This resource outlines strategies and corresponding tasks and resources for each of the seven HEOA categories to assist organizations to address opportunities for improvement based on their HEOA assessment report.
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.
Blood Thinner Safety Plan
This is designed for patients. It helps patients determine if they are ok with their anticoagulant treatment, should contact their doctor or go to the ED.
Buprenorphine for Pain: A Transition Guide from Full Agonist Opioid Prescriptions
Buprenorphine for Pain: A Transition Guide from Full Agonist Opioid Prescriptions is a tool intended to aid clinicians in switching patients off of full opioid agonists to buprenorphine, a partial mixed opioid agonist for pain management.
The information presented in this document should not be considered medical advice and is not a substitute for individualized patient or client care and treatment decisions.
Buprenorphine Resource Guide
The Buprenorphine Resource Guide is a resource that contains the various FDA-approved formulations of buprenorphine for Opioid Use Disorder and pain management. This resource guide also includes a brief history of buprenorphine and explains its analgesic effects.
Camden Coalition: Complex Care Startup Toolkit
This toolkit is designed for organizational and program leaders who are developing programs to improve the health and well-being of individuals with complex health and social needs.
Cardiac Rehabilitation Implementation Guide to Enhance Patient Referrals & Engagement
Despite the many benefits of Cardiac Rehabilitation, enrollment remains quite low – nationally, only 10% to 34% of eligible patients enroll. This resource provides guidance and tools to support awareness of the value of Cardiac Rehabilitation with patients, reduce barriers to participation, and implement evidence-based interventions, such as automatic referral with care coordination, to increase enrollment and patient engagement.
Cardiac Rehabilitation Programs – New England, New York, New Jersey, Ohio & Mid Atlantic Regions
Hospitals may treat patients who are eligible for outpatient cardiac rehabilitation (CR) that do not live or work nearby. Developing and maintaining a list of active CR programs with the facility’s address, contact information, and other relevant details can help CR care coordinators find a program that may be more convenient for the patient.
Regional listing for the following IPRO QIN-QIO areas are available:
Mid Atlantic (DC, DE & MD)
https://drive.google.com/open?id=1djV0rkR7Aamy72e4jOZ8Di5RApwtbj3o
New England (CT, MA, ME, NH, RI & VT)
https://drive.google.com/file/d/1ylOrOg67_5bzZVHq8J4Cs5qKziqEFJM9/view?usp=share_link
New York, New Jersey & Ohio
https://drive.google.com/file/d/13e8YETnQmlDO4c8WBuCNMubDYtwfkgra/view?usp=share_link
Care Transitions Warm Handoff Report
This is a comprehensive list of critical clinical information that can be shared during warm handoff with the next level of care.
Caring for a Patient or Resident with a Hemodialysis Central Venous Catheter (HD-CVC) Just-in-Time Training Module
This training module is designed to provide just-in-time essential guidance to nursing assistants who are providing care to a patient or resident with a hemodialysis central venous catheter (HD-CVC).
Caring for Those Who Care: Resources for Providers Meeting the Needs of Diverse Family Caregivers
This toolkit offers information for providers ready to learn how to support diverse family caregivers. It contains topline information on what providers need to know to help them build a more welcoming, supportive practice.
CDC Clinical Practice Guideline for Prescribing Opioids for Pain – Updated November 2022
This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1–49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1–3 months), and chronic (duration of >3 months) pain.
The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
The guideline addresses the following four areas:
1) determining whether or not to initiate opioids for pain,
2) selecting opioids and determining opioid dosages,
3) deciding duration of initial opioid prescription and conducting follow-up, and
4) assessing risk and addressing potential harms of opioid use.
CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation.
CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers.
CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances.
CDC National Healthcare Safety Network (NHSN) Long-term Care Facility COVID-19 Module
Guidance for submitting data to NHSN. Goals of the Module are to supplement case reporting and facility capacity to understand facility and resident specific impact and identify resource needs and prioritize public health action.
CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain Training for Healthcare Professionals
CDC developed trainings to assist clinicians and other healthcare personnel to provide patient-centered care. Trainings are offered as full or mini modules and patient cases. Many of the trainings offer continuing education (CE); please choose the trainings that best meets your needs.
Checklist for New Positive COVID-19 Area/Unit
An easy checklist for use in nursing homes when a new positive case of COVID-19 is identified. The checklist addresses area set up, staffing, supplies, notifications and more.