Notes and Disclaimers:
- Projects shown may also be operating in other states (see the Geographic Reach)
NATIONAL HEALTH CARE FOR THE HOMELESS COUNCIL
Project Title: "Medical Respite Care for People Experiencing Homelessness"
Geographic Reach: Minnesota, Oregon, Connecticut, Washington, Arizona
Estimated Funding Amount: $2,673,476
Summary: The National Health Care for the Homeless Council (NHCHC) is receiving an award to test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital with the goal of improving health, reduce readmissions, and reduce costs. Medical respite care is defined as acute and post-acute medical care for homeless persons who are too ill or frail to recover from a physical illness or injury on the streets but are not ill enough to stay in a hospital;these programs can provide a cost-effective discharge alternative for hospitals and provide patients with a place to receive ongoing post hospital care while working on their health and housing goals. The service model will incorporate evidence based practices including transitional care, patient centered self-management goal setting, and case management to address socio-economic and other factors affecting health outcomes and access to timely and appropriate care.
SEATTLE CHILDREN'S HOSPITAL
Project Title: "Pediatric Partners in Care (PPIC)"
Geographic Reach: Washington
Estimated Funding Amount: $5,561,620
Summary: The Seattle Children's Hospital project will test implementation of Pediatric Partners in Care (PPIC), which aims to provide a tiered set of community-based care management services for the participating children, their families, and their primary care providers. Care management efforts will focus on improving the care coordination and providing expert consultative resources to patients, families, and providers: (1) Review of health records of all 3,000 children against a standard set of criteria; (2) Establishing priorities for active care management by health care utilization history and health severity scores; (3) Care management by a community-based team of a registered nurse Care Manager and a Community Health Coordinator; (4) Development of a comprehensive care plan for those in care management; (5) Training/education and empowerment of the families of enrolled children; (6) Consultations with and training for their primary care physicians and specialists. PPIC's interventions aim to improve the health care of the target population by providing a higher level of coordination of care between the many different facets of the health care system with whom these children interface on an all-too-frequent basis.