Medicaid

Implementing Personalized Cross-Sector Transitional Care Management to Promote Care Continuity, Reduce Low-Value Utilization, and Reduce the Burden of Treatment for High-Need, High-Cost Patients

Description: 

This research will integrate cross-sector care alerts and interoperable personalized care planning into the existing Coordinating Transitions Intervention (CTI) tool and evaluate the impact of the revised tool on patient burden, care team collaboration, and utilization value for high-need, high-cost patients.

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Project Dates: 
April 1, 2021 to March 31, 2026

Engaging Disadvantaged Patients in Sharing Patient-Generated Health Data and Patient-Reported Outcomes through Health Information Technology - Final Report

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Clinical Decision Support for Collaborative Diet Goal Setting in Primary Care

Description: 

This research aims to enhance and implement a clinical decision support tool that will support providers and underinsured patients in making personalized decisions regarding diet goal setting.

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Project Dates: 
July 1, 2020 to June 30, 2022

Using Location-Based Smartphone Alerts Within a System of Care Coordination - Final Report

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PRISM: Personalized Reminders for Immunizations using Short Messaging Systems - Final Report

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Disparities in patient-reported interest in web-based patient portals: survey at an urban academic safety-net hospital.

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Effect of hospital readmission reduction on patients at low, medium, and high risk of readmission in the Medicare population.

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Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims.

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Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims.

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Reducing emergency room visits and in-hospitalizations by implementing best practice for transitional care using innovative technology and big data.

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