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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool13_ed_care_plan.docx
May 01, 2015 - This person will either directly develop the ED care plan or will delegate that task to a specific person … , shared drive, or paper binder) and train providers on what to do when a patient has a care plan in … /Email: _____________________________
ED Care Plan Example 1
High-Risk Patient Assessment
1
Clinical … or life-threatening condition]
· [Attempt to treat symptomatic pain without the use of narcotics]
· … Patient:
Age/Sex:
MRN#:
DOB:
[Acute or ED] Care Plan
Care Plan Date:
· [date plan was created and
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digital.ahrq.gov/ahrq-funded-projects/implementation-electronic-care-plan-people-multiple-chronic-conditions
January 01, 2023 - Medical Condition
Cardiovascular Disease
Chronic Pain
Diabetes Mellitus
Renal (Kidney) Disease … Health Care Theme
Care Coordination
Care Planning
Clinical Decision Making
Care … Existing care plans are typically those focused on a single disease or care setting and do not meet the … for managing those with chronic kidney disease and at least one additional chronic condition, such as … Design and execute a plan for pilot-testing the e-care plan applications by using the IG in a mix of
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_14-p008-1-ef.pdf
October 01, 2014 - Measure: Pediatric All-Condition Readmission Measure
Measure: Pediatric All-Condition
Readmission … Denominator: Certain hospitalizations
based on clinical criteria or for issues of
data completeness … or data quality criteria,
including: primary diagnosis for a mental
health condition, hospitalization … for birth
of a healthy newborn, or hospitalization
for obstetric care. … Evaluating hospital discharge planning: a randomized clinical trial.
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www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual/procedure-manual-section-3-topic-work-plan-development
June 22, 2025 - Effective Health Care Program review or a Cochrane review. … settings or are judged to be feasible for delivery in or referable from primary care. … Additionally, clinicians and/or related staff in the primary care setting should have (or could have) … or initiated by a primary care clinician. … and the impact of the condition on the health of these populations (including societal or caregiver
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/care/resources/ontime/pruprev/saworksheet.html
December 01, 2017 - Clinical areas to be covered
___
___
b. … Do you develop a care plan for residents at risk of developing a pressure ulcer? … Does your plan include interventions for skin care ? … Care plan review
b. Report or brief with CNAs
c. … QAPI * or performance improvement plan meeting
f.
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digital.ahrq.gov/sites/default/files/docs/survey/mainehealthcoalitionossurvey_comp.pdf
January 01, 2007 - Does your practice have an intervention program (written care
plan or tool kit, or referral source) … promote the best practice of care for a specific condition. … physicians and patients in discussing the care
plan for the patient. … referral to educators specializing in a specific disease or condition. … from a hospital, health plan, PHO, or other organization.
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/60-tenn-health-coach-sustainability-plan-toolkit.pdf
June 02, 2025 - Health Coach Intervention Sustainability Plan
Health Coach Intervention Sustainability Plan
Medicare … supports consists of clinical staff in
primary care office who can advice the physician of the screening … visit for diabetes or
other condition. … 99487-Complex Chronic Care Management Services (60 min) of
clinical staff time directed by physician … or have an acute episode
▪ Chronic Condition Education
▪ Smoking/Nicotine Cessation
▪ Weight Management
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www.ahrq.gov/talkingquality/measures/setting/health-plan/examples.html
December 01, 2022 - reported to consumers are a combination of clinical quality (doing the right thing, at the right time … treatment or an assessment) for a specific health condition. … Rates of health plan member complaints or appeals over coverage decisions. … care or dental practitioner. … The percentage of pregnant women receiving prenatal care during the first trimester or postpartum care
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruprev/saworksheet.docx
June 02, 2025 - Clinical areas to be covered
b. Timing or frequency of assessments
c. … to learn what is included in your pressure ulcer prevention care plan.
1. … Does your plan include interventions for skin care?
Yes No
3. … Care plan review
b. Report or brief with CNAs
c. … QAPI* or performance improvement plan meeting
f. Skin or wound meeting
g.
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www.ahrq.gov/talkingquality/plan/quality-measures.html
November 01, 2018 - quality to report, you will need to determine which aspects of their performance to measure (e.g., clinical … Such measures are usually too specific and clinical to be helpful to consumers, although some can be … rates, while the elderly may pay more attention to access to specialty care, care for chronic diseases … Some reports provide only one kind of data, such as clinical process measures, while others also include … In additions, some reports present measures only for a specific condition or procedure.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0129-fullreport.pdf
December 31, 2015 - Pediatric All-Condition Readmission Measure
Pediatric All-Condition Readmission Measure
Section 1 … • Prevalence of condition among children under age 21 and/or among pregnant
women. … • Fiscal burden of measure focus (e.g., clinical condition) on patients, families, public
and private … Health plan: Can compare quality of care among health plans. … Clinical or Other Rationale Supporting the Focus of the Measure (optional)
Section 6.
-
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-146-section-2.pdf
September 01, 2011 - and Clinical Program versions, English)
Appendix B: ADAPT surveys (Health Plan and Clinical Program … ) or (b) a defined population of covered individuals (e.g., health plan,
accountable care organization … services in a clinical program or (b) enrolled in a health plan or similar defined population. … plan
State of participating clinical program / health plan
Patient or Member ID
Name of patient … Have the letter signed by a representative of the clinical program or
health plan.
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www.uspreventiveservicestaskforce.org/uspstf/document/final-research-plan/screening-anxiety-children-adolescents
March 29, 2022 - Share to WhatsApp
Share to Email
Print
Final Research Plan … suicide risk engage with care (i.e., return for clinical evaluation and treatment)? … Does treatment (psychotherapy, pharmacotherapy, or collaborative care) of depression, anxiety, or suicide … ); studies that require patients to have a specific clinical condition for enrollment (e.g., cancer, … /no screening
KQ 2 (depression and anxiety): Clinical diagnosis based on structured clinical interview
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/overviewhandouts2.html
December 01, 2017 - Clinical areas to be covered
X
___
b. … Do you develop a care plan for residents at risk of developing a pressure ulcer? … Does your plan include interventions for skin care ? … Care plan review
b. Report or brief with CNAs
c. … QAPI * or performance improvement plan meeting
f.
-
www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/impmaterials.html
June 01, 2017 - that the team can use to identify gaps in their clinical practice. … Do you develop a care plan for residents at risk for hospital transfers? … Does your plan include ongoing discussions about advance care planning with resident and/or family? … QAPI or Performance Improvement Plan meeting
f. … Care plan meeting
g. MD/APRN rounds
h.
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www.ahrq.gov/ncepcr/care/coordination/atlas/chapter6r.html
June 01, 2014 - Validated Applications*:
Patient Age: Children
Patient Condition : General Population/Not Condition … teams or settings : 2, 4, 5, 7, 8, 10
Information transfer:
Across health care teams or settings … : 1, 6, 11
Create a proactive plan of care: 3
Link to community resources: 9, 10, 23, … Country: United States
Past or Validated Applications*:
Patient Age: Adults
Patient Condition … : United States
Past or Validated Applications*:
Patient Age: Adults
Patient Condition : Combined
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www.ahrq.gov/teamstepps-program/curriculum/team/tools/briefs.html
December 01, 2023 - Sharing the Care Plan: Brief
Briefs are a strategy for sharing care plans when leading a team … Clinical status of the team's patients—the current condition, diagnosis, and status of each patient assigned … to the team
The care plan for each of the team’s patients—what is to be accomplished, what are the … When the team includes a patient or family caregiver with limited English proficiency, including the … other team members about the goals for each patient and the care plan to ensure patient safety.
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www.ahrq.gov/sites/default/files/2025-02/silver2-report.pdf
January 01, 2025 - at
risk due to post-acute care or post-surgical clinical needs, diminished capacity for self-care, … assessment and care plan development,
• application of available clinical science,
• patient and caregiver … Less than adequate scope or intensity of care plan – This was a key finding from this investigation. … Specific care plan patterns observed in this category included:
• Physical therapy (with or without … ’s condition were not identified and/or appreciated during the assessment.
-
www.ahrq.gov/sites/default/files/2025-02/silver-report.pdf
January 01, 2025 - at risk due to post-acute care or post-surgical clinical needs, diminished capacity for self-care, … , or task-focused home care services. … LTA
Care plan training LTA –
incomplete (uninformed)
Care plan training LTA –
inaccurate (org … “Rescue”
care
Care plan
implementation
LTA
1. … professional can determine patient's status” or “management
and evaluation of patient care plan.”
-
digital.ahrq.gov/ahrq-funded-projects/community-shared-clinical-abstract-improve-care-mn
January 01, 2023 - A Community-Shared Clinical Abstract to Improve Care
Project Description … Setting
Ambulatory Setting
Emergency Department
Hospital
Medical Condition
Congestive … Acute Care
Health Care Theme
Medication Reconciliation
Transitions in Care … In this project, three partnering health care systems set out to develop an implementation plan for exchanging … Because the time for proposal preparation was unexpectedly halved, some planning steps were modified or