American Hospital Association Social Determinants of Health Resources for Hospitals

The AHA is working to support hospitals and health systems as they address social determinants of health, eliminate health care disparities and provide comprehensive care to every patient in every community—all of which improve community health. The AHA is continuously developing resources on how hospitals can address the social determinants of health in their communities. The website includes reports, case studies, webinars and videos on eight social determinants of health.

Anticoagulation Action Plan

CDC estimates that among the most common causes of hospital admissions, adverse drug events associated with anticoagulants is one of the top five reasons. Adverse events are associated with bleeding, blood clots, stroke, MI, brain hemorrhage, and other events. The Anticoagulation Action Plan provides SMART goals which may be initiated at your facility in a stepwise manner to progress toward an Anticoagulant Monitoring Program.

Antipsychotic Action Plan

The Antipsychotic Action Plan template is to be used by clinical staff in the nursing home setting to assess and review medication management. It is intended to be a template capable of being modified as needed.

The SMART goals in the plan address education, non-medication interventions, documentation and gradual dose reduction strategies and outcomes. The resource section includes links to augment education and implementation of interventions.

Appropriate Use of Immediate-Release vs. Extended Release Opioids

According to the Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain, 2022, when initiating opioid therapy clinicians should prescribe immediate-release (IR) opioids instead of extended-release and long-acting (ER/LA) opioids, which are slower acting medications with a longer duration of pain relieving action.

This guide provides definitions for opioid naïve and tolerant, identifies key differences between IR and ER/LA opioids, guides transitioning from IR to ER/LA, offers treatment pearls including opioid tapering algorithms, patient education and opioid disposal, provides comprehensive tables for commonly used IR and ER/LA opioids, and includes a morphine milligram equivalent conversion table.

ASPIRE – Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions

Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions is intended to help hospital-based readmission reduction teams design and deliver transitional care to address “whole-person needs” (clinical, behavioral, and social). This whole-person approach to transitional care is patient centered, data informed, evidence based, and field tested.

ASPR – Outbreak Considerations for Long Term Care Communities Toolkit

This toolkit is an informative resource for Skilled Nursing Facilities to use as reference to make sure their facilities are prepared for infectious disease outbreaks.

Nursing Home Survey Tag Specific Emergency Preparedness Checklist

Checklist to cross reference facility emergency preparedness plan with CMS survey requirements to ensure all elements are addressed in facility emergency preparedness plan. There is also a companion document that provides links to resources for emergency preparedness plan development.

Tag Specific Emergency Preparedness Resources

Companion document to Nursing Home Tag Specific Emergency Preparedness Checklist

Best Practice Strategies for Health Equity Data Collection

This resource supplements the Health Equity Organization Assessment (HEOA) and offers best practices to address opportunities for improvement from the HEOA results. It is a valuable resource for any organization seeking best practices for improving consistent patient demographic data collection – including REaL (race, ethnicity and language) and SDOH (social determinants of health) – and using the data to identify and address health disparities.

NQIIC Health Equity Roadmap

This resource covers three key areas that should be addressed before beginning any quality improvement or patient safety initiative. It does have a focus on health equity.–/view?usp=sharing

Best Practices from the Field: Using Social Determinants of Health Resource and Referral Data to Increase Equitable Access and Connection Rates to Essential Resources

Prior to COVID-19, health care investments in SDOH programs to support connecting patients to community resources were on the rise, supported by a proliferation of technology solutions like Aunt Bertha, Unite Us, NowPow and others. These resource databases serve as critical tools for tracking the local services landscape and connecting people to the essential resources they need to be healthy (Cartier et al. 2019). However, when adopting these technology solutions to support SDOH programs, it is important to recognize that more resource information does not always result in people being connected to resources. There are best practices for managing resource information, and using and interpreting the data to effectively and equitably connect people to resources. Here, we aim to provide examples to demonstrate the ways in which data usage and interpretation can impact equitable access to essential resources and improve connection rates.