August 7, 2019

Joint Principles of the Patient Centered Medical Home

The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. The AAP, AAFP, ACP, and AOA, representing approximately […]
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The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PC-MH.
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http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home

August 7, 2019

AHRQ Patient Fact Sheet: 20 Tips to Help Prevent Medical Errors

AHRQ Patient Fact Sheet: 20 Tips to Help Prevent Medical Errors. [Web site]. Http://www.ahrq.gov/patients-consumers/care-planning/errors/20tips/index.html . Updated September 2011. Accessed July 30, 2014. Medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors’ offices, nursing homes, pharmacies, and patients’ homes. Errors can involve medicines, surgery, […]
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AHRQ Patient Fact Sheet: 20 Tips to Help Prevent Medical Errors. [Web site]. Http://www.ahrq.gov/patients-consumers/care-planning/errors/20tips/index.html . Updated September 2011. Accessed July 30, 2014. Medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies, and patients' homes. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. These tips tell what you can do to get safer care.
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http://www.ahrq.gov/consumer/20tips.htm

August 7, 2019

AHRQ. Navigating the Health Care System: Advice columns from Dr. Carolyn Clancy

AHRQ. Navigating the Health Care System. [Web site]. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/070709.html . Published July 7, 2009. Accessed July 30, 2014. Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, […]
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AHRQ. Navigating the Health Care System. [Web site]. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/070709.html . Published July 7, 2009. Accessed July 30, 2014. Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.
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http://www.ahrq.gov/consumer/cc/cc070709.htm

August 7, 2019

MedLine Plus: Interactive Health Tutorials

MedlinePlus. Interactive Health Tutorials. [Web site]. http://www.nlm.nih.gov/medlineplus/tutorial.html . Updated April 18, 2012. Accessed July 30, 2015. MedlinePlus presents interactive health tutorials from the Patient Education Institute. Learn about the symptoms, diagnosis and treatment for a variety of diseases and conditions. Also learn about surgeries, prevention and wellness. Each tutorial includes […]
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MedlinePlus. Interactive Health Tutorials. [Web site]. http://www.nlm.nih.gov/medlineplus/tutorial.html . Updated April 18, 2012. Accessed July 30, 2015. MedlinePlus presents interactive health tutorials from the Patient Education Institute. Learn about the symptoms, diagnosis and treatment for a variety of diseases and conditions. Also learn about surgeries, prevention and wellness. Each tutorial includes animated graphics, audio and easy-to-read language.
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http://www.nlm.nih.gov/medlineplus/tutorial.html

August 7, 2019

Systematically improving physician assignment during in-hospital transitions of care by enhancing a preexisting hospital electronic health record

BACKGROUND: The nationwide expansion of the hospitalist movement brings rapid change in communication and work processes in many hospitals. While our fast-growing hospitalist program has greatly improved length of stay and quality measures, it has also faced complex operational challenges affecting the whole organization rather than just our division: assigning […]
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BACKGROUND: The nationwide expansion of the hospitalist movement brings rapid change in communication and work processes in many hospitals. While our fast-growing hospitalist program has greatly improved length of stay and quality measures, it has also faced complex operational challenges affecting the whole organization rather than just our division: assigning and tracking hospitalist coverage of admitted patients was one of these challenges.
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.401/abstract

August 7, 2019

AHRQ. Questions To Ask Your Doctor.

Agency for Healthcare Research and Quality. Questions To Ask Your Doctor. [Web Site] Updated September 2012. Accessed July 30, 2014. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html . Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, […]
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Agency for Healthcare Research and Quality. Questions To Ask Your Doctor. [Web Site] Updated September 2012. Accessed July 30, 2014. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html . Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.
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http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

August 7, 2019

The hospital discharge: A review of a high risk care transition with highlights of a reengineered discharge process. Journal of Patient Safety 3(2), pp. 97-106.

The hospital discharge is a handoff, ripe embedded structural risks and hazards that can result in passive or active failures among “sharp end” providers. These failures can result in medical errors and an array of postdischarge adverse events. There are now emerging data to suggest that postdischarge-related adverse events and […]
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The hospital discharge is a handoff, ripe embedded structural risks and hazards that can result in passive or active failures among "sharp end" providers. These failures can result in medical errors and an array of postdischarge adverse events. There are now emerging data to suggest that postdischarge-related adverse events and rehospitalizations can be reduced through interventions at the time of hospital discharge. This article reviews the modifiable components of the hospital discharge process related to adverse events and rehospitalizations, including those relating to the characteristics of the hospital, patient, and clinician. Using multimethod analysis, our group described the principles thought to be important to the discharge process and delineated what we now call the reengineered discharge, a set of 11 discrete and mutually reinforcing components that we believe should be consistently part of every hospital discharge. Finally, we discuss the work or the National Quality Forum Consensus Standards Maintenance committee who, in 2006, added the hospital discharge as one of its "safe practices for better healthcare."
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http://journals.lww.com/journalpatientsafety/Abstract/2007/06000/The_Hospital_Discharge__A_Review_of_a_High_Risk.9.aspx

August 7, 2019

Specialists/subspecialists and the patient-centered medical home

This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices […]
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This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices within the PCMH model is described, with a focus on the potential for these practices to serve as a PCMH for a subgroup of patients or, alternatively, as a PCMH "neighbor" that interfaces effectively with PCMH practices. The authors conclude that the model for effective connections between the PCMH and specialty/subspecialty practices requires further development, including the cross-specialty establishment of guidelines and processes regarding referrals, information flow, transitions in care, and accountability. The efforts of the American College of Physicians' Council of Subspecialty Societies PCMH Workgroup to further develop this model are described. The authors encourage involvement from all interested stakeholders to ensure that the issues and challenges identified are addressed through collaboration and consensus based on available evidence.
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http://journal.publications.chestnet.org/article.aspx?articleid=1086197

August 7, 2019

Questions Are the Answer

Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Quality health care is a team effort. You play an important role. One of the best ways to communicate […]
Read More
Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.
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http://www.ahrq.gov/questions/

August 7, 2019

Tying up loose ends: Discharging patients with unresolved medical issues. Archives of Internal Medicine 167, pp. 1305-1311.

Background: Patients are increasingly being discharged from the hospital with unresolved medical problems requiring outpatient follow-up. This study evaluates the frequency with which hospital physicians recommend outpatient workups to address patients’ unresolved medical problems and the impact that availability of discharge summaries has on workup completion. Methods: We conducted a […]
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Background: Patients are increasingly being discharged from the hospital with unresolved medical problems requiring outpatient follow-up. This study evaluates the frequency with which hospital physicians recommend outpatient workups to address patients' unresolved medical problems and the impact that availability of discharge summaries has on workup completion. Methods: We conducted a retrospective cohort study of patients discharged from the medicine or geriatrics service of a large teaching hospital between June 1, 2002, and December 31, 2003. Each subject's inpatient medical record was reviewed to determine if the hospital physician recommended an outpatient workup. Subjects' outpatient medical records were then reviewed to determine if the workups were completed. Results: Of 693 hospital discharges, 191 discharged patients (27.6%) had 240 outpatient workups recommended by their hospital physicians. The types of workups were diagnostic procedures (47.9%), subspecialty referrals (35.4%), and laboratory tests (16.7%). The most common diagnostic procedures were computed tomographic scans to follow up abnormalities seen on previous radiographic studies and endoscopic procedures to follow up gastrointestinal tract bleeding. Of recommended workups, 35.9% were not completed. Increasing time to the initial postdischarge primary care physician visit decreased the likelihood that a recommended workup was completed (odds ratio, 0.77; P = .002), and availability of a discharge summary documenting the recommended workup increased the likelihood of workup completion (odds ratio, 2.35; P = .007). Conclusions: Noncompletion of recommended outpatient workups after hospital discharge is common. Primary care physicians' access to discharge summaries documenting the recommended workup is associated with better completion of recommendations. Future research should focus on interventions to improve the quality and dissemination of discharge information to primary care physicians.
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http://archinte.ama-assn.org/cgi/content/full/167/12/1305

August 7, 2019

AHRQ. Patient Safety Network. PSNet.

Agency for Healthcare Research and Quality. Patient Safety Network. PSNet. [Web site]. http://psnet.ahrq.gov/default.aspx . Updated July 30, 2014. Accessed July 30, 2014. This toolkit includes comprehensive information for patients and families to facilitate safe transitions from hospital to follow-up care.
Agency for Healthcare Research and Quality. Patient Safety Network. PSNet. [Web site]. http://psnet.ahrq.gov/default.aspx . Updated July 30, 2014. Accessed July 30, 2014. This toolkit includes comprehensive information for patients and families to facilitate safe transitions from hospital to follow-up care.
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http://psnet.ahrq.gov/default.aspx

August 7, 2019

Age-in-Action: PACE

Educational Objectives 1. Describe the Program of All-inclusive Care for the Elderly model of care for frail seniors with chronic health care needs. 2. Demonstrate how PACE benefits providers in the delivery of services. 3. Explain how the PACE concept complements Virginia’s Long Term Care Reform, as well as initiatives […]
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Educational Objectives 1. Describe the Program of All-inclusive Care for the Elderly model of care for frail seniors with chronic health care needs. 2. Demonstrate how PACE benefits providers in the delivery of services. 3. Explain how the PACE concept complements Virginia’s Long Term Care Reform, as well as initiatives to develop further the PACE program in Virginia.
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http://www.sahp.vcu.edu/vcoa/newsletter/ageaction/agesp00.htm

August 7, 2019

The “continuum of care” for older adults: design and evaluation of an educational series

Geriatricians work within a continuum of health services designed to meet the diverse care needs of older adults. They must develop expertise in these care models and be able to guide safe and efficient transitions. This article describes a 9-week educational series designed to review the evidence base and practical […]
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Geriatricians work within a continuum of health services designed to meet the diverse care needs of older adults. They must develop expertise in these care models and be able to guide safe and efficient transitions. This article describes a 9-week educational series designed to review the evidence base and practical aspects of implementing key services that span the continuum of care for older adults. The sessions in the series covered geriatric assessment, ambulatory care, acute hospital, house call, hospital-at-home, Program of All-Inclusive Care for the Elderly, assisted living, inpatient consultation, rehabilitation, nursing home, chronic hospital, and palliative care and hospice. To assess the educational effect of these sessions, evaluations were collected at the end of each session, including one "summative evaluation" after the completion of the entire 9-week series. The vast majority (97%) of survey responses evaluating individual sessions were positive (scores of 4 or 5 on a 5-point Likert scale), and 89% of responses on the summative evaluation were in that range. This educational series efficiently provides a sequential "tour" of health services for older adults, allowing learners to appreciate the continuum of geriatric care models and relationships between services. Feedback from attendees suggests that this format increases knowledge of health services along the continuum of care for older adults and does so in an efficient manner for learners at different levels of training.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2009.02275.x/abstract

August 7, 2019

Improving on Transitions of Care: Emergency Department to Home

NTOCC believes in the commitment of healthcare workers, practitioners, and leaders and in their ability to make a difference in improving transitions of care. To further NTOCC’s reach for improving the quality of care transitions, we have added to our Implementation and Evaluation Plan by offering this additional module: the […]
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NTOCC believes in the commitment of healthcare workers, practitioners, and leaders and in their ability to make a difference in improving transitions of care. To further NTOCC’s reach for improving the quality of care transitions, we have added to our Implementation and Evaluation Plan by offering this additional module: the emergency department to home transition. The methodology used here is the same for the introductory module released in 2008—implement a plan and evaluate it to see how it is working. This document is intended to be used in conjunction with the original document, “Improving on Transitions of Care: How to Implement and Evaluate a Plan.” This plan includes evaluation questions, acceptable metrics or measures, tools, and tips applicable to emergency departments, home caregivers, and primary care offices. As with other NTOCC strategies, communication is the most important component of any plan, tool, or quality improvement effort.
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http://www.ntocc.org/Portals/0/ImplementationPlan_EDToHome.pdf

August 7, 2019

A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes

OBJECTIVES To study the feasibility and effectiveness of a discharge planning intervention. DESIGN Quasi-experimental pre-post study design. SETTING General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital. PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services. INTERVENTION […]
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OBJECTIVES To study the feasibility and effectiveness of a discharge planning intervention. DESIGN Quasi-experimental pre-post study design. SETTING General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital. PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services. INTERVENTION The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist-physician collaborative medication reconciliation, and predischarge planning appointments. MEASUREMENTS Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined accordig to interaction terms and Breslow Day statistics. RESULTS Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06-5.92). Return to the emergency department within 3 days of discharge was lower in the intervention period (10% vs 3%, OR=0.25, 95% CI=0.10-0.62). At 30 days, there was a lower rate of readmission (22% vs 14%, OR=0.59, 95% CI=0.34-0.97) and fewer visits to the emergency department (21% vs 14%, OR=0.61, 95% CI=0.36-1.03) (P=.06). CONCLUSION When hospitalized elderly patients are treated with consideration of their specific needs, healthcare outcomes can be improved.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2009.02430.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

August 7, 2019

Next Step In Care

United Hospital Fund. Next Step in Care. Family Caregivers & Health Care Professionals Working Together. [Web site]. http://www.nextstepincare.org/ Updated 2013. Accessed July 30, 2014. This website provides easy-to-use guides to help family caregivers and health care providers work closely together to plan safe and smooth transitions for chronically or seriusly […]
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United Hospital Fund. Next Step in Care. Family Caregivers & Health Care Professionals Working Together. [Web site]. http://www.nextstepincare.org/ Updated 2013. Accessed July 30, 2014. This website provides easy-to-use guides to help family caregivers and health care providers work closely together to plan safe and smooth transitions for chronically or seriusly ill patients. Transitions are moves between care settings, for example, from hospital to home or rehab facility, or the start or end of home care agency services. Because transitions are often rushed, miscommunication and errors can occur.
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http://www.nextstepincare.org/

August 7, 2019

AAHSA White Paper— National Studies in Caregiving: Implications for Providers

As the aging Baby Boom generation swells the ranks of America’s older population over the next 20 years, there will be an ever-increasing need for family caregiver support. In 2004, it was estimated that there were 44 million family caregivers in the U.S.1 To date, 80 percent of the long-term […]
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As the aging Baby Boom generation swells the ranks of America’s older population over the next 20 years, there will be an ever-increasing need for family caregiver support. In 2004, it was estimated that there were 44 million family caregivers in the U.S.1 To date, 80 percent of the long-term care provided in the home is provided by a family member. 2 Other reports show that family caregivers represent an economic value to our society of $375 billion annually in the care they provide our seniors.3 While the role of family caregivers is essential, it is often overlooked and undervalued by health care professionals for a variety of reasons, not the least of which is that many family caregivers do not self-identify. In addition, many health care professionals do not view family caregivers as part of a primary care team.
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http://www.leadingage.org/uploadedFiles/Content/Consumers/Consumer_Research/National_Studies_in_Caregiving__Implications_for_Providers.pdf

August 7, 2019

Improving handoffs in the emergency department

Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure […]
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Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area.
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http://www.annemergmed.com/article/S0196-0644(09)01261-X/abstract

August 7, 2019

Nursing home procedures on transitions of care

OBJECTIVE To identify nursing home standards through a nationwide survey of directors of nursing regarding transitions of care for residents transferred from acute care hospitals to skilled nursing facilities (SNFs). METHODS A national survey was distributed online and was completed by 241 directors of nursing of SNFs. The directors of […]
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OBJECTIVE To identify nursing home standards through a nationwide survey of directors of nursing regarding transitions of care for residents transferred from acute care hospitals to skilled nursing facilities (SNFs). METHODS A national survey was distributed online and was completed by 241 directors of nursing of SNFs. The directors of nursing were asked about communication methods, transfer of records, and staff involvement with admissions from acute care hospitals. RESULTS The results of the survey demonstrated widespread use of an admission coordinator in the nursing home to direct admissions to the facility. Admission nurses consistently had the most responsibility for ascertaining the correct medication regimen on admission to the facility. Although there was a variation in types of records received from the hospitals, more than 80% received medication administration record or discharge/transfer sheet within 1hour of a patient's arrival. CONCLUSION The results of this survey demonstrate that although direct verbal communication is not the norm, communication via paper documentation of transfer information is highly common. There was a statistically significantly increased likelihood of the SNF receiving the discharge/transfer sheet and the last medication list when it was directly affiliated with the transferring hospital. These affiliations would increase as a result of proposed payment changes that would bundle Medicare Part A acute hospital payments with the SNF payment.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19883886

August 7, 2019

Hospital at Home

As the number of older adults with acute health needs grows, hospitals need more innovative and cost effective ways to treat these patients. Hospital at Home provides safe, high-quality, hospital-level care to older adults in the comfort of their own homes. Developed by the Johns Hopkins School of Medicine and […]
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As the number of older adults with acute health needs grows, hospitals need more innovative and cost effective ways to treat these patients. Hospital at Home provides safe, high-quality, hospital-level care to older adults in the comfort of their own homes. Developed by the Johns Hopkins School of Medicine and tested at medical centers across the country, this innovative care model reduces complications, is highly rated by patients and caregivers, diminishes caregiver stress, and lowers health care costs by nearly one-third. If you are looking for innovative care solutions to solve your hospital’s growing business challenges, we can help you implement this program and bring quality care to your patients.
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http://www.hospitalathome.org/