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Total Results: 129 records

Showing results for "improving clinical-community linkages in primary care for patients with multiple chronic conditions".

61. Practice and Quality Improvement | Agency for Healthcare Research and Quality
    www.ahrq.gov/ncepcr/reports/2024-annual-report/recent-grants-improvement.html
    May 01, 2024 - P4: Impacts of Changes in Payment Policy on Access to Primary Care for People with Lower Incomes … P9: Using a Mobile Health Tool to Improve Patient-Centered Care for Patients with Type 2 Diabetes P10 … : Improving Clinical-Community Linkages in Primary Care for Patients with Multiple Chronic Conditions … ExPERTS-PC: Engaging Patients in Event ReporTing for Safety in Primary Care (K08) PI: Anjana Estelle … primary care, with the goals of improving care and reducing the need for specialty care.

62. 6. Research Gaps and Prioritization of Federally Funded HSR and PCR | Agency for Healthcare Research and Quality
    www.ahrq.gov/healthsystemsresearch/hspc-research-study/research-gaps.html
    June 01, 2020 - engage patients to become more empowered for their own self-care from chronic conditions and multiple … chronic conditions.” … of the key functions of primary care, while also not interfering with patient care. … with primary care clinicians and practices [on] how primary care should work and be more patient and … care clinicians so that they can then do the integrative work with a patient as a whole when the patients

63. 5. Moving Toward Sustainability | Agency for Healthcare Research and Quality
    www.ahrq.gov/evidencenow/projects/state/how-to-guide/guide5.html
    August 01, 2024 - Patient- and Family-Centered Care) x x x Foundations and private donors investing in improving health … technical assistance and education to primary care practices and other health system partners on improving … Some primary care extension programs receive fees for providing technical assistance to consult with … fund a primary care extension program housed in a state university for services that benefit patients … outcomes research in primary care. 

64. SDOH & Practice Improvement | Agency for Healthcare Research and Quality
    www.ahrq.gov/sdoh/practice-improvement.html
    August 01, 2023 - for social needs of their patients. … Determinants of Health Screening in Primary Care ". … Developing Primary Care-Based Recommendations for Social Determinants of Health: Methods of the U.S. … primary care preventive recommendations. … Learn about a tool to help primary care practices screen and refer patients for social needs  such as

65. Meeting Minutes, July 2016 | Agency for Healthcare Research and Quality
    www.ahrq.gov/news/events/nac/2016-07-nac/nacmtg0716-minutes.html
    November 01, 2016 - Ganiats, M.D., to be the new Director of the National Center of Excellence in Primary Care. … There will be no new research related to multiple chronic conditions, and the grant funding for research … people living with multiple chronic conditions. … The agency will use $9 million over 3 years to support, with grants, primary care practices and rural … health and primary care.

66. Optimizing Health and Function as We Age: Roundtable Report (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/healthy-aging-roundtable.pdf
    September 08, 2022 - which multiple chronic conditions and social needs are highly prevalent. … She highlighted the importance of preventing and managing multiple chronic conditions among midlife … Improving health outcomes for older adults requires reimagining and strengthening primary care; integrating … conditions with a focus on primary care and ambulatory settings: a blue-sky discussion of what the … who have multiple chronic conditions?

67. Executive Summary | Agency for Healthcare Research and Quality
    www.ahrq.gov/ncepcr/tools/workforce-financing/exec-summary.html
    July 01, 2019 - Major areas of focus were: care for complex patients and those with multiple chronic conditions, behavioral … with primary care visits, allow many more patient "touches" each day. … For patients with diabetes in a pilot program, the CHWs help with health behavior change and goal setting … For patients with multiple chronic conditions, the elderly, or those receiving palliative care, home … Cutting-edge innovation : To improve access to primary care in rural areas, an urban primary care physician

68. AHRQ New Models of Primary Care Workforce and Financing - Executive Summary (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/workforce-executive-summary.pdf
    October 01, 2016 - Major areas of focus were: care for complex patients and those with multiple chronic conditions, behavioral … with primary care visits, allow many more patient “touches” each day. … For patients with diabetes in a pilot program, the CHWs help with health behavior change and goal setting … For patients with multiple chronic conditions, the elderly, or those receiving palliative care, home … Cutting-edge innovation: To improve access to primary care in rural areas, an urban primary care physician

69. AHRQ New Models of Primary Care Workforce and Financing - Executive Summary (pdf file)
    www.ahrq.gov/sites/default/files/publications/files/workforce_executive_summary_0.pdf
    October 01, 2016 - Major areas of focus were: care for complex patients and those with multiple chronic conditions, behavioral … with primary care visits, allow many more patient “touches” each day. … For patients with diabetes in a pilot program, the CHWs help with health behavior change and goal setting … For patients with multiple chronic conditions, the elderly, or those receiving palliative care, home … Cutting-edge innovation: To improve access to primary care in rural areas, an urban primary care physician

70. External-Stakeholder-Report (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/pcor/external-stakeholder-report.pdf
    June 23, 2023 - Multiple Chronic Conditions Research Summit ......................................................... … Trust Fund PDSA Plan-do-study-act PLWMCC People Living with Multiple Chronic Conditions RE-AIM … strategies for improving and achieving comprehensive primary care. … of People Living With Multiple Chronic Conditions (PLWMCC) served as AHRQ's driving force in organizing … Proceedings from AHRQ Summit on Transforming Care for People Living with Multiple Chronic Conditions

71. Practice-Based Research Network Business Opportunities with ACOs and Other Health Care Systems: Training and Technical Assistance (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/primer-for-pbrn-business-opportunities.pdf
    September 01, 2015 - https://pbrn.ahrq.gov/events/patient-engagement-primary-care https://pbrn.ahrq.gov/events/patient-engagement-primary-care … multiple chronic conditions.19-23 To achieve practice change, PBRN researchers have developed expertise … Improving Quality of Care for Medicare Patients: Accountable Care Organizations. ICN 907407. … Improving chronic kidney disease care in primary care practices: an upstate New York practice-based … Validation of the diagnostic algorithms for 5 chronic conditions in the Canadian Primary Care Sentinel

72. Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions - Toolbox (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/medread-tools.pdf
    July 28, 2016 - with primary care, specialists, pharmacy, home health, etc … NEXT STEPS  Ensure all patients have a primary care provider or temporary provider (“bridge” clinic … )  Schedule followup with primary care provider  Schedule followup with relevant specialists  Schedule … ] [XXX] [Can schedule timely in-home followup appointments; will coordinate with patient’s primary care … linkages to services for patients.

73. AHRQ National Advisory Council (NAC) Meeting Minutes from November 17, 2021 (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/news/events/nac/nac-meeting-minutes-2021-nov.pdf
    January 01, 2021 - for improving primary care. … Networks and research in patient-centered medical homes, primary care transformation, care coordination … , team-based care, and multiple chronic conditions. … in many primary care settings. … Activities of strong interest will include care for people with multiple chronic conditions, advancing

74. AHRQ Multiple Chronic Conditions Research Network Publications | Agency for Healthcare Research and Quality
    www.ahrq.gov/prevention/chronic-care/decision/mcc/mccpublications.html
    May 01, 2014 - Assessment and management of patients with cognitive impairment and dementia in primary care. … Heterogeneity in the quality of care for patients with multiple chronic conditions by psychiatric comorbidity … The AHRQ Multiple Chronic Conditions Research Network conceptual model for research on complex patient … strategies for patients with multiple chronic conditions. … Out of context: clinical practice guidelines and patients with multiple chronic conditions.

75. Findings From the AHRQ Transforming Primary Care Grant Initiative: A Synthesis Report (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/tpc-synthesis-report.pdf
    July 22, 2015 - physician was associated with a small increase (+0.05 visits per patient year) in primary care office … for tracking care for patients with chronic conditions; designated primary care teams that collaborate … For patients whose level was greater than 9 percent, encounters with primary care providers declined … comments in which physicians and staff noted that the PCMH focus on improving primary care performance … A Multi-Payer Patient-Centered Medical Home Initiative in Pennslyvania.

76. Appendix C. Detailed Descriptions of Agency Research Portfolios | Agency for Healthcare Research and Quality
    www.ahrq.gov/healthsystemsresearch/hspc-research-study/appendix-c.html
    July 01, 2021 - patients to rate experiences with hospitals, other providers, and health plans ( Agency for Healthcare … As described above, CDC projects also have examined primary care linkages to broader public health and … primary care. … , and Advanced Primary Care Practice demonstrations for PCMHs in multipayer settings and FQHC safety-net … The agency’s Bureau of Primary Health Care not only provides major service funding for community health

77. New Models of Primary Care Workforce and Financing - Case Example #4: Foresight Family Physicians (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/case_example_4.pdf
    October 01, 2016 - primary care workforce, and conducted site visits to primary care practices with innovative workforce … Foresight aspires to be the premier primary care practice in its area. … health patients, since Foresight physicians are not their primary care providers. … as evidenced in meetings with all MAs to talk about procedures, improving individuals’ skills, and … primary care.

78. New Models of Primary Care Workforce - Case Example #6: Henry Ford Health System (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/case_example_6.pdf
    October 01, 2016 - primary care workforce, and conducted site visits to primary care practices with innovative workforce … patients with multiple chronic diseases. … as use of CHWs in primary care because of the Detroit area's diverse patient population and integrated … , secure room for dementia clients, and transportation services. … health care and support services to all community residents.

79. New Models of Primary Care Workforce and Financing - Case Example #1: Stanford Coordinated Care (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/case_example_1.pdf
    October 01, 2016 - primary care workforce, and conducted site visits to primary care practices with innovative workforce … interest because nationwide, the number and percentage of adults living with multiple chronic conditions … SCC patients have risk factors that are about 2.5 times higher than average primary care patients in … and self-management support, with the three in-house physicians providing primary care. … -SCC physician ▌pg. 3 Most patients seen at SCC have difficulty managing their multiple chronic

80. Biosketches | Agency for Healthcare Research and Quality
    www.ahrq.gov/news/events/ahrq-research-summit-diagnostic-safety-biosketches.html
    September 01, 2016 - She has a special interest in the care of persons with multiple chronic conditions and functional limitations … Ling represents CMS on the Health and Human Services (HHS) Multiple Chronic Conditions Workgroup, and … care, especially among patients presenting with acute, severe vertigo or dizziness. … Primary Care Dr. … the Harvard Medical School Center for Primary Care.