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  1. www.cpsi.ahrq.gov/ncepcr/tools/assessments/health-5.html
    September 01, 2013 - Studies Health Assessments Obesity Management Obesity Toolkit Research Communities
  2. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/pcpf-module-12-intro-to-assessing-practices.pdf
    September 01, 2015 - The book Building Communities from the Inside Out: A Path Toward Identifying and Mobilizing a Community … linkages • Patients are linked to outside resources • Practice partners with community organizations … Building communities from the inside out: a path toward finding and mobilizing a community’s assets. … Evanston, IL: Asset-Based Community Development Institute, Northwestern University; 1993. … Enthusiasm’s practice is located in a semi-rural community and is one of the only sources of primary
  3. www.cpsi.ahrq.gov/research/findings/nhqrdr/chartbooks/effectivetreatment/hiv.html
    April 01, 2018 - HIV and AIDS Among People in Rural Communities Who Inject Drugs Overall, HIV transmission related to … Increasing trends of prescription opioid analgesics and hepatitis C infections are seen in rural communities … testing and linkage to care: SAMHSA: Guide award recipients on HIV testing practices to focus on communities … Working with States, cities, and local community organizations, RWHAP works to improve the quality of
  4. www.cpsi.ahrq.gov/news/events/conference/2011/jack/index.html
    October 01, 2014 - Community Based Care Transitions Program (CCTP or 3026): New payment policies to encourage improved … Hospitals, Providers, Community-based organizations. … Office of the National Coordinator for Health Information Technology (Health IT): Beacon Communities
  5. www.cpsi.ahrq.gov/ncepcr/tools/case-studies/ncahec.html
    August 01, 2014 - Studies Health Assessments Obesity Management Obesity Toolkit Research Communities … recruit the start-up practices, the director reached out to practices and stakeholder groups, like Community … Training also includes access to a learning community of facilitators and a very active internal listserv … The program also relies on its partnerships with the State health information exchange, Community Care … of outside faculty members is seen as building credibility for the program in the guest faculties’ communities
  6. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/interview-protocol-qi-ny.pdf
    August 23, 2018 - ask you some questions about your experience working with your practice facilitators [PF NAME] from Community … PROBE: what about with stakeholders like state and national policy makers or community organizations … How do you help patient’s access community programs to help them deal with cardiovascular risk factors … For example, there are a number of community resources for patients like the New York State Smokers’ … Challenges in identifying community resources? 12.
  7. www.cpsi.ahrq.gov/ncepcr/care/coordination/atlas/chapter6d.html
    June 01, 2014 - National Center Research Initiatives Data Resources Tools and Resources Research Communities … follow up, and respond to change       Support self-management goals   ■   Link to community … follow up, and respond to change       Support self-management goals □     Link to community … follow up, and respond to change □     Support self-management goals ■     Link to communityCommunity Ment Health J 2010 Aug 24. [ePub ahead of print]. No doi number listed. 3.
  8. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/cooperative-context-external.pdf
    January 01, 2016 - academic detailing/expert consultation, HIT support, learning collaboratives, peer-to-peer learning, and community … practices, IHS practices, FQHCs, independent practices) Local Economic and Socio-Cultural Factors [community … context] How did key community factors shape or alter the external support your team provided (and … (e.g., community resources, culture, values) 2 mailto:gordole@ohsu.edu Historical Factors or
  9. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/intervention-tracking-worksheet-mw.pdf
    May 19, 2016 - POPULATION MANAGEMENT: COMMUNITY RESOURCES Referral to community pharmacist for hypertension medication
  10. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/asian-nhpi/asian-nhpi-chartbook.pdf
    May 15, 2020 - the leading causes of mortality, starting with cardiovascular disease • Healthy Living: Working with communities … Source: 2017 American Community Survey 1 Year Estimates – U.S. Census Bureau. … Source: 2017 American Community Survey 1 Year Estimates – U.S. Census Bureau. … Source: 2017 American Community Survey 1 Year Estimates – U.S. Census Bureau. … Source: 2017 American Community Survey 1 Year Estimates – U.S. Census Bureau.
  11. www.cpsi.ahrq.gov/ncepcr/care/coordination/atlas/chapter6t.html
    June 01, 2014 - National Center Research Initiatives Data Resources Tools and Resources Research Communities … follow up, and respond to change     □ Support self-management goals       Link to community … follow up, and respond to change     □ Support self-management goals       Link to community … follow up, and respond to change     □ Support self-management goals       Link to community
  12. www.cpsi.ahrq.gov/cpi/about/mission/strategic-plan/CHStratPlan.html
    December 01, 1999 - services researchers—respond to the stated needs and goals of the child health services research (CHSR) community … Improve communication with the child health services research stakeholder and user communities. … substitute for continued interaction between AHRQ staff and stakeholders and users in the child health community … It would also expand the knowledge base of the health services research community to include new aspects … balance periodically with the help of outside analyses, and share information with Agency staff, research community
  13. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/telediagnosis.pdf
    August 03, 2020 - ultimately be judged by whether it improves the quality, safety, and value of diagnosis for individuals and communities … Understanding the Impact of Health IT in Underserved Communities and Those With Health Disparities.
  14. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool8_cop_handout.docx
    November 01, 2015 - technique; Arrange for (not just refer to) posthospital services; Know the capabilities of postacute and community-based … providers, including Medicaid home- and community-based services; Provide patients data to help inform
  15. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/case_example_4.pdf
    October 01, 2016 - Community Health Workers The CHW is an employee of Mindspring, a local mental health clinic, but is … The CHW helps patients with substance abuse and mental illness or dual diagnosis, mostly in community … CHW sees patients in community settings. … ▌pg. 9 Community Linkages Foresight has a new relationship with the Mindspring local mental … “We want to be known as the best primary care practice in our community, so we need data to show we
  16. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/case_example_5.pdf
    October 01, 2016 - WellMed is embedded in the community and partners with local and State agencies to provide health and … All services, including nurse and social worker access, are free to any community member. … Comprehensiveness WellMed might be considered an aspiring “medical neighborhood.” … Onsite social workers offer connections to other community and caregiver support services. … • Partnering with community agencies in providing social and health services is an effective spread
  17. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/pa-spread-impact.pptx
    September 01, 2014 - techniques, in order to enable providers to incorporate such matters into their practice and to improve community … health by working with community-based health connectors.” … National PCEP Establish state hubs and local primary care extension agents (practice facilitators) Community-based … Using Plan-Do-Study-Act cycles to rapidly test improvement ideas NCQA PCMH Standards Linking with community … Provider Survey Results Top 10 Rated Needed Services Identifying and connecting with local community
  18. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool3_hosp_inv.docx
    September 02, 2016 - Schedule followup appointments prior to discharge · Conduct warm handoffs to postacute and/or community … Improvement Collaborations With: · Skilled nursing facilities · Medicaid managed care plans · Community
  19. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/impact-ny-success-story.pdf
    January 01, 2018 - develop a statewide patient-centered medical home (PCMH) model augmented by behavioral health and community … on the belief that Advanced Primary Care (APC)—the PCMH model augmented by behavioral health and community … population health by strengthening capacity as well as promoting linkages between primary care, community
  20. www.cpsi.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/interview-protocol-staff-ny.pdf
    August 23, 2018 - ask you some questions about your experience working with your practice facilitators [PF NAME] from Community … How do you help patient’s access community programs to help them deal with cardiovascular risk factors … PROBE: Challenges in identifying community resources? 9. … what they have worked on (e.g. dashboards, patient lists to improve call backs, creating templates, community

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