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Showing results for "clinical condition or care plan".

1. Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) (pdf file)
   integrationacademy.ahrq.gov/sites/default/files/2020-07/HbA1c.pdf
   January 01, 2020 - Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) Comprehensive Diabetes Care: Hemoglobin … or the year prior to the measurement year. … Setting: Ambulatory Care: Clinician Office/Clinic Condition: Endocrine, Endocrine: Diabetes Cross-Cutting … Area: Data Source: Administrative claims, Electronic Clinical Data, Electronic Clinical Data: Laboratory … , Clinician: Individual, Health Plan, Integrated Delivery System Measure Type: Outcome Target Population

2. Comprehensive Diabetes Care: Blood Pressure Control (<140/90 mm Hg) (pdf file)
   integrationacademy.ahrq.gov/sites/default/files/2020-07/Comprehensive_Diabetes_Care_Blood_Pressure.pdf
   January 01, 2020 - Comprehensive Diabetes Care: Blood Pressure Control (<140/90 mm Hg) Comprehensive Diabetes Care: Blood … type 2) during the measurement year or the year prior to the measurement year. … Setting: Ambulatory Care: Clinician Office/Clinic, Pharmacy Condition: Endocrine, Endocrine: Diabetes … Cross-Cutting Area: Data Source: Administrative claims, Electronic Clinical Data: Laboratory, Paper … Medical Records Level of Analysis: Clinician: Group/Practice, Clinician: Individual, Facility, Health Plan

3. Develop a Shared Care Plan | The Academy
   integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/implementing-plan/develop-shared-care-plan
   July 01, 2024 - Elements of a Shared Care Plan The development and use of a patient-centered care plan requires … A shared care plan can be used as a tool for easy exchange of clinical information, medication reconciliation … A shared care plan may include some or all of the following elements: Team roles and goals—the team members … Engage Patients in Creating Their Care Plan Engaging patients in the creation of their care plan … on developing a shared care plan with children who have chronic or complex health conditions.

4. Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus (pdf file)
   integrationacademy.ahrq.gov/sites/default/files/2020-06/Lexicon.pdf
   January 01, 2020 - plan, making joint follow-up appointments or other collaborative care functions. … Implementing a care plan means: 1. … the care plan. … care plan Identification of need for health behavior change as part of plan for any condition … Adjust care plan quickly for patients who are not improving, whose care doesn’t fit their goals or life

5. Tracking Patient Outcomes | The Academy
   integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/monitor-patient-and-program-progress/tracking-patient-outcomes
   February 01, 2024 - Primary care providers in busy clinical settings may want to use shorter instruments. … her condition. … for referring patients to higher levels of care, either voluntarily or administratively. … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

6. Controlling High Blood Pressure (pdf file)
   integrationacademy.ahrq.gov/sites/default/files/2020-07/Controlling_High_Blood_Pressure.pdf
   January 01, 2020 - Exclusions: Exclude all patients with evidence of end-stage renal disease (ESRD) or kidney transplant … on or prior to the end of the measurement year. … Setting: Ambulatory Care: Clinician Office/Clinic, Ambulatory Care: Urgent Care Condition: Cardiovascular … Cardiovascular: Hypertension Cross-Cutting Area: Data Source: Administrative claims, Electronic Clinical … Data, Paper Medical Records Level of Analysis: Health Plan, Integrated Delivery System Measure Type

7. Create Operational System Support Integration | The Academy
   integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/implementing-plan/establish-operational-systems-support-integration
   January 01, 2022 - different clinical interventions. … What, if any, treatment or coordination of care is needed from the medical provider? … Substance abuse treatment information in primary care or other medical settings can be shared like other … the Plan menu. … Team Develop a Shared Care Plan Build Patient Understanding of Setbacks

8. Payment and Reimbursement | The Academy
   integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/payment-and-reimbursement
   January 01, 2018 - should identify codes for screening and initial assessment; induction; maintenance visits; associated clinical … are often receiving care for a chronic medical condition from the practice or organization. … Unfortunately, such cost-driven strategies may not be consistent with clinical best practices and may … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

9. Clinical Outcome Measures | The Academy
   integrationacademy.ahrq.gov/expert-insight/measures
   June 01, 2022 - Clinical health outcomes were used as the primary markers of quality. … The Academy first performed an extensive search for clinical outcome measures that assess the quality … for evaluating quality of integrated care exist. … Measures in the articles either focused on an individual behavioral health condition or the physical … Connect With Us Sign up for Email Updates To sign up for updates or

10. Patient-Centered Care Plans | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/patient-centered-care-plans
    June 01, 2022 - Develop a Shared Care Plan A care plan is a patient-centered health document designed to facilitate … All care team members should refer to the care plan when managing and treating patients and record any … It can be used as a tool to exchange clinical information, communications, and other forms of coordination … A medication-assisted treatment (MAT) patient’s care plan may include some or all of the following elements … participant in developing and monitoring the care plan.

11. Integrated Behavioral Health (IBH) Definition | The Academy
    integrationacademy.ahrq.gov/products/ibh-lexicon/functional-definition
    January 01, 2025 - Clinical functions in place One care team with one plan; not separated physical and mental health … or clinical situations selected for biopsychosocial care Teamwork Clinical functions in … condition, gender, culture or ethnicity, or other identified subset of the population. … and medical care and at what level of severity or priority. 24 This includes clinical conditions, clinical … important to the overall care plan.

12. Chronic Pain Management | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/chronic-pain-management
    January 01, 2012 - A comprehensive patient assessment should be conducted to gather information that may help inform clinical … decisions and the treatment plan. … Similarly, depression may interfere with treatment adherence or ongoing management of the patient’s condition … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

13. Treatment Approaches | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/treatment-approaches
    January 01, 2020 - Then they should follow clinical guidance regarding the treatment and care of pregnant and postpartum … the care her or she needs. 8 Because of the potential delays in care, providers in rural areas should … materials, talking points, or strategies for the patient to use with others when discussing their condition … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

14. Behavioral Health Apps in Primary Care | The Academy
    integrationacademy.ahrq.gov/products/topic-briefs/behavioral-health-apps
    July 01, 2024 - This expanded capacity can be especially beneficial in rural areas or at any primary care setting affected … Randomized clinical trials (RCTs) and meta-analyses or systematic reviews can provide that information … Is there an evidence based app that can provide treatment for the patient's condition? … How will the app fit into the patient's overall comprehensive treatment plan? … For Researchers Conduct more clinical research to determine if behavioral health apps in primary care

15. Success Stories | The Academy
    integrationacademy.ahrq.gov/expert-insight/success-stories
    February 01, 2024 - Community Health Plan of Washington Community Health Plan of Washington 's website The … ’s EMR or in print form to the primary care physician. … The registry promotes a patient centered care plan in which care coordinators and patients work together … The data is then coded into the electronic medical record and a care plan is developed through provider … behavioral health condition is able to do so through the integrated physician’s notes and any documents

16. General Operations | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/general-operations
    August 01, 2024 - Information sharing can be key to care coordination both within a practice or organization and with external … Expiration date or condition of consent. Date of signature. Patient signature. … East Providence, RI: Providers Clinical Support System; 2014. … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

17. Developing an Implementation Plan | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/plan-integrate-mat-for-oud/developing-implementation-plan
    June 01, 2022 - , organizations, or health systems. … Identify Clinical Champions and the Implementation Planning Team Identify clinical champions of … How will you define the clinical care team?   … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

18. Tailor Care Team to Meet Patient Needs | The Academy
    integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/implementing-plan/tailor-care-team-meet-needs-identified-patients
    June 01, 2022 - The data is then coded into the electronic medical record and a care plan is developed through provider … The primary care physician provides about 80 percent of the mental healthcare using clinical protocols … Busy clinical teams do not always think to include the behavioral health provider in the care of appropriate … the Plan menu. … Team Develop a Shared Care Plan Build Patient Understanding of Setbacks

19. How Do IBH Practices & Functions Differ? | The Academy
    integrationacademy.ahrq.gov/products/ibh-lexicon/practice-differences
    July 01, 2024 - Clinical functions in place One care team with one plan; not separated physical and mental health … or clinical situations selected for biopsychosocial care Teamwork Clinical functions in … of shared working environment or “space” Type of clinical collaboration A systemic clinical … This appears as a difference between practices, but does not require it as a condition to be defined … test of effectiveness with a limited number of patients or clinical scope.

20. Develop Your Game Plan | The Academy
    integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/planning-for-integration/develop-your-game-plan
    January 01, 2024 - Define triage processes for the identified sub-population (e.g., use of registry, claims, clinical algorithms … You may start at the beginning of  Implementing the Plan  and follow the steps sequentially or customize … Set a timeline that is appropriate for your setting—it may be 6 months or several years depending on … and GANTT templates) that can help your organization plan the transition to integrated care. … Team Develop a Shared Care Plan Build Patient Understanding of Setbacks