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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module1/module1_pu-whychange_slides.pptx
June 16, 2017 - Develop hospital-specific action plans for implementing a pressure injury prevention program using the … Setting goals and plans for change
Specific goals have been set. … Leaders: Aligning improvement efforts and organizational priorities
Senior executives: Sharing prevention plans
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pcmh.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-5/slides.html
September 01, 2017 - All risk factors identified on the fall risk factor assessment need to be addressed in the care plans … Next, act on the care plans.
Critical thinking by staff. … Ensure that care plans address all areas of risk.
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/medread-tools.pdf
July 28, 2016 - Include Medicaid Managed Care Plans in the “Medicaid” category. … Care management contacts at Medicaid health plans. … Create care plans for patients after they have most recently presented (e.g., create care plans
for … Aim to discuss and finalize a
minimum of four care plans per hour meeting. … Recommend weekly or biweekly meetings to review and discuss care plans.
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pcmh.ahrq.gov/page/efficient-orthogonal-designs-testing-comparative-effectiveness-alternative-ways-implementing
March 01, 2013 - The authors use an example from a study of care management delivery by Special Needs Plans to individuals … Task Diagram
Mathematica’s Study of Care Coordination Intervention Options for Special Needs Plans. … to help identify care management strategies that work best for members served by three Special Needs Plans … — Medicare managed care plans serving disabled or frail elderly patients who are dually eligible for … components and options to test in collaboration with the care managers and leaders in the participating plans
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pcmh.ahrq.gov/sites/default/files/attachments/EfficientOrthogonal_032513comp.pdf
March 01, 2013 - The authors use an example from a study of care management delivery by Special Needs Plans
to individuals … Mathematica’s Study of Care Coordination Intervention Options for Special Needs Plans. … help identify care management strategies
that work best for members served by three Special Needs Plans … — Medicare managed care plans
serving disabled or frail elderly patients who are dually eligible for … components and options
to test in collaboration with the care managers and leaders in the participating plans
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pcmh.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-3/guide.html
September 01, 2017 - Examples of best practices are universal fall precautions, fall risk assessments, patient care plans … The most important use of an assessment tool is to identify fall risk factors for developing care plans … The use of individualized care plans supplements the use of universal fall precautions. … Is the stated goal the same between the two plans? Are you happy with your stated goal? … Are the categories to be addressed in the care plan the same between the two plans?
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pcmh.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20160315/susan-edgman-levitan-intro-slides.pdf
March 15, 2016 - www.cahps.ahrq.gov
CAHPS Ambulatory Care Improvement Guide
• A comprehensive resource for health plans
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pcmh.ahrq.gov/sites/default/files/attachments/Prospects+for+Care+Coord.+Using+Elect+Data+Sources+3-16-12.pdf
June 01, 2012 - ......................................................... 6
Challenge 1c: Barriers Related to Care Plans … in the context of care plans. … plans as it relates to care coordination. … Panelists with a clinical background agreed that, in their
experience, care plans are not typically … Integrating patient input into care plans, an
important aspect of care coordination, was noted as an
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pcmh.ahrq.gov/teamstepps/lep/traintrainers/lepslimp.html
December 01, 2012 - Note contingency plans.
Ensure that interpreter is present for entire encounter
Who?
How?
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/reference/teamattitude.pdf
March 21, 2014 - It is important for leaders to take time to discuss with their
team members plans for each patient.
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/dailygoals.docx
January 01, 2003 - Effective communication is particularly important in the unit if complicated care plans are to be effectively
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pcmh.ahrq.gov/health-literacy/publications/ten-attributes.html
January 01, 2024 - Communicates clearly what health plans cover and what individuals will have to pay for services .
1 … Communicates clearly what health plans cover and what individuals will have to pay for services.
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pcmh.ahrq.gov/page/coordinating-care-adults-complex-care-needs-patient-centered-medical-home-challenges-and-0
January 01, 2012 - CMIS also used to document CM interventions, assessments, care plans, and so on. … primary care, including home visits, comprehensive assessments, and developing individualized care plans … Physician leadership and buy in; CMs and clinicians regularly share treatment plans; some networks pay … P4P through some health plans.
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pcmh.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/data-research/cahps-data-research-abstract-form.pdf
January 01, 2024 - Notes: Because participating organizations (e.g., health plans, medical groups, hospitals)
voluntarily
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pcmh.ahrq.gov/evidencenow/tools/keydrivers/description.html
October 01, 2020 - Some patients will need support in the community to help them follow through on their plans. … could take responsibility for identifying and reaching out to patients in its panel to reassess care plans … decision-making techniques such as high quality decision aids, co-developing patient-centered care plans … Recognizing that support at home is often critical to following through on care plans, practices can … and meeting their health goals
Patients may need help in following evidence-based care plans, such
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pcmh.ahrq.gov/talkingquality/translate/labels/limit-info.html
November 01, 2018 - It is difficult to interpret such measures, particularly when making comparisons across plans or providers
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pcmh.ahrq.gov/cahps/surveys-guidance/item-sets/PCMH/Development-PCMH-Survey.html
November 01, 2020 - team assembled a panel of PCMH experts representing various stakeholders, including providers, health plans
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pcmh.ahrq.gov/ncepcr/research/care-coordination/pcmh/define.html
August 01, 2022 - care team, medical home practices ensure that they are fully informed partners in establishing care plans
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pcmh.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/item-sets/PCMH/PCMHFactSheet.pdf
September 01, 2010 - assembled a panel of PCMH experts representing various
stakeholders, including providers, health plans … Current plans include integrating the PCMH Survey into
the CAHPS Database once the survey is finalized
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pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module2/module2_slides_fallprev.pptx
August 24, 2017 - How should goals and plans for change be developed?
How do you bring staff into the process? … education and competency will be addressed
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Implementation Action Plan
The Action Plan also addresses:
Plans