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Total Results: 354 records

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

61. Race and Ethnicity Data Improvement Toolkit
    hcup-us.ahrq.gov/datainnovations/raceethnicitytoolkit/case_for_re.jsp
    February 01, 2025 - Improving Race, Ethnicity, and Language Data At the highest level, the case for improving R/E/L … In their interactions with their patients, clinicians must take into account not only factors such as … The Northwest region grantee conducted probabilistic record linkages with various public health datasets … not be used for any other purpose besides improving healthcare services and programs for patients. … Educating Patients FAQs about the Collection of Patient Race, Ethnicity, and Language For Patients

62. Patient-Centered Outcomes Research Trust Fund Strategic Framework (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/pcor/pcortf-strategic-framework.pdf
    June 01, 2023 - These included the Multiple Chronic Conditions Research Summit, the Primary Care Research Conference … Multiple chronic conditions (MCC) are costly and burdensome to patients and their families as well … Decreased fragmentation of care for people living with multiple chronic conditions. 3. … a particular focus on high-need, high-cost patients and those living with multiple chronic conditions … Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's

63. 3. Breadth and Focus Areas of Federal Agency Research Portfolios in HSR and PCR | Agency for Healthcare Research and Quality
    www.ahrq.gov/healthsystemsresearch/hspc-research-study/breadth-and-focus.html
    July 01, 2021 - Care of people with multiple chronic conditions. … Primary care linkages to broader public health and community prevention resources. … Management of multi-morbidities and complex, high-risk patients. … Its portfolios in PCR have focused on access to primary care, payment policy changes for primary care … The agency’s Bureau of Primary Health Care collects extensive data on the community health centers it

64. 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.

65. 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

66. 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. 

67. 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

68. 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.

69. Using HIT to Improve Transitions of Complex Elderly Patients from SNF to Home - Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/publication/r18hs017817-field-final-report-2012.pdf
    January 01, 2012 - each patient who had a Reliant Medical Group primary care physician. … with a patient closest in age. … medical group MD 71 (23%) 70 (22%) 0.9238 1.02 (0.70, 1.48) Office visit with primary care MD 34 … Improving primary care for patients with chronic illness. JAMA 2002 Oct 9;288(14):1775-1779. 3. … Improving the quality of transitional care for persons with complex care needs.

70. The U.S. Preventive Services Task Force: An Evidence-Based Prevention Resource for Nurse Practitioners | United States Preventive Services Taskforce
    www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/evidence-based-prevention-resource-nurse-practitioners
    April 01, 2019 - The recommendations of the Task Force are intended for use in primary care delivery settings for asymptomatic … The USPSTF suggests that clinicians in primary care practice routinely discuss and offer services with … 5A model. 8 , 18  However, robust implementation of all 5As in a primary care practice, with competing … Building referral linkages and partnerships between the primary care clinics and public health or community-based … multiple behaviors in primary care. 

71. 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?

72. 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

73. The U.S. Preventive Services Task Force: An evidence-based prevention resource for nurse practitioners (pdf file)
    www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/inline-files/epbnursep.pdf
    November 01, 2007 - The recommendations of the Task Force are intended for use in primary care delivery settings for asymptomatic … The USPSTF suggests that clinicians in primary care practice routinely discuss and offer services with … However, robust implementa- tion of all 5As in a primary care practice, with competing demands and reimbursement … Building referral linkages and partnerships between the primary care clinics and public health or community-based … multiple behaviors in primary care.

74. 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

75. 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

76. 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

77. The Role of Low-Threshold Treatment for Patients with OUD in Primary Care | The Academy
    integrationacademy.ahrq.gov/products/topic-briefs/oud-low-threshold-treatment
    February 01, 2025 - Patients with OUD in Primary Care Purpose Care of patients with opioid use … for providing low-threshold treatment for patients with OUD in primary care settings. … of low-threshold treatment for patients with OUD in primary care settings. … Summary Primary care is well-suited for treating patients with OUD due to its patient-centered … The Role of Low-Threshold Treatment for Patients with OUD in Primary Care.

78. Integrating Evidence-Based Clinical and Community Strategies to Improve Health (pdf file)
    www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/inline-files/tfmethods.pdf
    January 01, 2020 - in primary care settings, while he CTF focuses on preventive services targeted to ommunities/populations … with provider education Reducing patient costs for treatment Quitter telephone support with interventions … - ng with behavioral interventions for obese patients, or able 3. … Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale. … Behavioral counseling in primary care to promote physical activity: recommendation and rationale.

79. 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

80. 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.