Care Coordination

Evidence Report Briefing on Capitol Hill

At the briefing on Capitol Hill, hosted by the Congressional Primary Care Caucus, the Primary Care Collaborative (PCPCC) unveiled its latest report highlighting new evidence that links the patient-centered medical home (PCMH) and other forms of advanced primary care with improved outcomes, but not in every study examined.

The Role of Nurse Practitioners: Providing Patient-Centered Care

Today’s nurse practitioners play an important role in managing and delivering health care to Americans. Nurse practitioners (NPs) deliver health care to patients in a variety of settings. This presentation provides insight on the approach to patient-centered care by nurse practitioners. It also illustrates the role that NPs can play in our health care system, including a presentation by an NP-owned and operated clinic that provides primary health care to a diverse patient population across the lifespan.

Do Medical Homes Work?

On Feb. 2, 2016, the PCPCC released its new medical home evidence report, "The Patient-Centered Medical Home's Impact on Cost and Quality: Annual Review of Evidence 2014-2015." The report summarizes PCMH cost and utilization results from peer-reviewed studies, state government evaluations, and industry reports published within the past year. And new to this edition, the report also includes early federal program evaluations published between October 2014 and November 2015. 

From Regulation & Documentation to Transformation: The Planetree Framework for Patient-Centered Excellence

Long before patient-centered care became a centerpiece of health care reform efforts or a media buzz word, Planetree was defining what it means to be patient-centered. With more than three and a half decades of experience listening to patients and partnering with organizations to design and implement patient-centered approaches to care, the Planetree model provides, in concrete and actionable detail, a pathway for: 
  • Partnering more effectively with patients 
  • Engaging family members to improve quality, drive outcomes and foster continuity 

PCPCC National Briefing- Oral Health in Primary Care: A Framework for Action

Primary care teams, providing comprehensive care within a patient-centered medical home, have the clinical competencies, infrastructure, and relationships necessary to improve oral health and reduce oral health disparities. Yet few primary care practices include oral health as a component of routine medical care.

Clinicians and Patients: Natural Partners in Identifying the Right Care (Quantifying Total Cost of Care)

As patients encounter rising costs for health care services, there are new opportunities for clinicians to work with patients to understand how informed referrals and shared decision-making can improve patient experience. Too often, clinicians don't have information on the relative cost of health care services or facilities. In an effort to work toward standardization and enable comparisons, the Network for Regional Healthcare Improvement (NRHI) recently completed an 18 month pilot to produce total cost of care and resource-use data in 5 regions.

Engaging Primary Care Practices in Quality Improvement

The Patient Centered Primary Care Collaborative (PCPCC) hosted an Agency for Healthcare Research and Quality (AHRQ) webinar on July 8 on engaging primary care practices in quality improvement. Primary care can be considered the cornerstone of effective and efficient health care that meets the needs of patients, families, and communities. New resources authored by AHRQ and Mathematica Policy Research offer strategies to help build and sustain practices’ ability to continuously and effectively engage in quality improvement (QI) activities.

The CARE ACT: Supporting Caregivers for At-Home and Preventive Care

The American Association of Retired Persons (AARP) has focused their 2015 advocacy efforts on a bill called the Caregiver Advise, Record and Enable (CARE) Act in efforts to improve patient care at home. The CARE Act outlines a process by which a family can choose a designated caregiver for a loved one, where a Hospital then has the responsibility to instruct and demonstrate how to perform different medical tasks and give proper care.

PCPCC National Briefing: An Exploration of AHRQ's PCMH Resource Center

The Agency for Healthcare Research and Quality (AHRQ) has developed an extensive collection of resources for the primary care community to use in research and evaluation, quality improvement, and the delivery of improved primary care services. On May 21 at 1 p.m. EST, Janice Genevro, PhD, a health scientist at AHRQ, joined the PCPCC's National Briefing to provide an exploration of the PCMH Resource Center web site and other AHRQ tools designed to support the delivery of evidence-based, patient-centered primary care. 

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