Caring Beyond Healthcare
A handful of Idaho and Washington hospitals participated in our Caring Beyond Healthcare pilot project, which developed and implemented processes to identify patients with poor social determinants of health and connect them to the community’s existing services.
The pilot wrapped up in September 2018. We're sharing the project tools to help spread this intervention across the nation.
Download the project tools:
Screening & Referral Form: English Spanish
Patient Overview Flyer (English)
Evidence-based Screening Tools
BOOST 8Ps
Tool Related article (login required)
HOSPITAL
Related article
IHI Readmission Risk Assessment (STAAR)
Related article (login required)
LACE
Tool (print and online versions) Related article
PAM
Tool (available for purchase) Related article
Psychosocial Acuity Scale
Tool Related article (available for purchase)
Where does wellness happen?
Your hospital is working hard to provide top-notch medical care. But some of your patients are discharged into a world where they don’t have adequate housing, reliable transportation, or access to healthy food.
How soon will you see them again, and will they be worse for the wear?
With the transition to accountable care, these patients’ problems become yours, too.
Other Resources
You may also be interested in resources related to:
- Integrating behavioral health into care transitions
- Care transition interventions specifically designed for patients experiencing homelessness
- Using Teach Back
- Overcoming health disparities for LGBT communities and people of color
- Patient self-management
- Quality improvement planning & measurement
- Patient education materials
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