs in a culturally relevant context can improve their effectiveness, particularly in traditionally underserved communities.

The featured Innovations describe three programs that delivered culturally tailored services to promote behavior change and improve health status among their target populations.

The featured QualityTools provide resources to support the development of culturally tailored diabetes and tobacco control programs.
December 21, 2011

Redesigning Care Processes Through Technology

Information technology is increasingly being used to improve patient care processes and outcomes. Systems that facilitate access to comprehensive patient information before and during patient visits can enhance the ability of clinicians to provide efficient and systematic care management.

The featured Innovations describe how two providers leveraged the use of technology to redesign care processes, leading to greater adherence to recommended care and improved outcomes.

The featured QualityTools provide resources and tutorials to support the adoption of health information technology by physician offices and health care organizations.
December 07, 2011

Partnerships to Improve Care Coordination

The American medical system is extraordinarily fragmented and difficult to navigate. The average Medicare patient sees seven different doctors, according to the New England Journal of Medicine. Partnerships are an important strategy to enhance care coordination for patients.  Partnerships exist between primary care practices and specialty practices, primary care practices and community-based organizations, and between community based organizations and multidisciplinary health care teams.

The featured Innovations describe two programs that have implemented strategic partnerships to enhance care coordination for seniors and veterans.

The featured QualityTools offer a guide on how to create an ideal transition home and a toolkit to prepare your organization for care transitions for seniors.
November 23, 2011

Patient Engagement

Patient engagement is an ongoing process in which patients take an active role in their own health care. Many factors—including personal skills, motivation, and behaviors—affect an individual's ability to effectively engage in care.

The featured Innovations describe one program that used a storytelling approach and another program that provided text messaging to encourage behavior change among vulnerable populations, leading to greater patient engagement and improved outcomes.

The featured QualityTools provide resources to help health care professionals partner with patients and families to involve them in care, and information to assist health care consumers in communicating effectively with providers about their health care.
November 09, 2011

Algorithm-Based Treatment Decision Support

Treatment algorithms, also referred to as practice guidelines, are a series of treatment steps, each of which is defined by the clinical response of the patient to the preceding step. Algorithms are often integrated into computerized clinical decision support systems in patient care settings.

The featured Innovations describe how two different hospitals are using algorithms to improve patient care. The first hospital uses an algorithm to guide test ordering to detect a life-threatening condition while the second hospital uses an algorithm to detect medical errors in trauma treatment.

The featured QualityTools present a range of algorithms that support decision-making in the prevention, treatment, and evaluation of various health conditions and diseases.
 
October 26, 2011

Evaluation and Treatment of Alcohol Dependence

Individuals with alcohol dependence are often hospitalized and may require treatment for acute intoxication or to reduce the risk of alcohol withdrawal symptoms. Alcohol and drug dependence are generally considered to be chronic disorders that require some form of continuing care after initial treatment and stabilization to reduce the risk of relapse.

The featured Innovations describe two hospital programs that improved care and reduced length of stay for patients with alcohol dependence, and one outpatient program that provided continuing care services to help individuals avoid relapses.

The featured QualityTools provide resources for clinicians, substance abuse counselors, and program administrators to help improve the treatment of substance use disorders.
October 12, 2011

Reducing Hospital-Acquired Infections

Nearly 1.7 million hospital-acquired infections (HAIs) occur annually, leading to approximately 99,000 deaths every year, according to the Centers for Disease Control and Prevention (CDC). (Adobe Reader is required to view or print the PDF. Download a free copy hereExternal Web Site Policy) Recent efforts have demonstrated that infections can be controlled and significantly reduced through relatively simple measures.

The featured Innovations describe three programs that have reduced HAIs by implementing infection control measures ranging from weekly rounds to a set of common protocols and practices.

The featured QualityTools describe two toolkits designed to assist health care professionals in implementing infection control measures in hospitals.
September 28, 2011

Smoking Cessation Programs

Despite progress in reducing tobacco use, in 2010 nearly one in five adults smoked cigarettes, according to the Centers for Disease Control and Prevention.

Treatments such as counseling and use of medications can be effective, but many tobacco users lack awareness of or access to smoking cessation resources, especially among low-income and underserved individuals.

The featured Innovations describe two programs that led to increased use of smoking cessation resources and higher quit rates.

The featured QualityTools provide practical approaches for treating tobacco dependence in the clinical setting and for achieving tobacco-free hospitals and health systems.
September 14, 2011

Home Health Programs

Home health visitation programs offer a range of services to improve the health status of individuals and families. These include assessments, education, and support, which create healthier environments for families to thrive. 

The featured profiles describe two programs that provide home visits to conduct asthma assessments and health literacy education for low-income parents.

The featured tools describe workbooks, training aids, and toolkits for home health providers.
August 31, 2011

Palliative Care

Palliative care relieves suffering and improves quality of life for patients with serious conditions and their family caregivers. It involves symptom and pain management, shared decisionmaking, practical and psychosocial support, and coordination across care settings. Palliative care services are typically provided by multidisciplinary teams that consult with patients and family members to address their complex needs.

The featured Innovations describe three programs that deliver palliative care in different settings.

The featured QualityTools provide health care professionals with resources and tools to support the development and quality improvement of palliative care programs.
August 17, 2011

Reducing Readmissions in Special Settings

Hospital readmissions are costly and often avoidable with better care transitions between hospitals and different care settings. According to a recent study, 23.5 percent of all patients discharged to skilled nursing facilities in 2006 were rehospitalized within 30 days, at a total cost of $4.34 billion per year to the Medicare program.

The featured Innovations describe three different programs that reduced hospital readmissions from long-term residential care and skilled nursing facilities, leading to significant cost savings.

The featured QualityTools provide resources and tools for improving transitions of care and reducing avoidable rehospitalizations.
August 03, 2011

Clinical & Community Linkages

A long-term goal of AHRQ is to foster linkages between clinical practices and community organizations to enhance the delivery of preventive services. By increasing access to health care and community services, these linkages can improve health outcomes and reduce disparities.

The featured Innovations describe two programs that increased access to culturally competent services through a comprehensive approach that included linkages.

The featured QualityTools offer resources to build clinical and community partnerships, including an assessment of community health needs. 
July 20, 2011

Health IT in Care Coordination

Patients often receive fragmented care that is delivered across multiple providers and organizations. Health information technology is increasingly being used to improve care coordination by enabling the timely and effective exchange of clinical information between providers.

The featured Innovations describe three programs that use electronic systems in the coordination of care, with a focus on patient referrals and care transitions.

The featured QualityTools provide guidance for the electronic exchange of health information and other resources to support coordinated care.
July 06, 2011

Medical Electronic Alerts

Medical electronic alerts are being integrated into clinical decision support systems, electronic health records (EHRs), and electronic prescribing to improve patient safety and quality of care. Clinicians receive alerts or reminders at the point of care to take specific actions such as ordering a test or confirming the patient is not at risk for a drug-drug interaction. However, as one program discovered, it is important to be selective about the number and type of electronic alerts to have a positive impact on physician behavior.

The featured Innovations describe three programs that use electronic alerts or reminders along with clinical guidelines or other best practices to improve patient care and physician performance.

The featured QualityTools provide standard approaches to improve the usability of EHRs and frequently asked questions about clinical decision support systems.
June 22, 2011

Health Care for Prisoners

Prison inmates are vulnerable to infectious diseases, including HIV and Hepatitis C, and other health problems. More than 70 percent of the approximately 700,000 people released from U.S. Federal and State prisons each year have chronic medical, substance abuse, and other mental health problems. The need for treatment often competes with other important issues, such as finding housing, obtaining employment, and reuniting with their families. In addition, few programs are available to help recently released prisoners access medical and social services.

The featured Innovations describe three programs that provide medical and/or social services for prisoners or ex-prisoners with infectious or chronic diseases.

The featured QualityTools describe three tools health care professionals can use to treat offenders with chronic diseases.
June 08, 2011

Patient Self-Management

Self-management is an important aspect of health care for individuals with chronic conditions. Patients and their families often have to learn and follow complex medical regimens, and make challenging changes in lifestyle, such as weight loss or increasing exercise. Through collaboration, patients, family, and providers share information, understand the patient’s goals, and create a plan that can be used to guide care at home and in the clinical setting.

The featured Innovations describe three programs that implemented one or more of the components of self-management that led to increased knowledge, adopting healthy behavior, and/or goal-setting.

The featured QualityTools describe three practical resources that health care professionals can use to support patients in self-management.
May 25, 2011

Cultural Competence

Health care professionals increasingly encounter patients from diverse cultures and ethnic backgrounds, yet they are often ill-equipped to understand and respond effectively to the patient's cultural needs. Health care organizations can facilitate the cultural competence of their staff by establishing a set of congruent policies, attitudes, and behaviors that promote effective cross-cultural interactions and patient outcomes.

The featured Innovations describe three programs that have implemented strategies to increase providers' cultural and/or linguistic competence.

The featured QualityTools describe practical resources on cultural competence for providers.
May 11, 2011

Health in Underserved Women

Medically underserved women have difficulty accessing and using health care services, which increases their risk of serious health problems and even death. Women are more likely to be medically underserved if they reside in rural or geographically remote areas, have a physical or mental disability or low literacy, belong to a minority and/or speak a minority language, and are low-income, homeless, elderly, lesbian, migrant workers, immigrants, or refugees.

The featured Innovations describe three programs that provided health care services, including screening and information, to medically underserved women.

The featured QualityTools describe online health and wellness resources for women, including rural women.
April 27, 2011

Text Messaging & Sexual Health

The number of cell phone users has increased dramatically worldwide, making it easier to send mobile text messages. Public health agencies are using text messaging to communicate sexual health information and prevent sexually transmitted infections, especially among young people.

The featured Innovations describe three text messaging programs in England and the United States that provide sexual health information such as testing locations or test results.

The featured QualityTools summarize and link to Web resources on sexual and reproductive health text messaging programs.
April 13, 2011

Core Measures in Hospitals

On average, public hospitals have performed more poorly than private hospitals on four core measures involving clinical care for a heart attack, heart failure, pneumonia, and surgical care that are reported to the Centers for Medicare and Medicaid Services (CMS). The gap in performance measures may be due to public hospitals having more patients with complex physical and social needs, smaller budgets, or older infrastructure, according to The Commonwealth Fund.

The recommended clinical care processes are evidence-based and have been proven to be effective in improving patient outcomes, making it imperative that all patients receive the recommended treatment.

The featured Innovations describe three programs implemented by health systems to improve their hospitals' performance on the four clinical care core measures.

The featured QualityTools describe three practical tools that hospitals can use to track their progress on core measures.
March 30, 2011

Healthy Weight in Children

Nationwide, the prevalence of obesity among children and adolescents has more than tripled in recent decades. New strategies to promote healthy weight in children include policy-level initiatives and the implementation of practice changes by providers, schools, and communities to encourage the adoption of healthier lifestyles.

The featured Innovations describe a multi-sector, collaborative, statewide initiative that implemented new legislation, policies, and a social marketing campaign to promote behavior change and help halt the increase in childhood obesity.

The featured QualityTools provide toolkits and resources for families, community organizations, health care professionals, and employers to help promote healthy weight in children.
March 16, 2011

eMedication Monitoring

Electronic systems and devices are increasingly being used to monitor and evaluate medication-related processes such as ordering, administration, and medication reconciliation.

The featured Innovations describe three programs that utilized electronic systems in various ways to improve medication safety, reduce costs, and increase medication adherence.

The featured QualityTools provide information and guidelines related to telepharmacy, medication reconciliation, and safe, appropriate medication use among older adults.
March 02, 2011

Refugee Health

Refugees flee their homelands for many reasons, including violent conflicts, political or religious persecution, and famine. Refugees who settle in the United States often have disproportionate physical and/or mental health problems due to past traumatic experiences, refugee camp conditions, lack of access to health care, and economic hardships.

The featured Innovations describe three programs that enable refugees to receive health care and social and rehabilitative services that are culturally competent.

The featured QualityTools describe three toolkits that providers can use to educate refugees about lead poisoning prevention in children, nutrition, and healthy living.
February 16, 2011

Personal Health Records

Personal health records (PHRs) allow health care consumers to collect and maintain complete, updated health information that is easily accessible and can be shared with caregivers and health care providers. The use of PHRs can increase patients’ engagement in managing their own health care and can enhance provider efficiency, leading to improved quality of care.

The featured Innovations describe three programs that utilized personal health record systems in various ways to improve care.

The featured QualityTools provide resources and tools to assist health care consumers in creating their own personal health records.
February 02, 2011

Mental Illness Care

Individuals with mental illness often relapse and are hospitalized when they don't adhere to their medications, lack supportive services, and/or abuse substances.

Care coordinators play a vital role in reducing hospital readmissions by helping individuals with psychiatric conditions obtain mental health, medical, and social services.

The featured Innovations describe three programs that used care coordinators to assess, monitor, and connect individuals with mental illness to needed services.

The featured QualityTools provide practical tools to assist providers in improving communication and care coordination for individuals with mental illness.
January 19, 2011

Phone-Based Care Management

Telephone care management programs can help reduce medical costs and can lead to improved patient care, medication adherence, and patient satisfaction. The process typically involves nurses who call patients to provide education about specific medical conditions and therapeutic options, to assess symptoms, and to support individuals in health care decisionmaking.

The featured Innovations describe three programs that utilized a telephone-based approach to deliver care to specific patient populations.

The featured QualityTools provide clinicians with information about the use of telephone care for the management of specific conditions.
December 22, 2010

Workplace Wellness

Many workplaces offer programs for employees to support behavior change to improve their health and reduce associated health risks. Typical employee wellness activities include health fairs, health education, medical screenings, health coaching, weight management, wellness newsletters, and onsite fitness programs and/or facilities.

The featured Innovations describe workplace programs that address two common employee health problems—diabetes and substance abuse.

The featured QualityTools provide practical tools for employers to address overweight and obesity in the workplace and create a tobacco-free workplace.
December 08, 2010

Baldrige Award

This issue’s featured Innovations were developed by organizations that are past recipients of an award from the Baldrige Performance Excellence Program, a public-private partnership led by the National Institute of Standards and Technology. Congress created the Baldrige National Quality Award in 1987 to promote excellence in organizational performance. Although this Presidential Award is not given for innovation or specific services, the Innovations featured here represent the work of organizations previously recognized as health care performance leaders by the Baldrige program.

The featured QualityTools provide links to Baldrige program resources and tools that can assist health care organizations in the pursuit of performance excellence.
November 24, 2010

eBehavioral Health

Cognitive behavioral therapy (CBT) is effective in treating depression and anxiety disorders. However, individuals who could benefit from CBT may not have access to a therapist or avoid seeing a therapist due to stigma. These patients can benefit from new technologies that enable them to have remote access to CBT.

The featured Innovations describe two electronic methods of improving behavioral health: a mobile phone application with CBT exercises and Internet-enabled instant messaging with a CBT-trained therapist.

The featured QualityTools describe telepsychiatry guidelines and electronic patient safety alerts.
November 10, 2010

Childhood Obesity

Childhood obesity is a significant, growing problem that has severe health consequences for our nation’s youth. According to the White House Task Force on Childhood Obesity Report to the President (Adobe Reader is required. Download a free copy hereExternal Web Site Policy), obesity has more than tripled among children and adolescents since 1980, from 5% to 17%. Recent approaches to address the problem have focused on increasing family involvement and access to recreational activities to build healthier lifestyles.

The featured Innovations describe programs that used a family-centered approach and referrals to community exercise programs to promote healthy weight among children and adolescents.

The featured QualityTools provide policymakers, physicians, and parents with resources and information to manage and prevent childhood obesity.
October 27, 2010

Community Services for Seniors

Senior citizens want to live independently as long as possible. However, their ability to manage daily tasks is diminished by falls, fractures, and disability associated with chronic conditions and modifiable risk factors. Home- and community-based services for seniors can improve their health and prevent further decline.

The featured Innovations describe an in-home physical therapy program and a senior center self-management and coaching program that improved overall functioning of seniors.

The featured QualityTools offer health care professionals, community planners, and family caregivers practical tools to help seniors stay in their homes and communities.
October 13, 2010

Medication Management

Inappropriate medication use, adherence problems, and medication administration errors increase the risk of adverse events and can lead to unnecessary medical costs. The use of software-based screening protocols and medication reviews by pharmacists can help identify medication problems or concerns, improve appropriate use, and reduce the potential for errors.

The featured Innovations describe three programs that implemented medication management processes to reduce the risk of errors and adverse events.

The featured QualityTools provide guidelines and tools to improve medication safety and use in various care delivery settings.
September 29, 2010

Inpatient Flow Strategies

Wait times in hospital emergency departments (EDs) have increased dramatically, with implications for the health and health care of millions of people. Hospitals can use the Input/Throughput/Output Model of Patient Flow   (Adobe Reader is required to view or print the PDF. Download a free copy hereExternal Web Site Policy) to create a work plan for systematically assessing patient flow problems.

The featured Innovations describe three hospital programs that used inpatient flow strategies to solve the problem of patient overcrowding.
September 15, 2010

Community Care Coordination

Identifying at-risk individuals and connecting them to appropriate care can improve health outcomes and reduce health disparities. Community care coordination aims to improve the quality, efficiency, and coordination of health care and social services for at-risk populations. Such programs often use community health workers or navigators to help coordinate services.

The featured Innovations describe three programs that used the Pathways© model of community care coordination to connect at-risk individuals to needed services, thereby improving health outcomes.

The featured QualityTools provide resources that can assist communities in their efforts to improve the quality and coordination of health care services.
September 01, 2010

Health IT in Rural Communities

Residents of rural communities often have limited access to appropriate, high quality care due to distance and a shortage of hospitals, physicians, and medical specialists that serve rural populations. Health information technology (health IT) applications, such as telehealth, electronic medical records (EMRs), and health information exchanges, can help rural communities overcome the unique challenges they face in the provision of health care.

The featured Innovations describe three programs that utilized health information technologies to improve health outcomes in rural areas.

The featured QualityTools provide resources and tools to support planning and implementation of health IT applications in various health care settings.
August 18, 2010

Integrated Primary Care

"Integrated primary care" refers to the integration of behavioral health services--mental health, substance abuse, and health behavior change strategies--with primary care services. The level of integration can vary depending on whether both services are coordinated, co-located, or integrated into one treatment plan.

The featured Innovations describe three programs that developed integrated primary care services to address the needs of vulnerable patient populations.

The featured QualityTools describe learning modules and toolkits on how to develop integrated primary care services.
August 04, 2010

Language/Culture Matching

The proportion of the U.S. population with limited English proficiency (LEP) has nearly doubled from 1980 to 2000, and is projected to increase. Research has shown that language and cultural barriers complicate physician-patient communication and adversely affect health care quality.

To address this problem, new programs are matching patients with providers or health coaches who fit their language and/or cultural preferences, which can improve patient satisfaction and health outcomes. 

The featured Innovations describe three programs that took different approaches to addressing patients' language and cultural needs.

The featured QualityTools describe practical resources designed to improve communication with a diverse patient population.
July 21, 2010

Chronic Disease Management

Chronic diseases such as heart disease, cancer, and diabetes are responsible for 7 of 10 deaths annually and account for 75 percent of the nation’s health spending, according to the U.S. Department of Health and Human Services. However, most chronic diseases can be prevented and/or managed.

The featured Innovations describe three programs designed to prevent and/or manage chronic diseases and improve clinical outcomes.

The featured QualityTools provide clinicians and patients with practical guidance on ways to prevent and/or manage chronic diseases, including asthma and diabetes.
July 07, 2010

Shared Decisionmaking

In shared decisionmaking, both the patient and clinician share information, participate in the decisionmaking process, and agree on the best strategy for treatment. The clinician provides personalized information, tools, and/or decision aids to help the patient understand available treatment options, and encourages the patient to consider his or her personal values in making treatment-related decisions.

The featured Innovations describe three programs that have provided shared decisionmaking tools and support to patients.

The featured QualityTools include decision aids and tools for patients to increase their knowledge about treatment options, and tools for clinicians to assist patients in making health care decisions.
June 23, 2010

Medical Error Reporting

Since the 1999 Institute of Medicine Report publicized that up to 98,000 patients die annually due to often preventable medical errors, many hospitals have initiated programs to increase medical reporting of errors and reduce costs associated with additional patient care and malpractice lawsuits.  Effective programs have changed the hospital culture from blame and denial to transparency and open communication. 

The featured Innovations describe three programs that initiated new patient safety processes, including full disclosure of medical errors, open communication with patients, and corrective actions.

The featured QualityTools describe practical resources for reporting medical errors and communicating harm to patients.
June 09, 2010

Connecting Health Care and Social Services

Patients with multiple and complex health conditions, mental health problems, and/or limited English proficiency often need a range of social services and support to manage their conditions. Health care providers and organizations can help patients connect to behavioral health services, social support, financial assistance programs, and other services that address their specific needs.

The featured Innovations describe three different programs that help vulnerable populations access needed social services.

The featured QualityTools help health care providers refer patients to services and to identify community-based resources.
May 26, 2010

Clinical Decision Support Tools

Clinical decisionmaking has become increasingly complex. Health care professionals are turning to decision support tools defined broadly as clinical systems, applications, or processes to optimize clinical decisionmaking at the point of care. These tools range from computerized alerts and reminders, clinical guidelines, and order sets to documentation templates, diagnostic support, and patient data reports.

The featured Innovations describe three different programs that have used clinical decision support tools to improve the quality of patient care.

The featured QualityTools provide health care professionals with a range of practical clinical decision support tools.
May 12, 2010

Coaches/Patient Navigators

Coaches in health care settings work with patients to make behavior changes and with health care professionals to make process improvements that can lead to better health outcomes. Patient navigators help individuals understand how the health care system works and gain access by removing barriers to health care.


The featured Innovations describe three different programs that utilized coaching to improve health outcomes among different patient populations.

The featured QualityTools provide tools and resources that can help support patient navigation programs and coaches in health care settings.
April 28, 2010

Reducing Youth Health Disparities

Youth, especially among racial and ethnic minorities, experience higher rates of diseases, injuries, and violence than Whites and fewer opportunities to achieve optimal health.  Youth health risk factors include poor dietary choices, low levels of physical activity, lack of dental care, and substance abuse. 

The featured Innovations describe three different programs that addressed health disparities among youth.

The featured QualityTools provide best practices, tools, and information that can help reduce health disparities among youth.
April 14, 2010

Waste Reduction

Reducing waste and improving efficiency in health care delivery can reduce costs and improve health care quality. Inefficient processes waste limited health care resources that could otherwise improve health outcomes. Improvement strategies include implementing evidence-based practices and improving clinical process design and management.

The featured Innovations describe three programs that implemented activities to reduce waste and improve health care delivery processes.

The featured QualityTools provide health care organizations with resources and tools to identify and reduce waste and track associated cost savings. 
March 31, 2010

Medical Homes

The trend in primary care delivery toward patient-centered medical homes has gained the attention of policymakers.  The recently enacted health care reform legislation would expand practice- and community-based medical home demonstration projects through Medicare.

The featured Innovations describe three medical home programs that improved patient access to care and quality of care. 

The featured QualityTools provide practical resources to develop patient-centered medical homes.
March 17, 2010

Delivering Culturally Competent Care

Health care services that respect and respond to diverse patients' health beliefs, practices, and cultural and linguistic needs can produce positive health outcomes and reduce health disparities.

The Health and Human Services Office of Minority Health has established national standards for culturally and linguistically appropriate services.  Health care organizations receiving federal funding are required to meet the linguistic standards, and national, federal, and state accrediting agencies are encouraged to mandate the cultural competence standards.

The featured Innovations show how three programs implemented cultural and/or linguistic services to meet the needs of diverse patient populations.

The featured QualityTools provide several practical resources to develop health care services for diverse patient groups.
March 03, 2010

Pressure Ulcers

Pressure ulcers are a common problem across health care settings. The incidence of pressure ulcers varies by clinical setting: 0.4% to 38.0% for hospitals, 2.2% to 23.9% for long-term care, and 0% to 17% for home care, according to a 2003 article published in the Journal of the American Medical Association.   

The estimated cost to treat a pressure ulcer is between $500 and $40,000. Yet, pressure ulcers can be managed and prevented. 

The featured Innovations describe two programs that reduced hospital-acquired pressure ulcers by implementing new quality improvement measures. 

The featured QualityTools provide practitioners with practical resources to prevent and reduce pressure ulcers.
February 17, 2010

Health Promotion and Disease Prevention

Health promotion activities are designed to encourage healthy behaviors and reduce the risk factors associated with diseases and chronic conditions. Health education combined with related organizational, economic, and political interventions can enable individuals and communities to improve their health.

The featured Innovations describe three programs that implemented a range of health promotion activities to improve patient outcomes.  

The featured QualityTools provide health professionals with practical tools to plan and implement health promotion activities.
February 03, 2010

Care Coordination

Americans are living longer with multiple conditions and being cared for by multiple providers. Coordinating care as patients move from one health care setting to another or between a primary care professional and specialists is essential to avoid duplication of efforts, conflicting plans of care, and over-, under-, or mis-use of medications. 

The featured Innovations show how three care coordination programs are increasing efficiency, effectiveness, and patient satisfaction.

The featured QualityTools provide resources to help health care providers better coordinate patients’ care between settings.

January 20, 2010

Nursing Leadership

Nurses need professional opportunities to develop their leadership skills such as serving in various clinical roles and engaging in quality improvement initiatives. 

The featured innovations describe leadership roles nurses play across patient care settings.

The featured QualityTools describe practical resources to assist nurses in leadership roles.
December 23, 2009

Integrating Mental Health Care and Primary Care

People with mental health problems are more likely to visit their primary care doctors than mental health professionals. Yet, mental health problems are often overlooked in primary care settings due to time constraints and lack of training.   

The featured innovations describe a remote mental health consultation service for patients seen in primary care settings and the use of support services to encourage primary care providers to refer patients with behavioral problems to community-based organizations.  

The featured QualityTools provide primary care practitioners a range of mental health resources.
December 09, 2009

Social Media

Social media applications ranging from text messaging to social networking are increasingly being used by health care providers to improve patient care. 

The featured innovations describe mobile phone and text messaging programs to improve self-management of chronic diseases and increase awareness and testing for sexually-transmitted diseases. 

The featured QualityTools describe a range of Web sites offering health information and resources.
November 25, 2009

Elderly Health

The elderly (age 65 and over) have complex health and social needs. Almost 75 percent of the elderly have at least one chronic illness, while roughly one-half have at least two. Many elderly patients take multiple medications, with some taking as many as 10 on a daily basis.

The featured innovations describe programs that focus on improving care coordination, influenza and pneumonia vaccination rates, and nursing home quality.

The featured QualityTools offer a range of practical resources that complement the featured innovations.
November 11, 2009

Health Literacy

Nearly one in two adults living in the United States has limited health literacy, which affects their ability to obtain, process, and understand basic health information, according to a 2004 Institute of Medicine report. The highest rates of limited health literacy are among people who are older, low-income, medically underserved, and minorities. 

The featured innovations describe different approaches health professionals used in community-based settings to improve health literacy.  

The featured QualityTools provide several resources to assess patient's health literacy and address patients with low health literacy.
October 28, 2009

Oral Health Disparities

Oral health disparities persist in the U.S. population for many reasons, including complex cultural and social processes that affect oral health and access to effective dental health care. Infrequent preventive care and high rates of dental disease are associated with minority status, low socioeconomic status, and unemployment.

The featured innovations describe programs aimed at reducing oral health disparities in two vulnerable populations — older homeless adults and refugees.

The featured QualityTools provide oral health resources, including a toolkit and an educational video to assist health professionals working with vulnerable populations.
October 14, 2009

Healthcare-Associated Infections

In American hospitals alone, healthcare-associated infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year, according to a 2009 report from the Centers for Disease Control and Prevention. (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software.)

Implementing infection control practices can significantly reduce HAIs associated with catheters, central lines, ventilators, MRSA, Clostridium difficile, and surgical sites.   

The featured innovations describe several initiatives to reduce HAIs, including the AHRQ-funded ICU hospital collaborative (Michigan Keystone ICU Project) that saved an estimated 1,800 lives, 140,000 hospital days, and at least $270 million over a 5-year period. 

The featured QualityTools provide practical ways to reduce HAIs, including a central line care team insertion checklist.
September 30, 2009

Developmental Disabilities

People with developmental disabilities experience chronic conditions due to physical or mental impairments such as loss of vision, hearing impairment, cerebral palsy or autism. Although these disabilities occur by age 22, they usually last a lifetime and interfere with major life activities such as language, mobility, learning, self-help, and independent living, according to the CDC's National Center on Birth Defects and Developmental Disabilities.

The featured innovations describe two programs that deliver important health care services or health education to adults with developmental disabilities.

The featured QualityTools provide practical resources for schools and parents to support children with autism and special needs.
September 16, 2009

Worksite Wellness

Despite rising health care costs, employee health is worsening. This combination of factors threatens corporate viability and the sustainability of the American health care system. As the largest provider of health care coverage, employers offer the potential to exert transformative leadership, according to the U.S. Workplace Wellness Alliance.

The featured innovations describe a variety of employer-initiated programs designed to improve employee health and reduce health care costs. 

The featured QualityTools provide practical resources to assess and promote employee health.
September 02, 2009

The Patient-Centered Medical Home

A Patient-Centered Medical Home (PCMH) provides an interdisciplinary coordinated approach to delivering primary care and other services to patients based on their needs. There are currently more than two dozen different PCMH pilot projects and as many different models represented across the country.

The featured innovations describe two medical home programs that serve different populations.

The featured QualityTools provide practical resources to facilitate the implementation of medical homes.
August 19, 2009

Long-Term Care

The U.S. Government Accountability Office has found that one-fourth of the country's 16,000 nursing homes have serious deficiencies that cause actual harm to residents or place their health and safety at risk.

The featured innovations describe quality improvement efforts to reduce high rates of ventilator-associated pneumonia, pressure ulcers, and staff turnover at long-term care facilities.

The featured QualityTools provide practical information and resources to improve long-term care.
August 05, 2009

Integrating Health Information Technology with Care Delivery

The Institute of Medicine has recommended that hospitals and medical groups adopt electronic medical record (EMR) systems, electronic order entry and prescribing, and other process improvements to improve patient care and safety. However, physicians have been slow to adopt health information technology (HIT) due to time and financial constraints.

The featured innovations describe programs that implemented HIT systems—one used financial incentives to increase physician use—and improved care delivery.

The featured QualityTools provide practical information and resources to facilitate HIT use.
July 20, 2009

Reducing Hospital Readmission Rates

Hospital readmissions are common and costly. One in five Medicare patients were readmitted to a hospital within 30 days of being discharged in 2003 and 2004, which generated an estimated total of $17.4 billion in hospital payments in 2004, according to an April 2, 2009 New England Journal of Medicine article.

The featured innovations describe two programs that reduced hospital readmission rates and a third one that did not reduce readmission rates. Both types of innovation experiences offer important lessons learned. The featured QualityTools provide practical discharge planning tools.
July 06, 2009

Service Delivery Changes in Caring for Children with Disabilities

About 14 percent of all children in the United States are at increased risk of chronic physical, developmental, behavioral or emotional conditions that require multiple health care services, according to a Maternal and Child Health Bureau survey. Yet, children with disabilities often do not receive adequate services. 

The featured innovations describe innovative programs that improve access to needed services for children with disabilities. The featured QualityTools describe practical tools to better identify children with disabilities.
June 22, 2009

Women's Health

Programs that use community health workers and telephone consultations may help women at-risk for health problems especially in underserved communities. The featured innovations describe the use of these components to advance women's health while the featured QualityTools describe practical aides to women's health.
June 08, 2009

Mental Health Care

Half of all lifetime cases of mental illness begin by age 14, and despite effective treatments, individuals typically don't seek and receive treatment until several years later, according to a study funded by the National Institute of Mental Health. 

The featured innovations and QualityTools describe a range of mental health programs and approaches to improving detection, diagnosis and treatment.
May 25, 2009

Implementing Evidence-Based Clinical Practice Guidelines

Clinical practice guidelines are more likely to lead to quality care when they are evidence-based and actionable.  AHRQ's National Guideline Clearinghouse has more than 2,000 current guidelines that meet specific criteria. 

The featured innovations and QualityTools describe a range of guideline implementation strategies and ways to improve guideline adherence.
May 11, 2009

Management of Asthma

Asthma is a common disease that affects an estimated 22 million Americans including more than 6 million children, according to the CDC's National Center for Health Statistics.

The featured content describes innovations and QualityTools that focus on asthma education and self-management.
April 27, 2009

Prevention Through Screening

The featured content describes innovations and QualityTools that focus on integrating screening and other preventive services with clinical patient care.
April 13, 2009

Improving the Health of Obese and Overweight Youth

More than 23 million children and adolescents are overweight or obese in the United States. They are at increased risk of heart disease and stroke, diabetes, asthma and certain types of cancer, according to the Robert Wood Johnson Foundation's program on obesity.
 
The featured content describes innovative programs and QualityTools to help obese youth achieve a healthy weight and life-style.
March 30, 2009

Teamwork and Communication

Patient safety experts have identified effective teamwork as an essential factor in reducing medical errors. Encouraging team approaches to health care delivery can increase communication timeliness and accuracy and reduce adverse events. 

The featured profiles describe programs designed to enhance teamwork and communication.
March 16, 2009

Culturally Competent Care

According to the National Center for Cultural Competence, providing culturally competent health care services requires an understanding of: 

  • cultural beliefs, values, traditions and practices;
  • culturally defined, health-related needs of individuals, families and communities;
  • culturally based belief systems of the etiology of illness and disease and those related to health and healing; and
  • attitudes toward seeking help from health care providers.
The featured innovations describe culturally competent programs that serve diverse populations.  
March 02, 2009

Improve Patient Safety and Reduce Medical Errors

The rate of medical errors in American hospitals remains high. About 1 million patient safety incidents occurred in approximately 40 million Medicare hospitalizations between 2004 and 2006, according to the Fifth Annual HealthGrades Patient Safety in American Hospitals Study. (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software.) The Institute of Medicine reported in 2006 that medication errors alone injure at least 1.5 million Americans annually, costing the nation more than $3.5 billion a year.

The featured profiles describe innovative hospital programs designed to improve patient safety and reduce medical errors.
February 16, 2009

Improve Patient Care upon Hospital Discharge and Patient Safety during Transfers

In today's fragmented health care system, there is a lack of coordination and continuity of care when patients transition from hospital to home or to another health care institution. The featured innovations describe programs designed to improve patient care upon hospital discharge and patient safety during intra-hospital transfers.
February 02, 2009

Using the Pathways Model to Increase Access to Health Care

The featured innovations describe "pathways" programs involving community health workers or counselors who implement action steps to connect at-risk people to needed health care care and services.
January 19, 2009

Delivering Health Care to Uninsured and Low-Income People

According to the 2007 U.S. Census Bureau, 45.7 million Americans lack health insurance.

The featured innovations describe programs that are designed to increase access to and use of health care services.
December 22, 2008

Improving the Health Literacy of Patients

Ninety million Americans have difficulty understanding and acting on health information, according to the 2004 Institute of Medicine Report: Health Literacy: A Prescription to End Confusion.  

The featured innovations describe health care programs or processes that address the literacy needs of patients.
December 08, 2008

Linking Clinical Practices and the Community

The featured innovations focus on improving service coordination and delivery through collaborative arrangements among health care providers and community organizations.
November 24, 2008

Improving HIV Prevention, Detection, and Treatment

The featured innovations focus on providing outreach and community-based services to high-risk populations.
November 10, 2008

Using Teams to Improve Health Care Delivery

The featured innovations focus on improving access to care through multidisciplinary and culturally competent teams and evidence-based approaches to teamwork.
October 27, 2008

Improving the Health and Care of the Elderly

The US Census Bureau has projected that nearly one in five Americans will be age 65 or older by 2030, which will increase the demand for health care services. The featured innovations, by providing outreach to the elderly, preventive services, and care management, may reduce the need for intensive and expensive health care services.
October 13, 2008

Cultural Competence

This issue focuses on cultural competence, which embraces the principles of equal access and non-discriminatory practices in service delivery. Cultural competence is achieved by identifying and understanding the needs and help-seeking behaviors of individuals and families, according to the National Center for Cultural Competence. 

The featured innovations describe health care programs that provided culturally and linguistically appropriate outreach and services to diverse patients.

The featured QualityTools provide materials that organizations can use to assess and improve their cultural competence.
September 29, 2008

Role of Nurses in Improving Health Care Delivery

The featured innovations describe nurse-led hospital interventions and home health programs in which nurses play a key role. 

The featured QualityTools provide a range of educational resources for nurses and nursing assistants.
September 15, 2008

Improving the Health of Children, Adolescents, and Their Families

The featured innovations describe programs that can increase positive health behaviors in youth, reduce risk factors, and improve communication with parents. 

The featured QualityTools educate health care practitioners and parents about ways to prevent diseases.
September 01, 2008

Improving the Detection, Diagnosis, and Treatment of Mental Illness

The featured innovations describe collaborative models for integrating behavioral health care with primary care. The featured QualityTools educate practitioners about  common psychiatric disorders, prescribing practices, and community suicide prevention efforts.
August 18, 2008

Improving the Care of Elderly in Hospitals, Nursing Homes, and Other Settings

The innovations describe programs aimed at reducing conditions such as delirium and pressure ulcers experienced by the elderly in hospitals and nursing homes. The QualityTools describe best practices and quality improvement methods to care for the elderly.
August 04, 2008

Enhancing Patient Safety

The innovations describe programs at local clinics and hospitals aimed at reducing medical and medication errors. The QualityTools present the latest patient safety information from national health care organizations.
July 21, 2008

Preventing and Managing Infections in Health Care Settings

The featured innovations describe the bundling of evidence-based practices to reduce infections acquired in hospitals, especially intensive care units.
July 07, 2008

Management of Chronic Illnesses

More than 90 million Americans live with a chronic illness and many live with more than one. Seventy-five percent of the nation's aggregate health care spending is devoted to treating chronic illnesses. 

Health care providers and payers have responded to this challenge by developing innovations in disease and/or care management services.
June 23, 2008

Health and Health Care Disparities Among Vulnerable Populations

In this issue, the featured innovations and QualityTools address health and health care disparities among vulnerable populations, which are defined by race/ethnicity, socioeconomic status, geography, age, gender, and disability status.

The featured innovations describe initiatives to deliver health services that are culturally and linguistically appropriate to Latinos and American Indians.
June 09, 2008

Providing Access to Care in Rural and Community-based Settings

The featured innovations show how to extend specialty health care to rural and underserved populations by using telemedicine and health aides.
May 26, 2008

Managing Chronic Health Conditions

An estimated 133 million people — or about one in two Americans — live with a chronic condition such as diabetes, asthma, high blood pressure, or depression. Of that number, about half experience multiple chronic conditions. 

Given that high prevalence, health care organizations are challenged to provide coordinated, efficient, and effective health care to patients with chronic conditions. The featured innovations explain how three health care organizations addressed these challenges.
May 12, 2008

Patient Flow Management

Improving patient flow in hospitals increases patient safety, access to care, patient and staff satisfaction, and revenue. 

Overcrowding in hospitals can lead to bottlenecks in patient flow, delays in care, lack of continuity in care, and other inefficiencies.

The featured innovations describe how three hospitals used strategies and flow management principles from the private sector to redesign their health care processes.
April 28, 2008

Patient-centered Care

In today's complex, fragmented, and volume-driven health care system, care has become centered around the system rather than the patient.

Patient-centered care, as the Institute of Medicine 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century noted, has the following characteristics: 
•  It involves patients and their loved ones in the design of care.
•  It reliably meets patients' needs and preferences.
•  It ensures that transitions between providers, departments, and health care settings are respectful, coordinated, and efficient.

The featured innovations describe how three institutions integrated patient-centered care into their new programs or initiatives.
April 14, 2008

Inaugural Issue

Welcome to the inaugural issue of the AHRQ Health Care Innovations Exchange Web site! 

This issue includes 100 Innovation Profiles that provide windows into a wide range of creative efforts to improve health care delivery in different settings — hospitals, medical offices, nursing homes, community organizations, schools, workplaces, and patient homes. 

Start an exchange with the innovators and other interested change agents by posting comments and questions on these profiles.  Our innovators welcome queries from health care professionals who are seriously considering adopting their innovations. 

This inaugural issue also includes hundreds of QualityTools that have been updated and reformatted consistent with the Innovation Profiles.

Featured in this inaugural issue are the initial six innovations that were posted on the earlier version of the Web site.  We are especially grateful to these first contributors to the Innovations Exchange.  We also feature three new QualityTools.

New issues of the Innovations Exchange Web site will be published every two weeks,  accompanied by an e-mail announcement.  Please sign up for our e-mail updates

We look forward to your participation in a vibrant and active Innovations Exchange community.

Last updated: July 16, 2014.