-
pcmh.ahrq.gov/sites/default/files/wysiwyg/topics/diagnostic-safety-workgroup-march-2022-meeting-notes.pdf
January 01, 2022 - Program
o Investigators will develop a pharmacist-led hospital-community
collaborative transitions of care … NIH/NCI/
HSIRB
• Grants awarded to improve care management of depression
o A new grant awarded,
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pcmh.ahrq.gov/sites/default/files/attachments/pcpf-module-27-ehr-and-pcmh.pdf
September 01, 2015 - Comprehensive
team-based care
Coordinated care
Continuous access to
care … )
Adopt proactive preventative care practices
Adopt or improve value-driven care processes (e.g … They can help improve coordination of care and
communication among care team members working with the … proactive patient care possible. … in care.
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pcmh.ahrq.gov/sites/default/files/attachments/pcpf-module-14-collecting-performance-data.pdf
September 01, 2015 - HGBA1C
Metabolic Panel
Lipid Panel
Hemoccult
Education/Counseling (time): 10 minutes
Coordination … Orders:
UA
Education/Counseling (time): 20 minutes
Coordination of Care (time): 5 minutes … HGBA1C
Metabolic Panel
Lipid Panel
Hemoccult
Education/Counseling (time): 10 minutes
Coordination … Orders:
Lipid Panel
Education/Counseling (time): 15minutes
Coordination of Care (time): 5 … Orders:
UA
Metabolic Panel
Education/Counseling (time): 5 minutes
Coordination of Care (time
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pcmh.ahrq.gov/cpi/centers/cepi/dpi.html
September 01, 2023 - how to: increase adoption of effective healthcare practices, integrate behavioral health into primary care … , provide practice facilitation for primary care, redesign health systems to make them more efficient … EvidenceNow
Learn about projects that use the EvidenceNOW Model of external support for primary care … The Academy
Visit the Academy for Integrating Behavioral Health and Primary Care, a national resource … AHRQ Announces Interest in Primary Care Research .
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pcmh.ahrq.gov/page/engaging-patients-and-families-medical-home-table-4
June 01, 2010 - engagement in the medical home INSERT HEADING INSERT HEADING Patients and families engaged in their own care … Learn about how the practice works Discuss roles with team Get help with organizing and coordinating care … Self-care Work with team to set self-care goals Get help with managing chronic illness Participate in … evidence-based decision aids Discuss risks and benefits of different options Decide jointly with the health care
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/rrs/rrs_slides/rrsslides.pdf
January 01, 2008 - Crit Care Med. 2004;32:916-921. … Qual Saf Health Care. 2004;13(4):251-254. … Watch the RRS in Action
TEAMSTEPPS 05.2Mod 1 05.2 Page 16Page 16
RRS
ConflictConflict
Lack of coordination … Lack of coordination
DistractionsDistractions
FatigueFatigue
WorkloadWorkload
Misinterpretation of … The
patient was intubated
and transferred to a higher level of care.
-
pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module5/ebsitmonitor.pdf
January 01, 2013 - .2
SMMs and situation awareness have been empirically linked to improved communication,3-5
team coordination … whereas high situation awareness has been linked to increased team performance
needed for patient care … .10 Fortunately, situation awareness is a learnable skill, and health
care providers can increase their … It allows health care providers
to increase awareness of the patient condition, the environmental state … Teamwork training improves the clinical care of trauma patients. J
Surg Educ 2010;67:439-43.
15.
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pcmh.ahrq.gov/teamstepps/instructor/fundamentals/module1/slintro.html
June 01, 2019 - Patients with Limited English Proficiency
TeamSTEPPS® Dental Module
TeamSTEPPS® Long-Term Care … Version
TeamSTEPPS® for Office-Based Care Version
TeamSTEPPS® 2.0 Online Master Trainer … Lack of coordination and followup.
Distractions.
Fatigue.
Workload.
-
pcmh.ahrq.gov/sites/default/files/attachments/logic-model-brief.pdf
March 01, 2013 - , patient-centeredness, coordinated care, accessible care, and a commitment to providing safe, high … and of
high quality
Activities (Examples)
Comprehensive care
• Use care teams
• Use care plans … (e.g.,
more
preventive
care, better
planned
care, better
clinical
outcomes,
lower
mortality … so they begin to use this care? … (e.g.,
preventive
care, better
planned
care)
Improved
patient
experience
Formative
feedback
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pcmh.ahrq.gov/ncepcr/communities/pbrn/registry/colorado-research-network.html
January 01, 2012 - More topics in this section
National Center for Excellence in Primary Care … improve health and well-being by the application of scientific methods to questions important to primary care … with the potential to understand health, disease, and illness, and the roles and values of primary care
-
pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module4/ebleadership.pdf
January 01, 2013 - effectiveness by facilitating team problem solving through developing a shared
vision or plan; facilitating coordination … Proper leadership has been demonstrated to be effective within the health care context. … Crit Care Med 2003;31(6):1620-9.
16. Hynes P, Kissoon N, Hamielec C, et al. … J Crit Care 2006;21(2):224-8.
17. Capella J, Smith S, Philp A, et al. … Teamwork training improves the clinical care of trauma patients.
-
pcmh.ahrq.gov/teamstepps/lep/handouts/leptrlist.html
December 01, 2012 - Patients with Limited English Proficiency
TeamSTEPPS® Dental Module
TeamSTEPPS® Long-Term Care … Version
TeamSTEPPS® for Office-Based Care Version
TeamSTEPPS® 2.0 Online Master Trainer
-
pcmh.ahrq.gov/sites/default/files/wysiwyg/teamstepps/instructor/onlinecourse/tsonlinemodule1.pptx
January 01, 2011 - sharing
Hierarchy
Defensiveness
Conventional thinking
Varying communication styles
Conflict
Lack of coordination … emergency department risk management cases determined that 43% of errors resulted from problems with team coordination … Former President Clinton established a quality interagency coordination task force to develop a coordinated … You'll be able to adapt to changes in the care plan. … people in decisions and examining and adjusting the team's physical workplace all works to optimize coordination
-
pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool11_comm_resource.docx
September 12, 2016 - Use the quick reference part of this tool to populate Tool 12: Whole Person Transitional Care Planning … Care management contacts at Medicaid health plans. … for warm handoff; center has onsite social worker]
[HIV/AIDS Clinic]
[Point person]
[XXX]
[Care … work]
[High-Volume Dialysis Center]
[Point person]
[XXX]
[Contact center care coordinator for … Resource Reference for Hospital ABC
Care Management
Readmissions Community Care, Inc.
-
pcmh.ahrq.gov/healthsystemsresearch/hspc-research-study/research-gaps.html
June 01, 2020 - Impacts
Research Gaps & Prioritization
Conclusions & Recommendations
Overlap & Coordination … prioritization of different conditions, deescalating medications or treatments to meet people’s values, coordination … on coordination of specific conditions between primary and specialized care (i.e., medical homes for … Starfield and colleagues in the 1980s and 1990s (comprehensiveness, coordination, continuity, and first … , access to care, management and coordination of care, and patient- and relationship-centered care.
-
pcmh.ahrq.gov/sites/default/files/attachments/Strategies%20to%20Put%20Patients%20at%20the%20Center%20of%20Primary%20Care.pdf
February 01, 2011 - with this model of care and may think
patient in care plans. that the PCMH is simply a primary care … way care is oftenneeds, including prevention and wellness, acute care, and
provided.chronic care and … self-care goals and care plans. … coordination) and to engagement. … Primary care and
accountable care—two essential elements of delivery-system
reform.
-
pcmh.ahrq.gov/sites/default/files/attachments/strategies-to-put-patients-at-center-of-primary-care-brief.pdf
February 01, 2011 - with this model of care and may think
patient in care plans. that the PCMH is simply a primary care … way care is oftenneeds, including prevention and wellness, acute care, and
provided.chronic care and … self-care goals and care plans. … coordination) and to engagement. … Primary care and
accountable care—two essential elements of delivery-system
reform.
-
pcmh.ahrq.gov/evidencenow/research-results/results/infographics/ehr-text.html
April 01, 2019 - Incontinence
Tools for Change
A Snapshot of EHR Use in Small Primary Care … Practices (Text Description)
AHRQ’s EvidenceNOW: Snapshot of EHR Use in Small Primary Care Practices … EvidenceNOW regional cooperatives worked with more than 1,500 small- and medium-sized primary care … Use of EHRs Before EvidenceNOW
Before EvidenceNOW:
93 percent of primary care practices used EHRs … originally created April 2019
Internet Citation: A Snapshot of EHR Use in Small Primary Care
-
pcmh.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-final-es.pdf
January 01, 2021 - , receiving timely
care, and receiving care when needed. … Quality of Care
• Person-Centered Care: More than half (14 of 26) of Person-Centered Care measures were … • Care Coordination: More than half (5 of 9) of Care Coordination measures were improving,
but one-third … • Affordable Care: When accounting for the overall population, all (2 of 2) Affordable Care
measures … on more measures than better care.
-
pcmh.ahrq.gov/sites/default/files/attachments/pcpf-module-5-working-with-safety-net-practices.pdf
September 01, 2015 - www.ahrq.gov
Primary Care Practice Facilitation Curriculum MODULE 5 M5-i
Primary Care Practice … such as team-based care. … coordination with specialists and hospitals, and the addition of case managers to care teams to
provide … Continuity of Care and Access to Care
Every patient is empaneled to a primary care provider (PCP -- … Providers have one 20-minute slot for each 5 slots for catch-up and care coordination,
but many transfer