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Integrating Behavioral Health in the Emergency Department and Upstream
This IHI Innovation Report discusses barriers to integrating behavioral health in the ED, and presents five drivers (emerging from six key themes from existing approaches) that form the building blocks of a theory of change for making improvements in this area.
WIHI: Health Care Innovation and R&D: Taking Stock at Ten Years
November 9, 2017 | The health care quality improvement movement has rallied around some significant innovations over the years, many of which have had a lasting impact.
Discharge to Assess: “Flipping” Discharge Assessment from Hospital to Home
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.
10 IHI Innovations to Improve Health and Health Care
This curated publication highlights 10 ideas that have emerged from IHI's systematic 90-day innovation approach, including reflections on the Triple Aim, the concept of a health care Campaign, the Breakthrough Series Collaborative model, and other frameworks and fresh thinking that have been replicated around the world.
Experience-Based Co-Design of Health Care Services
This case study from the IHI/Commonwealth Fund International Program for US Health Care System Innovation describes experience-based co-design (EBCD), developed in the UK, which brings together narrative-based research with service design methods to catalyze a process wherein patients and staff work together to design, implement, and test improvements to health care services.
Reducing Inappropriate Medication Use by Implementing Deprescribing Guidelines
This case study from the IHI/Commonwealth Fund International Program for US Health Care System Innovation describes how a multidisciplinary team of clinical experts in Ottawa, Canada, created a credible, low-cost process for developing and implementing evidence-based deprescribing guidelines and tools for assessing, tapering, and stopping medications that may cause harm or no longer benefit patients.
Postal Service “Call & Check Visits” for Isolated, Frail Elderly in the Community
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.
For specific procedures and treatments, health care providers can train individuals to administer their own self-care, on their own time, without supervision or dependence on a licensed professional. Patient-administered self-care can occur either in traditional health care facilities or another location of the patient's choosing outside of a facility.
Large Employers Are Key to Reforming Health Care
The authors of this Harvard Business Review article argue that to achieve the pragmatic solutions President Obama seeks with the Affordable Care Act, employers have a huge opportunity to work with providers to create more efficient, market-driven approaches to improve care and reduce costs.
Addressing the Opioid Crisis in the United States
This IHI Innovation Report discusses key reasons why current efforts to reduce prescription opioid use and misuse in the US have thus far been largely ineffective in stemming the crisis; highlights gaps in current efforts that underscore the need for a coordinated and collaborative community-wide approach; identifies four primary drivers to reduce opioid use; and proposes a high-level construct for a system approach at the community level to address the US opioid crisis.
Lessons in Leadership for Improvement: Kaiser Permanente’s Improvement Journey Over 10 Years
Kaiser Permanente (KP) has achieved impressive improvements in quality of care over the past decade — a testament to their engaged and effective leadership and staff, and also due in part to a unique 10-plus-year collaboration with the Institute for Healthcare Improvement (IHI) that accelerated improvement at KP, greatly informed IHI’s own learning, and helped KP build system-wide capacity for improvement.
A Two-Way Street: What the United States Can Learn from Resource-Limited Countries to Improve Health Care Delivery and Reduce Costs
This article highlights five key ideas for "bidirectional innovation," gathered from the experience of health care providers and health system managers in resource-limited countries, that may have a meaningful impact on health care quality and safety if applied in resource-rich countries.
Community-Based Behavioral Health Integration: A Focus on Community Health Workers to Support Individuals with Behavioral Health and Medical Needs
The aim of the IHI 90-day innovation project described in this report was to develop an approach to managing patients with comorbid behavioral health and medical needs in community-based settings. The report identifies four populations who could be well-served by community-based behavioral health integration and potential interventions to support these populations; describes the role and key functions of community health workers; and discusses key areas for future research and improvement.
The Employer-Led Health Care Revolution
Intel is using Lean improvement methods to manage the quality and cost of its health care suppliers in Portland, OR. Their Healthcare Marketplace Collaborative model holds potential for employers, with their large purchasing power, to take the lead in securing better health for local populations and lowering costs for employees and companies alike.
Gaining Ground: Care Management Programs to Reduce Hospital Admissions and Readmissions Among Chronically Ill and Vulnerable Patients
Preventable hospital admissions and readmissions are indicators of health system fragmentation associated with suboptimal patient outcomes and avoidable costs of care. This synthesis report looks at three case studies that illustrate the potential of care management programs to address this problem by improving care coordination and transitions among high-risk patients.
Pursuing the Triple Aim: The First Seven Years
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.
Escape Velocity: Going from Incremental to Exponential Results in Achieving the Triple Aim
To escape the powerful forces that bind us to current models of care, IHI authors propose that we need inspired leadership and an ambitious aim — and we must accelerate the pace of improvement in health care and innovate with communities and organizations to improve health, improve the care experience, and reduce costs (the Triple Aim).
Flipping Health Care
The authors argue that to meet today’s health care challenges, we need to flip our thinking to develop innovative models of care that can improve health, improve care delivery, and lower costs — the goals of the Triple Aim.
A Framework for Selecting Digital Health Technology: IHI Innovation Report
The intent of this IHI Innovation Project was to scan for health technology innovations that will provide the greatest value to health systems working to achieve the IHI Triple Aim. Using validated approaches to software selection, we created a Digital Health Selection Framework (DHSF) to guide patients, providers, and payers through the procurement of such technology.
Integrating Behavioral Health and Primary Care: IHI 90-Day R&D Project Final Summary Report
This IHI 90-day R&D project report examines the basic principles underlying existing, exemplary integration models and integrated organizations, identifies the core components required for success, and assesses how (or if) they are operationalized by each of the different models. The aim is to understand the core principles underlying successful integration of behavioral health services into primary care.
Integrating Behavioral Health into Primary Care
This article discusses ideas for overcoming common challenges in treating patients with medical and behavioral issues in a more integrated fashion; presents a set of Collaborative Care Components for Integrated Care that have shown results in reducing cost and improving outcomes and satisfaction; and describes layers of service in full-spectrum integrated care.
Joint Learning Network for Universal Health Coverage Update
This report from the Joint Learning Network highlights the network's unique collaborative model to ensure universal health coverage in low- and middle-income countries, some early results, and innovative tools and approaches to address priority areas such as expanding coverage, utilizing information technology, and improving and/or maintaining quality.
Counties of Interest: Achieving Better- or Worse-Than-Expected Health Outcomes: IHI 90-Day R&D Project Final Summary Report
The intent of this project was to identify counties in the US with health outcomes significantly better or worse than one would expect based in their socioeconomic status. Once these counties were identified, we sought to understand what drivers may have led to those results.
Enhancing the Effectiveness Effectiveness of Follow-Up Phone Calls to Improve Transitions in Care: Three Decision Points
This study used a nonsystematic review of the literature focused on the use of telephone follow-up to improve postdischarge processes and reduce avoidable readmissions, and examined use of such calls among organizations participating in the STate Action on Avoidable Rehospitalizations (STAAR) initiative.
STAAR Issue Brief: The Effect of Medicare Readmissions Penalties on Hospitals’ Efforts to Reduce Readmissions
To understand the impact of the Medicare financial penalties for hospitals that have higher than expected rates of 30-day readmissions for select conditions, this Issue Brief synthesizes perspectives from leaders of state hospital associations, quality improvement organizations, and hospitals representing a range of performance and experiences in readmissions and their reduction.