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pcmh.ahrq.gov/cahps/surveys-guidance/cg/cahps-mips.html
July 01, 2022 - and Systems (CAHPS®)
About CAHPS
Surveys and Guidance
American Indian
Cancer Care … Emergency Department
Health Plan
Home and Community-Based Services
Home Health Care … Hospice
Hospital
In-Center Hemodialysis
Mental Health Care
Nursing Home … Outpatient and Ambulatory Surgery
Surgical Care
Supplemental Items
Using … Care Coordination (core).
Courteous and Helpful Office Staff (core).
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pcmh.ahrq.gov/ncepcr/research/health-it/index.html
September 01, 2022 - Coordination
Care Management
Disseminating Evidence into Practice
Health IT and Digital … transitions, including in primary care. … Many of AHRQ's other programs examine how health IT can transform care. … is empowering primary care using data and analytics to improve care and health outcomes. … patient-reported outcomes (ePROs) data for clinical care delivery.
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pcmh.ahrq.gov/policymakers/hrqa99b.html
October 01, 2014 - sources of health information, including the development of information networks; (4) the delivery and coordination … clinical problems; (C) the management of undifferentiated clinical problems; and (D) the continuity and coordination … COORDINATION OF FEDERAL GOVERNMENT QUALITY IMPROVEMENT EFFORTS. … executive agencies and departments, shall develop and manage a process to— (A) improve interagency coordination … improve the efficiency and effectiveness of quality improvement programs through— (i) the improved coordination
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pcmh.ahrq.gov/evidencenow/tools/keydrivers/optimize-health-it.html
November 01, 2018 - Key Driver 2: Implement QI
Key Driver 3: Optimize Health IT
Key Driver 4: Create Care … Staff throughout the practice, even data novices, may be tapped to take on data coordination duties. … members often report that they are overwhelmed by documenting the care they provide. … care and the need to keep documentation requirements manageable. … registries to track the care provided to patients with particular diseases, provide care management
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pcmh.ahrq.gov/page/medical-home-what-do-we-know-what-do-we-need-know-review-earliest-evidence-effectiveness-of-the-patient-centered-medical-home-model-table-12
March 01, 2013 - Guided Care 1.5 years: Decision support 1.5 years: Care coordination, overall quality of care, … Mood–Promoting Access to Collaborative Treatment 3 months; 12 months: Improved satisfaction with care … Veterans Affairs Team-Managed Home-Based Primary Care Year 1: Improved access to care, interpersonal … , communication, and self-reported outcomes among nonterminal patients Year 1: Satisfaction with care
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pcmh.ahrq.gov/sites/default/files/attachments/Vermont_020413comp.pdf
January 01, 2013 - The Blueprint supports practices with a range of resources—including facilitation, care
coordination … coordination and the CHTs into their workflow. … coordination, and NCQA’s Physician Practice
Connections-PCMH recognition. … Care coordination consists of effective transitions for acute
episodic care to preventive care planned … coordination.
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pcmh.ahrq.gov/patient-safety/settings/long-term-care/resource/epc.html
August 01, 2018 - Setting
Hospital
Hospital Labor and Delivery Units
Emergency Department
Long Term Care … Injuries
Multiple Chronic Conditions
On-Time
Quality of Life
Ambulatory Care … Coordination
White Paper: A Primer for Systematic Reviewers on the Measurement of Functional Status … and Palliative Care for Advanced and Serious Illness Closing the Quality Gap: Revisiting the State of … https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/epc.html
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pcmh.ahrq.gov/page/engaging-patients-and-families-medical-home-table-2
June 01, 2010 - More emphasis on patients’ needs and preferences
Care Coordination
Care is coordinated and … /or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals … The PCMH takes responsibility for coordinating its patients’ health care across care settings and services … the quality of care the care team provides. … The patient has ready access to care.
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pcmh.ahrq.gov/research/findings/nhqrdr/chartbooks/ruralhealth/index.html
November 01, 2021 - 2016 National Healthcare Quality and Disparities Report
Chartbook on Patient Safety
Chartbook on Care … Coordination
Chartbook on Access to Care
Chartbook on Healthy Living
Chartbook on Effective Treatment … Chartbook on Person- and Family-Centered Care
Chartbook on Care Affordability
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pcmh.ahrq.gov/patient-safety/settings/ambulatory/reduce-readmissions-primarycare-rpt.html
March 01, 2021 - Setting
Hospital
Hospital Labor and Delivery Units
Emergency Department
Long Term Care … Ambulatory Care
Tools
Toolkit for Engaging Patients To Improve Diagnostic Safety … examines the evidence base on what is currently known about reducing readmissions from the primary care … As primary care is increasingly called the key integrator role across the health system, the purpose … : Final Report (PDF, 2.5 MB)
Addendum: The Five Principles of Effective Primary Care-Based Care Coordination
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pcmh.ahrq.gov/sites/default/files/attachments/pcpf-module-25-pcmh-principles.pdf
September 01, 2015 - Coordination
of care may be facilitated by patient registries, use of health information technology … The goal of coordination is greater efficiency
through avoidance of duplication of services, synchronization … Population health
management
Care management
and support
Care coordination and
care transitions … FFS with a per-member per-month (PMPM) payment,
sometimes called a monthly care coordination or … coordination
services, QI programs).
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pcmh.ahrq.gov/prevention/resources/chronic-care/index.html
February 01, 2020 - More topics in this section
Prevention
Chronic Care … Health
Resources
AHRQ works to improve the delivery of preventive care … health care delivery system. … The Roadmap will be of use to funders, researchers, and program evaluators interested in primary care … Thus, the Roadmap also may prove applicable to those interested in effective relationships and coordination
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pcmh.ahrq.gov/page/early-evidence-patient-centered-medical-home-appendix
February 01, 2012 - Interventions: Geriatric Resources for Assessment and Care of Elders 1 year: 2 process of care measures … 1 year: 16 process of care measures Processes of Care Interventions: Care Management Plus 1 year: … support 1.5 years: Care coordination, overall quality of care, goal setting, problem solving, patient … Professional Experience Interventions: Guided Care 12 months: Satisfaction with care management, time … spent on chronic care, knowledge of patients’ personal circumstances, and coordination of care 12 months
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pcmh.ahrq.gov/patient-safety/reports/healthaffairs.html
March 01, 2019 - Approaches
Advancing Patient Safety: A Decade of Evidence, Design, and Implementation
Health Care … to reduce medication errors and adverse events, improve communication strategies that support better care … coordination, and lower the rate of diagnostic errors through better teamwork and integration of health … Learn more about AHRQ's work to improve health care quality and safety .
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pcmh.ahrq.gov/sites/default/files/attachments/EfficientOrthogonal_032513comp.pdf
March 01, 2013 - Mathematica’s Study of Care Coordination Intervention Options for Special Needs Plans. … an enhanced
approach for each of 11 components of care coordination. … the participating plans, based on their
past experience with care coordination for this population … and desire to learn more about the effects of
particular care coordination features. … Which alternative care coordination strategies or protocols should care managers follow?
3.
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pcmh.ahrq.gov/research/findings/nhqrdr/chartbooks/index.html
April 01, 2024 - Beginning with the 2014 reports, findings on health care quality and health care disparities are integrated … into a single document that provides a comprehensive overview of the quality of health care received … by the general U.S. population and disparities in care experienced by different racial, ethnic, and … Affordability ( updated August 2016 ) ( PDF , 1.5 MB) Chartbook on Care Coordination ( updated June … 2015 ) (PDF, 2.4 MB) Chartbook on Hispanic Health Care ( September 2015 ) (PDF, 4.4 MB)
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pcmh.ahrq.gov/ncepcr/index.html
Research Initiatives
AHRQ invests in primary care research to help primary care practices improve … Behavioral Health and Substance Use Disorders
Care Coordination
Care Management
Disseminating … Primary Care Research Videos
Estimating the Costs of Primary Care Transformation
IMPaCT Grants … Transforming Primary Care Findings
30-Year Investment in Primary Care Research … Research (NCEPCR) is the home for primary care research at AHRQ.
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pcmh.ahrq.gov/page/efficient-orthogonal-designs-testing-comparative-effectiveness-alternative-ways-implementing
March 01, 2013 - Task Diagram
Mathematica’s Study of Care Coordination Intervention Options for Special Needs Plans. … enhanced approach for each of 11 components of care coordination. … the participating plans, based on their past experience with care coordination for this population and … desire to learn more about the effects of particular care coordination features. … Which alternative care coordination strategies or protocols should care managers follow?
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pcmh.ahrq.gov/research/findings/nhqrdr/nhqdr21/index.html
July 01, 2023 - comprehensive overview of the quality of healthcare received by the general U.S. population and disparities in care … Quality is described in terms of six priorities: patient safety, person-centered care, care coordination … , effective treatment, healthy living, and care affordability.
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pcmh.ahrq.gov/research/findings/nhqrdr/nhqdr19/index.html
July 01, 2023 - comprehensive overview of the quality of healthcare received by the general U.S. population and disparities in care … Quality is described in terms of six priorities: patient safety, person-centered care, care coordination … , effective treatment, healthy living, and care affordability.