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Discharge to Assess: “Flipping” Discharge Assessment from Hospital to Home
Current average rating is 0 stars.
Discharge to Assess (D2A) (also referred to as "flipped discharge") is a redesign of the care process at Sheffield Teaching Hospitals in the UK that involves assessing a patient’s needs after discharge in the patient’s own home rather than in the hospital. Activities that traditionally happen at the end of a hospital admission are instead performed successfully and safely at home, thus enabling patients who are medically ready to go home earlier and spend less time in the acute care setting.
Creating Age-Friendly Health Systems: How to Meet the Needs of a Growing Population of Older Adults
Current average rating is 5 stars.
This article explains an emerging care model for older adults focused on the “4Ms” of Age-Friendly Health Systems — What Matters, Mobility, Medications, and the Mentation of older adults — that is in the testing phase at five health systems, as part of the Creating Age-Friendly Health Systems initiative led by IHI.
Postal Service “Call & Check Visits” for Isolated, Frail Elderly in the Community
Current average rating is 0 stars.
This case study from the IHI/Commonwealth Fund International Program for US Health Care System Innovation describes the "Call & Check Visits” program developed by Jersey Post in Jersey, British Channel Islands, in which postal service workers check on isolated, frail elderly residents in the community, deliver prescription refills, remind clients of upcoming medical visits, and ask about their health and social needs.
The Age-Friendly Health System Imperative
Current average rating is 0 stars.
The article gives an overview of how five early-adopter US health systems — working in partnership with IHI and The John A. Hartford Foundation as part of the Creating Age-Friendly Health Systems initiative — are testing prototype models for age-friendly care using continuous improvement efforts to streamline and enhance new approaches to geriatric care.
Creating Age-Friendly Health Systems: A Vision for Better Care of Older Adults
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This article describes the background, evidence-based changes, and testing, scale-up, and spread strategy that are part of the design of the Creating Age-Friendly Health Systems initiative to improve care for older adults.
WIHI: How to Fail Forward (Quickly) on the Road to Population Health
Current average rating is 0 stars.
June 29, 2017 | Learning from failure is an important part of the quality improvement process in health care. Groups focused on improving the health of communities are also discovering the value of "failing forward;" leveraging the learning from failure to accelerate progress.
WIHI: Creating Age-Friendly Health Systems
Current average rating is 4 stars.
April 20, 2017 | Best practices for older or elderly patients aren’t always top of mind, and practitioners don't always know how they might do things differently. Now, a small group of health systems is about to test some new, evidenced-based interventions that promise to model for the rest of the industry.
What If We Flipped the Patient Discharge Process?
Current average rating is 5 stars.
At Sheffield Teaching Hospitals in the United Kingdom, an improver came up with the idea of assessing frail elder patients’ needs in patients’ homes instead of at the hospital. One PDSA cycle led to another, and another. Eventually, 10,000 patients got home 3 to 4 days faster in one year.
WIHI: Claiming the Edge with Quality Improvement in Communities
Current average rating is 0 stars.
February 23, 2017 | Communities in Wisconsin, Scotland, and Boston are building coalitions to change the trajectory of people’s lives and health for the better. Using quality improvement methods and tools to tackle socioeconomic issues is proving to be a game changer in all three locations.
Improving the Health of Populations
Current average rating is 4 stars.
With the rapid growth of accountable care organizations, health care delivery organizations are expanding their scope of accountability and changing how they identify and define their immediate goals and longer-term aspirations. Yet the terms to describe this approach — “population health” and “population management” — are often used interchangeably. This article makes the case that a common language is needed, provides clarification around terminology, and offers five questions for health care leaders to explore.
Healthy Shelby: A Triple Aim Improvement Story
Current average rating is 5 stars.
This Triple Aim improvement story examines the work of the Healthy Shelby Initiative in Tennessee, a community pursuing a regional focus to improve population health by linking public health, hospitals, health care providers, social service providers, academic institutions, the faith community, local government, and funders to work together to tackle some of the county’s most critical health problems: infant mortality, chronic disease management, and end-of-life care.
WIHI: Relationships Count: Community Health Workers and Team-Based Care
Current average rating is 4 stars.
October 15, 2015 | Community health workers (CHWs) are increasingly being utilized to bridge gaps for patients between health care, home, and the community. This WIHI explores the growing interest in CHWs that is sparking some important discussions and the development of innovative programs.
Signature Healthcare: A Triple Aim Improvement Story
Current average rating is 0 stars.
By creating a process to improve care for the frail elderly Medicare population with complex needs, and by building the supporting infrastructure in primary care, Signature Healthcare was successful in decreasing emergency department utilization and reducing acute admissions while maintaining patient satisfaction. The organization was a participant in the IHI Triple Aim Community from 2012 to 2014.
Assessing Community Health Needs
Current average rating is 5 stars.
This article presents four practical ways hospital leaders can improve the linkage between the community health needs assessment process, community benefit spending, and efforts to improve population health in the communities they serve.
Guide for Developing an Information Technology Investment Road Map for Population Health Management
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This article proposes an organized approach with specific steps to help health care organizations invest in population health management information technology, to enhance their chances for a successful transition from volume-based to value-based care.
Cross-Continuum Collaboration in Health Care: Unleashing the Potential
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This articles proposes enabling factors for successful cross-continuum collaboration to ensure that relevant post-acute and primary care, as well as community services and supports, are available in a coordinated fashion to meet the needs of patients across the care continuum.
Can the Accountable Care Organization Model Facilitate Integrated Care in England?
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Accountable care organizations (ACOs) in the US, in which groups of providers are responsible for the helath outcomes of a designated population, are regarded as having the potential to foster collaboration across the continuum of care. This article contends that ACOs could have a similar role in England’s National Health Service (NHS), provided that the differences in context are taken into consideration before implementing a similar model, adapted to suit the NHS’s strengths.
Pursuing the Triple Aim: The First Seven Years
Current average rating is 5 stars.
The concept of the Triple Aim is now widely used, because of IHI’s work with many organizations and also because of the adoption of the Triple Aim as part of the national strategy for US health care. Drawing on IHI's seven years of experience, this article describes the three major principles that guided the organizations and communities working with IHI on the Triple Aim.
WIHI: Home for Life, Aging, and Aging in Place
Current average rating is 0 stars.
May 2, 2013 | This WIHI is focused on an initiative in South Georgian Bay, a community along the Severn River in Ontario, where six organizations have come together to create a web of resources called Home for Life, focused on the growing population that’s over 65.
Author in the Room: Hearing Deficits in the Older Patient
Current average rating is 4 stars.
April 2012 | A discussion with the author of the JAMA article "Hearing Deficits in the Older Patient."
Author in the Room: Elder Mistreatment
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September 2011 | A discussion with the author of the JAMA article "Elder Mistreatment: 'I don't care anything about going to the doctor, to be honest...'"
Author in the Room: Finances in the Older Patient with Cognitive Impairment
Current average rating is 5 stars.
June 2011 | A discussion with the author of the JAMA article "Finances in the Older Patient with Cognitive Impairment: 'He Didn't Want Me to Take Over'.”
Passport Exclusive: Minimizing Risk for Elderly Patients
Current average rating is 0 stars.
In this video, Kevin Stewart, describes the key things providers should consider when caring for elderly patients in order to reduce complications, avoid readmissions, and improve patient experience.
Author in the Room: Managing Medications in Clinically Complex Elders
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November 2010 | A discussion with the author of the JAMA article "Managing Medications in Clinically Complex Elders."
Author in the Room: Incontinence in Older Women
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August 2010 | A discussion with the author of the JAMA article "Incontinence in Older Women."
  
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