Treating Opioid & Alcohol Use Disorders (OAUD) via Collaborative Care @ Venice Family Clinic FQHC

A randomized control trial examined the impact of a collaborative care intervention in primary care patients with opioid and alcohol use disorders (OAUD) vs. primary…

Reducing Clinician Burden via Team-Based Labs Ordering @ Iora Health

This project aimed to increase efficiency by having health coaches attend office visits with clinicians to document lab orders in the electronic health record during…

Improving Discharge Coordination in Integrated Behavioral Health (IBH) Settings via ‘Health Systems Genogram’ Patient Assessment Tool @ Saint Louis University Family and Community Medicine

This project aimed to improve follow-up care for Integrated Behavioral Health (IBH) patients being discharged from the hospital through Health Systems Genogram, an electronic, provider-facing…

Intensive Primary Care via Patient Aligned Care Teams (PACT) Intensive Management @ VA

The VA currently offers primary care through patient-centered medical homes, or Patient Aligned Care Teams (PACT) for all enrolled Veterans. Selected demonstration sites augmented the…

Improving Advance Care Planning via the Life-Sustaining Treatment Decisions Initiative (LSTDI) @ US Department of Veteran Affairs

The VHA aims to improve care for patients with advanced illness and at heightened risk of a life-threatening event by promoting high-quality Goals of Care…

Home-Based Palliative Care (HBPC) Program @ ProHEALTH Care ACO

ProHEALTH Care, a New York-based ACO, developed a program for high-need patients that employs home nursing visits, telehealth appointments with palliative care physicians, and other…

Employing Community Health Workers (CHWs) to Improve Population Health via the IMPaCT Model @ Penn Center for Community Health Workers

The IMPaCT (Individualized Management of Patient-Centered Targets) model is a standardized, scalable, evidence-based Community Health Worker (CHW) intervention proven to improve chronic disease control, quality…

Implementing an Interdisciplinary Collaborative Experience in Diabetes Care @ People’s Community Clinic

People’s Community Clinic (PCC) created an interdisciplinary approach to overcome barriers to diabetes self-management by integrating nurses and health educators specialized in diabetes education into…

Improving Multicultural Depression Screening and Follow-up via Multilingual and Standardized Tools @ Harrisonburg Community Health Center

This quality improvement project aimed to improve depression management by offering both universal screening in several languages and additional tools for treatment decision-making and follow-up…

Engaging Substance Use Disorder (SUD) Patients in Outpatient Care via Implementation of Recovery Coaches @ Arms Acres

This project aimed to demonstrate the value of adding recovery coaches to the multidisciplinary team at Arms Acres in order to improve transitions of care…