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Deploying the 4Ms to Improve Outcomes and Health Experiences for Older Adults

More than 45 percent of patients admitted to Anne Arundel Medical Center (AAMC) are ages 65 and over, and we expect that percentage to increase as Baby Boomers age. We’re located in Annapolis, MD, near Chesapeake Bay, which attracts a lot of retirees. While AAMC has taken a number of steps to improve outcomes for older patients, including opening a geriatric inpatient unit, we believe more needs to be done. Too many older Americans suffer from falls, inappropriate medication use, delirium and other avoidable harms.


Emergency Department Partners with Community Volunteer Dental Program

In 2009, there were over 13,000 Muskegon County, Michigan, low-income residents who were uninsured or underinsured. These residents have unmet healthcare needs including the inability to pay for dental treatment. These residents are veterans, retired and working families, and people with disabilities. Once provided with access to high quality dental care and oral health education, it can decrease the number of people who utilize the hospital emergency department (ED) for dental emergencies and improve the overall health of our community.

The Muskegon County Oral Health Coalition wanted to assess how man...


Reducing Rural Transportation Barriers

Transportation combined with poverty creates a true barrier to health care in a rural environment. In the Mt. Ascutney Hospital and Health Center (MAHHC) service area, 7% of households have no vehicle available. Compared to New Hampshire and Vermont, 5.2% and 6.6% respectively, the service area has significant disparity in available transportation. In MAHHC’s most recent community health needs assessment (CHNA), transportation ranked third in overall barriers to care. Key stakeholders in the CHNA ranked lack of transportation as the number one barrier to accessing services (72.7%).


Huddling to Improve Teamwork

In DSCC’s Mokena Regional Office, each Care Coordinator is paired with a Program Coordinator Assistant to work as a team to meet a child and family’s needs. A Care Coordinator is a DSCC staff person who is a nurse, social worker, speech pathologist or audiologist. A Program Coordinator Assistant (PCA) is often a family’s first contact with DSCC. The PCA takes referrals, discusses the child’s needs and sends the application to families. The PCA also determines financial eligibility and updates this information periodically.

The Care Coordinator and PCAs’ individual responsibilities often are co...


Calvert CARES Program Reducing Readmissions: It’s All About Relationship

CalvertHealth Medical Center (CHMC) was challenged with developing an innovative plan to address high utilizer recidivism in the ED and inpatient settings. Early success with the Transitions to Home Program resulted in readmission targets being significantly decreased. To identify resource access gaps, CHMC called on its “village” (local health care coalition and their case management team of acute care and emergency department nurses and social workers) to identify opportunities for program enhancement by using a SWOT analysis. Medication and medical supply affordability, transportation access and other s...


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