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Clinical Design

22 03, 2017

STEPS Forward: Practical Strategies for Optimizing Medical Practice

2017-03-22T10:36:19-04:00March 22nd, 2017|

The pressure on health care practices to be accountable for quality and cost is real and intensifying.  But sometimes we need to optimize our underlying practice structure and culture before we can devote adequate time and thought to producing quality breakthroughs that really matter.  STEPS Forward can help by providing quick-start ideas for streamlining workflow and creating more time for clinicians to do what they do best.

STEPS Forward is a practice-based initiative produced by the American Medical Association. As stated on the STEPS Forward website:

Our goal is to provide you with proven strategies that can improve practice efficiency and help you reach the Quadruple Aim — better patient experience, […]

9 03, 2017

The 6:18 Initiative: Accelerating Evidence into Action

2017-03-14T10:37:14-04:00March 9th, 2017|

The 6:18 initiative targets 6 common and costly health conditions using 18 proven interventions.  6:18 is a national initiative of the CDC that can be implemented in every community and practice setting.  From the 6:18 website:

CDC is partnering with health care purchasers, payers, and providers to improve health and control health care costs. CDC provides these partners with rigorous evidence about high-burden health conditions and associated interventions to inform their decisions to have the greatest health and cost impact. This initiative offers proven interventions that prevent chronic and infectious diseases by increasing their coverage, access, utilization and quality. Additionally, it aligns evidence-based preventive practices with emerging value-based payment […]

15 09, 2016

PCMH: Maintaining 2014 NCQA Recognition

2016-10-31T08:29:33-04:00September 15th, 2016|

The National Committee for Quality Assurance (NCQA) is launching the newest iteration of their Patient Centered Medical Home (PCMH) recognition program March 31, 2017. This program differs significantly in concept and in process to the 2008, 2011, and 2014 PCMH standards previously released by NCQA.

Practices currently recognized under NCQA PCMH 2014 Standards have a few options for maintaining their recognition. Use the infographic below to inform the path your practice will choose regarding PCMH recognition. Click here for more information on the NCQA website.

Maintaining 2014 PCMH

9 08, 2016

Medication Reconciliation and Hospital Readmissions

2016-10-31T08:29:34-04:00August 9th, 2016|

There are a number of recent studies around medication reconciliation, particularly in the hospital setting, and whether interventions may effect readmissions as well as patient experience. We highlight three studies below which may provide insights and best practices for organizations considering a medication reconciliation program at their organization. All three studies demonstrated improved/enhanced patient experience. Two of the three studies demonstrated reductions in readmissions.


Cleveland Clinic Ask 3, Teach 3 Program

Abstract/Summary: At Cleveland Clinic Health System, several unit-based teams were already working to improve performance on the medication HCAHPS questions, but attempts were isolated and not coordinated well enough to share best practices throughout the organization. A multidisciplinary improvement […]

8 07, 2016

ICU Transfer Best Practices

2016-10-31T08:29:34-04:00July 8th, 2016|

There are a number of studies about transfer of patients from ICU to other areas of the hospital. Best practices about ICU transfer include Stepdown Units, discharge strategy checklists, and staffing strategies. We highlight a few key studies below which address best practices in ICU transfer.

The Role of Stepdown Beds in Hospital Care

Source: American Journal of Respiratory and Critical Care Medicine (2014)

Abstract: Stepdown beds provide an intermediate level of care for patients with requirements somewhere between that of the general ward and the intensive care unit. Models of care include incorporation of stepdown beds into intensive care units, stand-alone units, or incorporation of beds into standard […]

14 10, 2015

Population Health Management

2016-10-31T08:29:34-04:00October 14th, 2015|

Population health management can be defined as the daily practice of improving health and health care for defined populations.  Population health management requires new capabilities for organizations across the spectrum of clinical care.  Organizations that continually improve these capabilities will be positioned to engage in new models of health care delivery and financing that reward accountability for population health.  As outlined below, Community Health Solutions has identified seven core capabilities that are essential for population health management.  Much of our work is focused on helping organizations strengthen these capabilities.

Seven Core Capabilities for Population Health Management Seven Core Capabilities for Population Health […]

14 10, 2015

Integrated Oral Health

2016-10-31T08:29:34-04:00October 14th, 2015|

The 2011 Institute of Medicine (IOM) reports, Advancing Oral Health in America and Improving
Access for Oral Health for the Vulnerable and Underserved, highlighted the importance of viewing oral health as inseparable from total health.  The IOM and other leading health organizations have also called for the integration of oral health and primary care to enhance access, quality, and outcomes for individuals and populations.  The resources below provide ideas, insights, and promising practices for integrating oral health and primary care practice.  The resources can be adapted to support improvements in community care models.



14 10, 2015

Care Transitions

2016-11-11T10:52:25-05:00October 14th, 2015|

Care transitions occur when a patient moves from one health care provider or setting to another, or from a health care provider to home.  Effective care transitions are important for optimizing patient health and for avoiding unnecessary utilization of hospital services and related services.   As CMS has noted:

Nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million seniors—is readmitted within 30 days, at a cost of over $26 billion every year. Hospitals have traditionally served as the focal point of efforts to reduce readmissions by focusing on those components that they are directly responsible for, including the quality of care during the hospitalization and […]

14 10, 2015

Chronic Care Resources

2016-10-07T15:22:34-04:00October 14th, 2015|

Chronic care models are designed to optimize the care of patients who have or are at significant risk for chronic conditions.  The prevalence of chronic conditions has been increasing due to the aging of the population and rising levels of lifestyle-related risk factors.   Projecting these trends forward, the growing burden of disease and costs could be crippling.  Consequently, chronic care improvement is a high priority for population health management.  The resources below provide ideas, insights, and promising practices for improving chronic care. These resources can be used to support collaborative learning and improvement in community models of care.



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