This nine-part series developed by TMF Health Quality Institute explores the integration of evidence-based strategies that identify and address underlying behavioral health needs as an approach to reducing preventable hospital utilization.
Issue 1: Series Introduction
Issue 2: Coordinating Interdisciplinary Teams
Issue 3: Use Risk Stratification to Determine Resources Needed
Issue 4: Develop Patient-Directed Care Plans and Coordinated Discharge Plans to Support Transitions of Care
Issue 5: Integrate Behavioral Health Screening, Intervention and Follow-Up
Issue 6: Involve Community Health Workers
Issue 7: Coordinate Caregiver Support
Issue 8: Ensure Interoperability with Electronic Communication
Issue 9: Expand Access to Behavioral Health Services
References
Identifying and treating sepsis in older people: a quality improvement project in hospitals and nursing homes in Texas. Nursing Older People, 2021.
Evaluating Medicare Fee-For-Service payment patterns for post-acute care. Compliance Today, 2020.
Texas MIH Initiative Reduces Hospital, Ambulance Use: Plano’s program lowered readmissions and cut non-emergent 9-1-1 calls using community paramedics. EMS World, 2018.
Addressing Social Determinants of Health: The Need for Provider-Community Collaboration
Reducing Administrative Burden: Refocusing on Patient-Centric Care
Integrating Behavioral Health into Primary Care: Lessons Learned from the Comprehensive Primary Care Initiative
Patient Portals: A Streamlined Approach to Engaging Patients