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		<updated>2026-10-24T10:38:45Z</updated>
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	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:49:55Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]] and [[Health Risk|health risk]]  &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|  --&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plans]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]' - This is the measure of the initial health of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the improvement in the [[Health Status|health status]] and [[Health Risk|health risk]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] and [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:48:34Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]] and [[Health Risk|health risk]]  &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plans]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]' - This is the measure of the initial health of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the improvement in the [[Health Status|health status]] and [[Health Risk|health risk]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] and [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:46:51Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plans]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]' - This is the measure of the initial health of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the improvement in the [[Health Status|health status]] and [[Health Risk|health risk]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] and [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:44:55Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plans]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]' - This is the measure of the initial health of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the improvement in the [[Health Status|health status]] and [[Health Risk|health risk]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:41:51Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plans]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:41:16Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plans]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Outcomes]]&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:39:13Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plans]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:38:46Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plan]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|}&lt;br /&gt;
'1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:38:00Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plan]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-}&lt;br /&gt;
''1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:37:37Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Status]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Health Risk]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Goals]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|[[Care Plan]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;| &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
}&lt;br /&gt;
''1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:35:03Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''A'''&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|--&amp;gt;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|'''B'''&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Mission]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|Yes&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Aspirer]] &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|Yes &amp;lt;br&amp;gt; &amp;lt;br&amp;gt; &amp;lt;br&amp;gt;  &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[ImproveIncome]] &amp;lt;br&amp;gt; #[[MoreCareerOpportunities]] &amp;lt;br&amp;gt; #[[MoreRewardingCareer]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Beneficiary|Beneficiary(ies)]]  &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Aspirer]] Only &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|}''1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:34:06Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
{| class=&amp;quot;wikitable sortable&amp;quot;&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|[[eDream|'''eDream Components''']]&lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|[[eDream|'''Elements''']] &lt;br /&gt;
!style=&amp;quot;background: #e3e3e3;&amp;quot;|#[[eDream|'''ProblemUnmetNeed''']] &lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Mission]]&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|Yes&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Aspirer]] &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|Yes &amp;lt;br&amp;gt; &amp;lt;br&amp;gt; &amp;lt;br&amp;gt;  &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[ImproveIncome]] &amp;lt;br&amp;gt; #[[MoreCareerOpportunities]] &amp;lt;br&amp;gt; #[[MoreRewardingCareer]]&lt;br /&gt;
|-&lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Beneficiary|Beneficiary(ies)]]  &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|#[[Aspirer]] Only &lt;br /&gt;
|align=&amp;quot;left&amp;quot;|&lt;br /&gt;
|-&lt;br /&gt;
|}''1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:32:31Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
&lt;br /&gt;
'''1. Initial [[Health Status]] and [[Health Risk]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:30:54Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: &amp;lt;br&amp;gt;&lt;br /&gt;
[[Health Outcomes Deep Learning]]&lt;br /&gt;
&lt;br /&gt;
'''1. Initial [[Health Status]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:29:15Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: [[Health Outcomes Deep Learning]]&lt;br /&gt;
&lt;br /&gt;
'''1. Initial [[Health Status]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Outcomes</id>
		<title>Health Outcomes</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Outcomes"/>
				<updated>2020-02-07T17:28:26Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;These are the [[Health Outcomes]] performance measures to help determine the impact on the patient's [[Health Status|health status]]: [[Health Outcomes A-&amp;gt;B]]&lt;br /&gt;
&lt;br /&gt;
'''1. Initial [[Health Status]]''' - This is the measure of the risk-adjusted [[Health Status|health status]] of the person prior to a determined timeframe, a new mission ([[Care Goals]]), a new strategy ([[Care Plans|Care Plan]]) or a new solution ([[Medical Interventions]] and [[Non-Medical Interventions]]). The will be the baseline used to measure the [[Health Status|health status]]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''2. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Health Mission]''' ([[Care Goals]]) &amp;lt;br&amp;gt;&lt;br /&gt;
'''3. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Health Strategy]''' &amp;lt;br&amp;gt; &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Objectives_.28Care_Plan.29_Determinants Strategy Objectives]'' ([[Care Plans|Care Plan]]) &lt;br /&gt;
* Objectives List - examples include lower Hemoglobin A1c, lower blood pressure, loss weight, increase physical activity, etc.  &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Solutions_.28Interventions.29_Determinants Strategy Solutions]'' (Interventions) - The solutions are how the Health Mission and Health Strategy - Objectives will be achiveved. Examples include medication, weight loss program, patient's commitment to 10,000 steps per day. &lt;br /&gt;
* Interventions List - including [[Medical Interventions]] and [[Non-Medical Interventions]] &lt;br /&gt;
''[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_Measures_Determinants Strategy Measures]'' &lt;br /&gt;
* Measures List - for Mission (Health Goals), Strategy Objectives (Care Plan), Strategy Solutions (Interventions) Measures, Impacting Elements Measures (people, realities and activities not included above), Care Plan Adherence Measures. Examples include pain levels, function levels, blood sugar. &lt;br /&gt;
'''4. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting Realities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Competencies], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Socioeconomic], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Digital_Content_.26_Technology_Determinants Digital Content &amp;amp; Technology]&lt;br /&gt;
'''5. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants]''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Impacting People List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations] &lt;br /&gt;
'''6. [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants]'''&amp;lt;br&amp;gt;  &lt;br /&gt;
* Impacting Activities List - [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Healthy_Lifestyle_Determinants Healthy Lifestyle], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physical_Activities_Determinants Physicial Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_.26_Passion_Activities_Determinants Social &amp;amp; Passion Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Nutrition_Determinants Nutrition], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Functional_Activities_Determinants Functional Activities], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Sleep_Determinants Sleep], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Planning_Activities_Determinants Care Planning], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management Communications], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management Operational], [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategy_Activities_Determinants Health Strategy Activities]&lt;br /&gt;
'''7. Subsequent''' [[Health Status]] &amp;lt;br&amp;gt;&lt;br /&gt;
'''8. Health Outcome Measures''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Health Status]] Performance &lt;br /&gt;
* Health Objective Performance&lt;br /&gt;
* Health Solution Performance &lt;br /&gt;
&lt;br /&gt;
Organizations Focused on developing [[Health Outcomes Measures]]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Status</id>
		<title>Health Status</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Status"/>
				<updated>2020-02-02T23:06:27Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;In order to measure [[Health Outcomes|health outcomes]], we need to measure [[Health Status|health status]] before and after '''interventions''' ([[Medical Interventions|Medical]] &amp;amp;&lt;br /&gt;
[[Non-Medical Interventions|Non-Medical]]) and [[Biological Age|biological age]] and [[Health Status|health status]] on each birthday. The following are components of [[Health Status|health status]]:  &amp;lt;br&amp;gt;&lt;br /&gt;
* [[Symptoms]] (Patient) - Patient's assessment of their physical and mental symptoms. They include pain or discomfort, visual symptoms, cold or flu-like, physical abnormalities, mental health and other.&lt;br /&gt;
* Clinical Conditions (Medical) - These are [https://www.cdc.gov/DiseasesConditions/az/a.html disease and conditions] (i.e., diabetes, hypertension) as well as biomarkers (i.e., blood pressure, weight, blood glucose) as documented by a medical professional in the patients Electronic Medical Record. &lt;br /&gt;
* [[Functional Status]] (Patient) - Patient's assessment of their function (i.e., walking, going to work, doing what they love).&lt;br /&gt;
* Clinical Risk (Medical) - These are Medical Risks (i.e., for disease, disease progression, acute event, mortality) &lt;br /&gt;
* Determinant Risk (Patient) - Patients assessment and monitoring of patient behavior based on health determinants (i.e., fiancial, transportation, housing).   &lt;br /&gt;
* Well-Being (Patient) - Patient's assessment of Support, Health, Basic Needs, PHQ, Purpose, Love &amp;amp; Connection, Competence&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Determinants</id>
		<title>Health Determinants</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Determinants"/>
				<updated>2020-01-22T23:19:03Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
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&lt;div&gt;[[Health Determinants]] (current and history) can decisively affect a patient's overall health and well-being. [[Health Determinants]] include [[barriers]], [[symptoms]] and [[Functional Status|functional status]]. The [http://www.dcoe.mil/Libraries/Documents/Phase_2_IOM_Social_Behavioral_Domains_2014_18951.pdf Institute of Medicine (IOM) recommends] capturing social and behavioral determinants in Electronic Medical Records. [https://www.cdc.gov/nchhstp/socialdeterminants/faq.html CDC defines Determinants of health as factors that contribute to a person's current state of health.] &lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) ''Determinants''==&lt;br /&gt;
Health '''Mission''' Determinants (current and history) impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See Health [http://www.patientdeterminants.org/index.php?title=Health_Insight#Mission_.28Health_Goals.29_Insight Mission (Health Goals) Insight].&lt;br /&gt;
&lt;br /&gt;
===Personal Goals (Missions) ''Determinants''===&lt;br /&gt;
'''Personal Goals (Missions)''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Health Mission &amp;amp; Care Goals Insight]. Patient specific care goals related to improving or maintaining the patient's [[Health Status|health status]].&lt;br /&gt;
* Patient's Life Goals  - non health related, responsibilities, passions, etc.&lt;br /&gt;
* Patient's Health  - that includes preventitive &amp;amp; wellness goals, managing acute and chronic conditions, end-of-life&lt;br /&gt;
&lt;br /&gt;
===Health Goals (Care Goals) ''Determinants''===&lt;br /&gt;
'''Health Goals (Care Goals)''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Health Mission &amp;amp; Care Goals Insight]. Patient specific care goals related to improving or maintaining the patient's [[Health Status|health status]].&lt;br /&gt;
* Symptoms Goals (Patient) - improvement of patient's assessment of their physical and mental symptoms. They include pain or discomfort, visual symptoms, cold or flu-like, physical abnormalities, mental health and other.&lt;br /&gt;
* Conditions Goals (Medical) - improvement or stabilizing disease and conditions (i.e., diabetes, hypertension) as well as biomarkers (i.e., blood pressure, weight, blood glucose) as documented by a medical professional in the patients Electronic Medical Record.&lt;br /&gt;
* Function Goals (Patient) - improvement of the patient's assessment of their function (i.e., walking, going to work, doing what they love).&lt;br /&gt;
* Clinical Risk Goals (Medical) - improvement of medical risks (i.e., for disease, disease progression, acute event, mortality)&lt;br /&gt;
* Behavioral Risk Goals (Patient) - improvement of the patients assessment of their behavior or ability to be compliant with the care plan based on health determinants (i.e., fiancial, transportation, housing).&lt;br /&gt;
* Well-Being Goals (Patient) - improvement in the patient's assessment of Support, Health, Basic Needs, PHQ, Purpose, Love &amp;amp; Connection, Competence&lt;br /&gt;
* Timing Goals - 2 days, 2 weeks, 2 months, 2 years&lt;br /&gt;
* Medical Interventions &amp;amp; Events Goals - Acute events, surgeries, ER visit, hospital, medication or medical treatment etc.&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) ''Determinants''==&lt;br /&gt;
'''Strategy (Health Plan)''' Determinants (current and history) impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Strategy_.28Health_Plan.29_Insight Strategy (Health Plan) Insight]. &lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Determinants''===&lt;br /&gt;
Strategy Objectives ('''Care Plan''') Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight].&lt;br /&gt;
 &lt;br /&gt;
* Overall Strategy objectives of how each of the care goals will be achieved&lt;br /&gt;
* Specific details of how each of the care goals will be achieve&lt;br /&gt;
* Potential Barriers (Impacting Activities, People, &amp;amp; Realities) - potential barriers (health determinants) that could impact achieving the Care Goals and how each will be addressed&lt;br /&gt;
* Key People &amp;amp; Roles (Impacting People)&lt;br /&gt;
* Key Activities &amp;amp; Interventions (Impacting Activities)  &lt;br /&gt;
* Measures&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) ''Determinants''===&lt;br /&gt;
====Medical Interventions ''Determinants''====&lt;br /&gt;
'''Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Interventions_Insight Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* Part A ([https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html hospital/facility interventions]), &lt;br /&gt;
* Part B ([https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html physician interventions]), &lt;br /&gt;
* Part C ([https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html Medicare Advantage Health Plans]), &lt;br /&gt;
* Part D ([https://www.medicare.gov/part-d/ medication interventions]). &lt;br /&gt;
Most health plans are based on Medicare fee schedules, so they typically reimburse for the same or similar services. &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Medical Interventions Results can impact the strategy:  &lt;br /&gt;
* Testing - Clinical Consults, Lab, Imaging, ECG, etc.&lt;br /&gt;
* Qualified Option Development - diagnosis, progonosis and treatment options&lt;br /&gt;
* Medical Interventions&lt;br /&gt;
* Shared Decision Making - process helps to develop interventions based on care goals.&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions ''Determinants''====&lt;br /&gt;
'''Non-Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Insight Non-Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* [[Care Management Programs]] - team-based, patient focused programs designed to meet specific needs of patients based on the program's criteria. &lt;br /&gt;
* [[Health Services]] - a specific focused health services or capabilities designed to meet specific health needs of patients based on the services's criteria. &lt;br /&gt;
* [[Support Services]] - a specific focused support services or capabilities designed to meet specific needs of patients based on the services's criteria. &lt;br /&gt;
* [[Patient/Caregiver Interventions]] - activities or actions by patients and caregivers that will likely improve health, health outcomes and reduce overall cost.&lt;br /&gt;
* [[Health Insurance Payment Models]] - these are health insurance payment models design to improve patients outcomes, health and reduce cost&lt;br /&gt;
* [[Organization Interventions]] - employers, communities and governments interventions&lt;br /&gt;
&lt;br /&gt;
Non-Medical Interventions Results can impact the Care Plan&lt;br /&gt;
====Intervention Adherence ''Determinants''====&lt;br /&gt;
====Intervention Changes ''Determinants''====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures ''Determinants''===&lt;br /&gt;
Strategy '''Measures''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight].&lt;br /&gt;
* Measures - These are measures that will demonstrate progress toward achieving the health mission. This is the list of measures (i.e., pain levels, function levels, blood sugar levels) that will be used to measure progress of the startegy objectives toward achieving the health mission. &lt;br /&gt;
* Measures types:&lt;br /&gt;
** Mission (Health Goals) Measures - measure progress toward achieving the mission&lt;br /&gt;
** Strategy Objectives (Care Plan) Measures - measure the progress of the strategy objectives toward achieveing the mission&lt;br /&gt;
** Strategy Solutions (Interventions) Measures - measure the effectiveness of individual interventions in respect to achieving the missio and objective strategy &lt;br /&gt;
** Impacting Elements Measures - measure the impact of impacting people, realities and activities not included above&lt;br /&gt;
** Adherence Measures - adherence to interventions&lt;br /&gt;
** Change Measures - timing, reason codes, for changes in interventions, people, realities, activities &lt;br /&gt;
* Measurement Timeframes - These are the times when progress will be measures&lt;br /&gt;
* Measurement Baseline - This is the initial measures that will be used to measure the health outcome of the strategy objectives.&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting People ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting People''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Disciplines_.26_Resources_Insight Health Disciplines &amp;amp; Resources Insight]. &lt;br /&gt;
&lt;br /&gt;
'''List - Impacting People'''&amp;lt;br&amp;gt;&lt;br /&gt;
* Clinical Providers - These are licensed professionals. Primary Care Physicians, Physician Assistants, Nurse Practitioners, Physician Specialists, Pharmacists, Therapists (Speech, Physical, Occupational), Behavior Health (Psychologist, Psychiatrist), Nurse (Care Manager), Dietitian, Education Providers (Clinical)&lt;br /&gt;
* Support (Social and Behavioral) Providers - Care givers (family or friend), Recovery Navigator (patient navigator), Recovery Coaches (included MSW Social Workers and Health Coaches), Education (Non-Clinical), Technical Support and technicians&lt;br /&gt;
* Community (Basic Needs) Resources - Financial Counseling, Meals Delivery (Meals on Wheels), Transportation Assistance, Programs (Smoking Cessation, Weight Loss, Alcoholics Anonymous), Delivery Services, Transportation Services, Other Services (handy man, plumber, etc.), Community Health Services (Community Health Centers, free flu shots, etc.), Convenient Care (Minute Clinics, 24 hour services)&lt;br /&gt;
* Changes to Impacting People List&lt;br /&gt;
&lt;br /&gt;
'''Roles - Impacting People''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Role within Strategy (Care Plan)&lt;br /&gt;
* Role within Solution (Interventions)&lt;br /&gt;
* Frequency and types of communications&lt;br /&gt;
* Influence&lt;br /&gt;
* Activities&lt;br /&gt;
* Tasks&lt;br /&gt;
* Types of Support&lt;br /&gt;
&lt;br /&gt;
'''Behavior - Impacting People Behavior'''&lt;br /&gt;
* Adherence to Strategy&lt;br /&gt;
* Frequency and types of communications&lt;br /&gt;
* Influence&lt;br /&gt;
* Activities&lt;br /&gt;
* Tasks&lt;br /&gt;
* Support Provided&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting People'''&lt;br /&gt;
* List of potential barriers due to impacting people&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting Realities ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting Realities''' Determinants (Health Determinats) can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''List - Impacting Realities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Health Conditions&lt;br /&gt;
* Competencies&lt;br /&gt;
* Social&lt;br /&gt;
* Socioeconomic&lt;br /&gt;
* Environmental&lt;br /&gt;
* Digital Content &amp;amp; Technology&lt;br /&gt;
* Changes to Impacting Realities List&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting Realities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* List of potential barriers due to impacting realities&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting Activities ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Strategy - Impacting Activities Insight].&amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
'''List - Impacting Activities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Physical Activities&lt;br /&gt;
* Social &amp;amp; Passion Activities&lt;br /&gt;
* Nutrition&lt;br /&gt;
* Functional Activities&lt;br /&gt;
* Sleep&lt;br /&gt;
* Stress, Emotions &amp;amp; Meditation&lt;br /&gt;
* Adverse Behaviors &lt;br /&gt;
* Self-Management Behavior&lt;br /&gt;
* Care Management Communications&lt;br /&gt;
* Care Management Operational&lt;br /&gt;
* Health Strategy Activities&lt;br /&gt;
&lt;br /&gt;
'''Behavior - Impacting Activities'''&lt;br /&gt;
* Adherence to Strategy&lt;br /&gt;
* Changes to Behavior&lt;br /&gt;
* Potential Assets from Behavior&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting Activities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* List of potential barriers due to impacting activities&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities ''Determinants''==&lt;br /&gt;
'''Impacting Realities''' Determinants (current and history) impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_Realities_Insight Impacting Realities Insight]. &lt;br /&gt;
===Health Conditions ''Determinants''===&lt;br /&gt;
'''Health Conditions''' Determinants that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Conditions_Insight Health Conditions Insight].&lt;br /&gt;
====Physical Conditions ''Determinants''====&lt;br /&gt;
'''Physical Conditions''' Determinants can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].  See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Physical_Conditions_Insight Physical Conditions Insight]. Medicare has developed a model to categorize Physical Conditions in order to risk [http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html '''risk adjust'''] health insurers that are covering patients. The [[CMS-HCC Risk Adjustments]] model adjust for patient demographics (i.e., age, disabled) and disease (i.e., diabetes, congested heart failure). &lt;br /&gt;
&lt;br /&gt;
* Allergies &amp;amp; Adverse Drug Reactions&lt;br /&gt;
* [https://en.wikipedia.org/wiki/Comorbidity Comorbidities] -  chronic disorders (or diseases) that need to be managed. Most comorbidities do not get cured.  &lt;br /&gt;
* Demographics - Age, Sex, Disabled, Long Term Institutional Status (LTI Designated Status) &lt;br /&gt;
* [http://www.cdc.gov/vaccines/vpd-vac/vaccines-list.htm Immunizations] - Flu, Tetanus&lt;br /&gt;
* Physical Impairments -  Physical Impairments (Use of limbs, arthritis, amputation, birth defects, Epilepsy), Sensory Impairments (Blind or Visually Impaired, Deaf or Hard of Hearing, loss of taste and smell)&lt;br /&gt;
* Medical History - Adverse events, Family Medical History, Medical Conditions, Surgeries&lt;br /&gt;
* Physiological Metrics - Blood glucose level, Blood pressure, Cholesterol level (HDL, LDL, etc), Heart rate&lt;br /&gt;
* Problem and Symptom lists - Pressure Ulcers, Pain, asthma, Fever, Fractures, Headache, Rash or skin infection, Shortness of Breath, Sprains, Upper respiratory tract infection, Wounds&lt;br /&gt;
* [http://www.biomedcentral.com/1471-2318/14/25 '''Frailty Index''']&lt;br /&gt;
* [[CCS Diagnostic Categories]]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Determinants''====&lt;br /&gt;
'''Mental Health Conditions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Mental_Health_Conditions_Insight Mental Health Conditions Insight].&lt;br /&gt;
* Comorbidities -  mental health disorders (or diseases) that need to be managed. Most comorbidities do not get cured.&lt;br /&gt;
* Disorders - Anxiety Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autism, Bipolar Disorder, Eating Disorder, Depression, Obsessive Compulsive Disorder (OCD), Panic Disorders, Post Traumatic Stress Disorder, Schizophrenia&lt;br /&gt;
* History&lt;br /&gt;
* Impairments - Cognitive Impairments (Delirium &amp;quot;confused state&amp;quot;, Dementia), Developmental&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Determinants''====&lt;br /&gt;
'''Functional Conditions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Functional_Conditions_Insight Functional Conditions Insight].&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* Required Devices - pacemakers, artificial limb, etc.&lt;br /&gt;
* Logistic Capabilities - Walk, Assisted Walking, Wheelchair, Equipment Requirements (Oxygen, heart device, etc.)&lt;br /&gt;
* Disabilities and Impairments as defined by the [http://www.dc37.net/about/graphics/factsheetspdf/disability_defined.pdf American Disabilities Act]&lt;br /&gt;
* Homebound - unable to travel to physician offices&lt;br /&gt;
* Work - Physically able to go back to work or enough functional ability to find a new job&lt;br /&gt;
* Passion - Physically able to go back to work or enough functional ability to find a new job&lt;br /&gt;
* Mental - Not prevented from working, pursuing passion and functional activities because of mental health challenges&lt;br /&gt;
* [[Requires Support]] - for ADLs or IADLs&lt;br /&gt;
* Functional History&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Determinants''====&lt;br /&gt;
'''Genomic Profiles''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Genomic_Profiles_Insight Genomic Profiles Insight].&lt;br /&gt;
&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Human_genome '''Human Genome'''] - complete set of genetic information encoded as DNA sequences within the 23 chromosome pairs. It includes the genomes of [http://en.wikipedia.org/wiki/Tumor '''tumors'''], the abnormal mass of tissue from abnormal growth or division of cells. &lt;br /&gt;
&lt;br /&gt;
* [https://ghr.nlm.nih.gov/handbook/howgeneswork/epigenome '''Epigenome''']  multitude of chemical compounds that have been added to the entirety of one’s DNA (genome) as a way to regulate the activity (expression) of all the genes within the genome. These chemical compounds of the epigenome are not part of the DNA sequence, but are on or attached to DNA (“epi-“ means above in Greek).&lt;br /&gt;
&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Microbiome '''Microbiome'''] - the collective genomes of the microorganisms that share our body space. The resident bacteria, viruses ([http://en.wikipedia.org/wiki/Human_virome '''virome''']) and [http://en.wikipedia.org/wiki/Eukaryote '''other microbes with genomes''']. &lt;br /&gt;
&lt;br /&gt;
* Other Genomic Profiles - [http://en.wikipedia.org/wiki/Metabolome '''Metabolome'''] - are small molecules with metabolism functions of fuel, structure, signaling, stimulatory and inhibitory effects on enzymes and other catalytic activities. [http://en.wikipedia.org/wiki/Proteome '''Proteome'''] - set of proteins expressed by a genome, cell, tissue or organism at a given time, under defined conditions.  [http://en.wikipedia.org/wiki/Transcriptome '''Transcriptome'''] - set of all molecules use to create new cells with genomes.&lt;br /&gt;
&lt;br /&gt;
====High Cost High Need Patients ''Determinants''====&lt;br /&gt;
'''High Cost High Need Patients''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Genomic_Profiles_Insight Genomic Profiles Insight].&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Determinants''===&lt;br /&gt;
'''Competencies''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Competencies_Insight Health Competencies Insight].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Determinants''====&lt;br /&gt;
Health Literacy Determinants impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Literacy_Insight Health Literacy Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - Undertands why and how to manage their health. These competencies help improve [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior].&lt;br /&gt;
* Health Risks - understand their health risks and how to manage them&lt;br /&gt;
* Health Conditions - understands their health conditions &lt;br /&gt;
* Health Condition Management Knowledge - understands how to manage their health conditions (i.e., Diabetic glucose monitoring and injecting insulin)&lt;br /&gt;
* Interventions (Medical and Non-Medical)- understands why the interventions are necessary for overall health.&lt;br /&gt;
* Assistance Engagement - Know when to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Education - Diagnosis, Prognosis, Treatments, Understand Options and onboard with the treatment plan&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Determinants''====&lt;br /&gt;
Self Management Competencies Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Self-Management_Competencies_Insight Self-Management Competency Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - demonstrates competencies to manage conditions, interventions (medical or non-medical) and is committed to the treatment. These competencies help improve [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior].&lt;br /&gt;
* Health Condition Management Competencies - demonstrates abilities to manage their health conditions (i.e., Diabetic glucose monitoring and injecting insulin)&lt;br /&gt;
* Conscientiousness - a desire to do a task well being thorough, careful, or vigilant. &lt;br /&gt;
* Reliable and Organized - as opposed to easy-going and disorderly.&lt;br /&gt;
* Intervention (Medical or Non-Medical) Competencies - Medication Adherence, Nutrition, Therapies, Physician Visits, Recommended Activity levels &lt;br /&gt;
* Medication Management Competencies - management and adherence of oral and injectable medicine&lt;br /&gt;
* Assistance Engagement - Know when and how to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Technology Competencies (patient or authorized care giver) - Internet and Online Usage, Education Videos, Patient Portal Usage, Use of Secure Texting, Video Conferencing, email, Use of remote monitoring devices (Blood Pressure cuff, remote diagnostic devices (ecg app), Use of tablet, computer or smartphone&lt;br /&gt;
* Access Online Personal Health Record - Online Electronic Health Record, Blue Button, Access Authorization (Care Team access), Patient Provided Input History (Patient answer questions or inputs data into Personal Health Record)&lt;br /&gt;
* Technology Access - Broadband Internet, Wifi Router, Telecom Network (AT&amp;amp;T, Verizon), Computer, Smartphone or Tablet, Remote Monitoring Devices&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Determinants''====&lt;br /&gt;
'''Functional Competencies''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Competencies_Insight Competencies Insight]. &lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* [[Education and Literacy Determinants|Literacy]] - ICD Codes&lt;br /&gt;
* Languages - Speaking &amp;amp; Reading&lt;br /&gt;
* Technology Usage - Smart Phone, Google, Online Patient Portals&lt;br /&gt;
&lt;br /&gt;
====Education ''Determinants''====&lt;br /&gt;
'''Education''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Education_Insight Education Insight]. &lt;br /&gt;
* [[Education and Literacy Determinants|Education]] - ICD Codes&lt;br /&gt;
* [[Educational Attainment]] - Completed levels of formal education,&lt;br /&gt;
* Vocational Training&lt;br /&gt;
* Certifications, Licenses or degrees (diplomas)&lt;br /&gt;
&lt;br /&gt;
===Social ''Determinants''===&lt;br /&gt;
'''Social''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Social_Insight Social Insight].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Determinants''====&lt;br /&gt;
'''Patient (About &amp;amp; History)''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Patient_.28About_.26_History.29_Insight Patient (About &amp;amp; History) Insight].&lt;br /&gt;
* About - Narrative/Story, Photos&lt;br /&gt;
* [[Marital Status]]&lt;br /&gt;
* [[Childhood Events Determinants|Childhood events]] &lt;br /&gt;
* [[Childhood Upbringing Determinants|Childhood upbringing]]&lt;br /&gt;
* Military Service&lt;br /&gt;
* [[Psychosocial Circumstances Determinants|Psychosocial Circumstances]] &lt;br /&gt;
* Passions/Goals - Sports Teams, Television, reading, social media, Activities - Walking, shopping, etc.&lt;br /&gt;
* Sexual Orientation&lt;br /&gt;
* [[Race &amp;amp; Ethnicity]]&lt;br /&gt;
* Country of Origin/US Born or Non-US Born&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Determinants''====&lt;br /&gt;
'''Adverse Events''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Adverse_Events_Insight Adverse Events Insight].&lt;br /&gt;
* [http://www.cdc.gov/violenceprevention/acestudy/ '''Adverse Childhood Experiences (ACE)''']&lt;br /&gt;
* Victim of physical or verbal abuse&lt;br /&gt;
* Victim of crime &lt;br /&gt;
* Compelling Events - death, loss of home, job, &lt;br /&gt;
* Adversity Exposure - Violence, crime, verbal abuse, death, poverty, financial stress, depression, anxiety&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Determinants''====&lt;br /&gt;
'''Beliefs''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Beliefs_Insight Beliefs Insight].&lt;br /&gt;
* Health Literacy Beliefs&lt;br /&gt;
* Religion and faith&lt;br /&gt;
* Perspectives - politics, lifestyle, culture&lt;br /&gt;
* Trust and faith in Institutions - Healthcare, Education, Government&lt;br /&gt;
* Trust and faith in Physicians, nurses and the medical professions&lt;br /&gt;
* Beliefs about impacting people, caregivers, family, friends, care team&lt;br /&gt;
* Beliefs in whether the current care plan will work&lt;br /&gt;
* Beliefs about current health conditions&lt;br /&gt;
* Beliefs about physicial activity, nutrition and sleep&lt;br /&gt;
* Beliefs about adverse behavior&lt;br /&gt;
* Beliefs about self-management of health&lt;br /&gt;
&lt;br /&gt;
====Determination ''Determinants''====&lt;br /&gt;
'''Determination''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Determination_Insight Determination Insight].&lt;br /&gt;
* Willingness to change or do something different&lt;br /&gt;
* Desire to make change happen&lt;br /&gt;
* Eagerness to learn how to improve health&lt;br /&gt;
* Desire to improve health&lt;br /&gt;
* Detrmination to stick to a plan to achieve the desired outcome&lt;br /&gt;
* Desire to make something happen&lt;br /&gt;
* Enthusiasm to make something happen&lt;br /&gt;
* Personal goals and dreams&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Determinants''====&lt;br /&gt;
'''Relationships''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Resilience_Insight Relationships Insight]. A patient with good or functional relationships with the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People] can have a positive effect on patient outcomes. The [http://wikidreams.org/index.php?title=Relationships relationship type], type and frequency of communication as well as what is recieved from the relationship. &lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team] members&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family &amp;amp; Friends]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Other_Contributors_Determinants Other Contributors]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Determinants'' - (Psychological Fitness)====&lt;br /&gt;
'''Resilience''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Resilience_Insight Resilience Insight]. A patient that is psychologically fit can have a positive effect on patient outcomes. &lt;br /&gt;
* ''Emotional Fitness'' -positive and negative emotions, optimism, flexible thinking, coping, character strengths &lt;br /&gt;
* ''Social Fitness'' - trust, friendships, balance between privacy and loneliness&lt;br /&gt;
* ''Family Fitness'' - trust, friendship, intimacy, supportive dialog, manage conflict, avoid escalation&lt;br /&gt;
* ''Spiritual Fitness'' - religious and non-religious, what provides purpose and meaning&lt;br /&gt;
* ''Socioeconomic fitness'' - income, marketable job skills, savings, sources of money, &lt;br /&gt;
* Stress Factors - Recent Stressful Events, Ongoing Stressful Challenge, Potential Stressful Events&lt;br /&gt;
* Optimism and Self-Efficacy - belief in ability to succeed in specific situations or accomplish a task which can play a major role in how one approaches goals, tasks, and challenges.&lt;br /&gt;
* Support system&lt;br /&gt;
* Sentiment - related to health, social, socioeconomic, environmental and care management [[Health Determinants|determinants]].&lt;br /&gt;
* Change Acceptance and Determination - Acceptance to '''change''' to Behavior, Lifestyle, address Problem (Stress), Patient Activation, Patient Technology Adoption. Determination to make '''change''' happen. University of Rhode Island Change Assessment Scale [http://www.umbc.edu/psyc/habits/content/ttm_measures/urica/  '''(URICA)''']&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Determinants''====&lt;br /&gt;
'''Responsibilities''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Responsibilities_Insight Responsibilities Insight].&lt;br /&gt;
* Family - Dependent Children, sick family member&lt;br /&gt;
* Caregiver role - for family members or friend&lt;br /&gt;
* Community Commitments - that helps other people&lt;br /&gt;
* Employment Income - that provides income, health insurance that is critical to support family&lt;br /&gt;
* Other Demands - pressing demands such as finish school, sell a house, resolve a legal issue.&lt;br /&gt;
* Personal Commitments - go to Church on Sunday, go to granddaughters soccer game&lt;br /&gt;
* Legal Responsibilities - criminal, civil, divorce decree, immigration, etc&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Determinants''====&lt;br /&gt;
'''Social Well-Being''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Social_Well-Being_Insight Social Well-Being Insight].&lt;br /&gt;
* [[Social Environment Determinants|Social Environment]] &lt;br /&gt;
* Goals&lt;br /&gt;
* '''Purpose &amp;amp; Meaning''' - ''Spiritual Fitness'', part of something bigger than self, responsibilities &lt;br /&gt;
* '''Competence &amp;amp; Success''' - ''Emotional Fitness'', Life Satisfaction, responsibilities &lt;br /&gt;
* '''Passion Engagement'''  - engaging in passions, activities, social, career, religious beliefs, mindfulness, hobbies, etc.&lt;br /&gt;
* Perspectives&lt;br /&gt;
* Dignity - feeling worthy of acceptance, feeling you have something to contribute, you can accomplish things without help&lt;br /&gt;
* '''Connection &amp;amp; Love''' - feeling love or feeling meaningful connections that you believe the other person really understands you.&lt;br /&gt;
* ''Family'' - a sense of belonging to and having a role in a family, group of friends or community, having meaningful connections that you believe the other person really understands you. &lt;br /&gt;
* '''Friendships''' - people you feel comfortable talking to, spending time with or sharing a passion with&lt;br /&gt;
* '''Social Status''' - how we believe we are scene within family, friends, community, work, etc.&lt;br /&gt;
* ''Spouse''&lt;br /&gt;
&lt;br /&gt;
====Support ''Determinants''====&lt;br /&gt;
'''Support''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Support_Insight Support Insight]. &lt;br /&gt;
* [[Social Support Group Determinants|Social support group]]&lt;br /&gt;
* Caregiver&lt;br /&gt;
* Emotional support - from family and friends, provider&lt;br /&gt;
* Physical support - someone who can be there physically to help&lt;br /&gt;
* Influential support - people who the patient trusts to help with decision making&lt;br /&gt;
&lt;br /&gt;
===Socioeconomic ''Determinants''===&lt;br /&gt;
'''Socioeconomic''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Socioeconomic_Insight Socioeconomic Insight].&lt;br /&gt;
====Can't Afford Treatments ''Determinants''====&lt;br /&gt;
'''Can't Afford Treatments''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Can.27t_Afford_Treatments_Insight Can't Afford Treatments Insight]. &lt;br /&gt;
* Delaying medical care&lt;br /&gt;
* Not filling prescribtion because of cost&lt;br /&gt;
* Not beliveing the treatment cost is worth the value&lt;br /&gt;
&lt;br /&gt;
====Financial ''Determinants''====&lt;br /&gt;
'''Financial''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Financial_Insight Financial Insight].&lt;br /&gt;
* Credit Rating&lt;br /&gt;
* Bankruptcy Threat&lt;br /&gt;
* [[Economic Circumstances Determinants|Economic circumstances]] - ICD Codes&lt;br /&gt;
* [[Financial Concerns]]&lt;br /&gt;
* Financial Health - Income, Wealth, Patient Contributions Capabilities, Financial Constraints (Debt, family commitments)  &lt;br /&gt;
* Financial History&lt;br /&gt;
&lt;br /&gt;
====Food Insecurity ''Determinants''====&lt;br /&gt;
'''Food Insecurity''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Food_Insecurity_Insight Food Insecurity Insight]. &lt;br /&gt;
* Missed Meals&lt;br /&gt;
* Low nutrition food due to cost&lt;br /&gt;
* Low nutrition food due to food desert&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Determinants''====&lt;br /&gt;
'''Health Insurance''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Insurance_Insight Health Insurance Insight].&lt;br /&gt;
* Employer Health Insurance, Cobra, etc. &lt;br /&gt;
* Medicare, Medicaid, private plan&lt;br /&gt;
* Health Plan Terms - Deductibles, co-payments, provider network, etc.&lt;br /&gt;
* Potential eligibility for Medicaid, disability or other subsidized insurance program&lt;br /&gt;
&lt;br /&gt;
====Income &amp;amp; Work ''Determinants''====&lt;br /&gt;
'''Income &amp;amp; Work''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Income_.26_Work_Insight Income &amp;amp; Work Insight].&lt;br /&gt;
* [[Employment Determinants|Employment challenges]] - ICD Codes&lt;br /&gt;
* Employment Flexibility - Sick Days/Leave Availability, Occupation&lt;br /&gt;
* [[Employment Level]] - ICD Codes&lt;br /&gt;
* [[Employment Status]] - ICD Codes&lt;br /&gt;
* [[Household Income]] - ICD Codes&lt;br /&gt;
* Income History&lt;br /&gt;
* Income Sources&lt;br /&gt;
* Income Stability - via employment, retirement or other&lt;br /&gt;
* Occupation&lt;br /&gt;
* [[Occupational Exposures Determinants|Occupational exposures]] - ICD Codes&lt;br /&gt;
&lt;br /&gt;
====Legal ''Determinants''====&lt;br /&gt;
'''Legal''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Legal_Insight Legal Insight]. &lt;br /&gt;
* Financial or Legal judgments&lt;br /&gt;
* Legal obligations&lt;br /&gt;
* [[Legal or Criminal Determinants|Legal or criminal]] - ICD Codes&lt;br /&gt;
* Legal Status - citizen status&lt;br /&gt;
* Pending Legal Challenges - criminal, civil, traffice violation, divorce decree, immigration, etc&lt;br /&gt;
&lt;br /&gt;
===Environmental ''Determinants''===&lt;br /&gt;
'''Environmental''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Environmental_Insight Environmental Insight]. The top unmet basic needs that effect clinical outcomes are: housing, food, finances, transportation and literacy. (See: [http://www.health3-0.com/reimbursement/addressing-social-and-basic-needs/ ''Improving Clinical Outcomes By Addressing Social And Basic Needs''])&lt;br /&gt;
&lt;br /&gt;
====Access &amp;amp; Logistics ''Determinants''====&lt;br /&gt;
'''Access &amp;amp; Logistics''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Access_.26_Logistics_Insight  Access &amp;amp; Logistics Insight]. &lt;br /&gt;
* Necessities Access (via delivery or going to the store) - Medicines, Food (via delivery or going to the store), Other&lt;br /&gt;
* Public Transportation, pedestrian and bike infrastructure to promote physical activity&lt;br /&gt;
* Unsafe pedestrian crossings increase risk of injury&lt;br /&gt;
* Transportation - Physician Offices, shopping, activities, Special Transportation Needs (Wheel Chair Vehicle)&lt;br /&gt;
* Clinical Services Access - Same day access to Physicians, Nights &amp;amp; Weekend Access to providers, Clinical Care in area, region (i.e., dialysis)&lt;br /&gt;
&lt;br /&gt;
====Communication ''Determinants''====&lt;br /&gt;
'''Communication''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Communication_Insight Communication Insight].&lt;br /&gt;
&lt;br /&gt;
The physical form of available communications.&lt;br /&gt;
* Phone&lt;br /&gt;
* Internet&lt;br /&gt;
* Text Messaging&lt;br /&gt;
* Mail&lt;br /&gt;
* Face-to-face&lt;br /&gt;
* Mobile Apps&lt;br /&gt;
* Through caregiver&lt;br /&gt;
&lt;br /&gt;
====Community ''Determinants''====&lt;br /&gt;
'''Community''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Community_Insight Community Insight]. &lt;br /&gt;
* [[Physical Environment Determinants|Physical environment]]&lt;br /&gt;
* Neighborhood - safe, places to walk, amenities within walking distance, &lt;br /&gt;
* Supportive Neighbors - friendly, quiet at night (able to get restful sleep), someone to check in nearby &lt;br /&gt;
* Amenities - proximity to groceries, pharmacy, parks, etc., density of liquor stores can increase use&lt;br /&gt;
* Proximity to child care, clinics and jobs &lt;br /&gt;
* Transportation Access&lt;br /&gt;
* Social events&lt;br /&gt;
* Food deserts - lack of fresh foods&lt;br /&gt;
* Clinical Care Services&lt;br /&gt;
* Air Quality - pollution may degrade indoor air quality and increase risk of asthma, heart disease and other illnesses&lt;br /&gt;
* Crime &lt;br /&gt;
* Noise - from roadways, industry and airports can degrade quality of sleep&lt;br /&gt;
&lt;br /&gt;
====Home ''Determinants''====&lt;br /&gt;
'''Home''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Home_Insight Home Insight]. &lt;br /&gt;
* [[Physical Environment Determinants|Physical environment]] - exposure to noise, air pollution, water pollution, soil pollution, radiation, other pollution, inadequate drinking-water supply, tobacco smoke (passive smoking)&lt;br /&gt;
* [[Housing Circumstances Determinants|Housing circumstances]] - Homelessness, Inadequate housing (Lack of heating, Restriction of space, Technical defects), Discord with neighbors, lodgers and landlord, Problems related to living in residential institution (Boarding-school resident), problems related to housing and economic circumstances (Foreclosure on loan, Isolated dwelling, Problems with creditors) &lt;br /&gt;
* Housing Costs - affect ability to afford food and other essential basic needs&lt;br /&gt;
* Housing Structure - Old Carpet and mold can trigger asthma, Structural problems increase the risk of falls and burns, stairway design can promote exercise, safety amenities (banisters, smoke alarms, etc.), Accessibility (Wheel Chair accessible)&lt;br /&gt;
* Home Furnishing - Throw rugs (falls, recent hip replacements) &lt;br /&gt;
* Home - Environmental (Heat, Air conditioner, water, hot water)&lt;br /&gt;
* Place to store medications to keep cold&lt;br /&gt;
* Exposure to firearms&lt;br /&gt;
* Exposure to opioids  &lt;br /&gt;
* Household members - disruptive/supportive family member, Onsite Care Giver Support or from family members&lt;br /&gt;
* Living Arrangement - living alone, congregate living, etc.&lt;br /&gt;
* Private Facility - Apartment, House, Room, etc.&lt;br /&gt;
* Institution Facility (Supportive) - Facility type (Nursing home, senior living center, etc.), Onsite staff (match needs of patients), Onsite resources (food, outdoors, etc.), Accessible (Wheel Chair ramps), Safety (Safety Bathrooms, smoke alarms), Environmental (Heat, A/C, Mold), &lt;br /&gt;
* Temporary Housing - Homelessness, Homeless Shelters, friend or family members home, Halfway House (after recent prison term), Victim Shelters (domestic and sexual violence, disaster relief)&lt;br /&gt;
&lt;br /&gt;
====Security ''Determinants''====&lt;br /&gt;
'''Security''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Security_Insight Security Insight]. &lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Determinants''===&lt;br /&gt;
'''Digital Content &amp;amp; Technology''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Content_Insight Digital Content &amp;amp; Technology Insight].&lt;br /&gt;
&lt;br /&gt;
====Medical Records Determinants==== &lt;br /&gt;
'''Medical Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Records_Insight Medical Records Insight].&lt;br /&gt;
* Comprehensive Medical Record - Ensure one location has combined medical records from multiple providers, such as a Primary Care Physician office. &lt;br /&gt;
* Accurate - Ensure the Medical Record ion accurate&lt;br /&gt;
* Preventitive Care - Ensure recommended Home Technology - wifi, broadband internet, cable TV, phone &lt;br /&gt;
* No Care Gaps - Ensure their are no open care gaps (i.e., diabetic, yet no hA1C test in past 6 months&lt;br /&gt;
* Diagnosis Codes (ICD-10 Codes)&lt;br /&gt;
* Physical and Mental Health Biomarkers - Blood Pressure, HbA1C blood test, cholesterol, Depression, Anxiety, etc.&lt;br /&gt;
* [[Symptoms]] &lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions]&lt;br /&gt;
* Quality of Life Limitations - [http://www.patientdeterminants.org/index.php?title=Determinants#Activity_Determinants Activity], [http://www.patientdeterminants.org/index.php?title=Determinants#Socioeconomic_Determinants Socioeconomic] and [http://www.patientdeterminants.org/index.php?title=Determinants#Social_Determinants Social]&lt;br /&gt;
* Advanced Directives&lt;br /&gt;
* Preferences - Authorizations, Living Will, etc.&lt;br /&gt;
* [[Medical Interventions]] and [[Non-Medical Interventions]]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records==== &lt;br /&gt;
'''Health Determinants Records''' can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Determinants_Records_Insight Health Determinants Records Insight].&lt;br /&gt;
* Methods of capturing Health Determinants&lt;br /&gt;
* Record of Health Determinants&lt;br /&gt;
* Patient Generated Data&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records Determinants====&lt;br /&gt;
'''Health Interventions Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Interventions_Records_Insight Health Interventions Records Insight].&lt;br /&gt;
* History of Interventions (Medical and Non-Medical)&lt;br /&gt;
* Current Health Interventions&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records Determinants====&lt;br /&gt;
'''Health Outcomes Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Outcomes_Records_Insight Health Outcomes Records Insight].&lt;br /&gt;
* Health Outcomes tied to Health Determinants and Health Interventions&lt;br /&gt;
* Current Health Outcome Plans&lt;br /&gt;
* History of Health Outcomes&lt;br /&gt;
* Patient Reported Outcomes&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Determinants''====&lt;br /&gt;
'''Technology &amp;amp; Apps''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Technology_.26_Apps_Insight Technology &amp;amp; Apps Insight]. &lt;br /&gt;
* Apps - mobile, computer applications &lt;br /&gt;
* Durable Medical Equipment - Oxygen equipment, nebulizers, Continuous positive airway pressure (CPAP) devices, single and bi-level, manual and power wheelchairs, scooters, and walkers&lt;br /&gt;
* Home Technology - wifi, broadband internet, cable TV, phone &lt;br /&gt;
* Mobile - cell phone, cell phone service&lt;br /&gt;
* Passive Sensors (wifi enabled weight scale, blue tooth enabled blood pressure cuff)&lt;br /&gt;
&lt;br /&gt;
==Impacting People ''Determinants''==&lt;br /&gt;
'''Impacting People''' Determinants (current and history) impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight Impacting People Insight]. &lt;br /&gt;
&lt;br /&gt;
===Physicians===&lt;br /&gt;
* Primary Care Physicians &lt;br /&gt;
* Physician Specialists &lt;br /&gt;
* Advanced Practice Professional (APPs)  - Physician Assistants, Nurse Practitioners,&lt;br /&gt;
* Behavior Health (Psychologist, Psychiatrist)&lt;br /&gt;
&lt;br /&gt;
===Care Team ''Determinants''===&lt;br /&gt;
'''Care Team''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Team_.26_Resources_Insight Care Team &amp;amp; Resources Insight].&lt;br /&gt;
====Credentialed Care Specialists ''Determinants''====&lt;br /&gt;
Credentialed Care Specialists providers that could influence health outcomes &lt;br /&gt;
* Pharmacists, &lt;br /&gt;
* Therapists - Physical Therapists (PT) / Occupational Therapists (OT) / Speech Therapists (ST)&lt;br /&gt;
* Behavior Health (Psychologist, Psychiatrist), &lt;br /&gt;
* Clinical Social Worker - Licensed Social Workers (LSW) or Medical Social Workers (MSW)&lt;br /&gt;
* Nurses (Care Manager) Registered Nurses (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN)&lt;br /&gt;
* Dietitians &lt;br /&gt;
* Clinical Educators Providers&lt;br /&gt;
====Credentialed Support Providers ''Determinants''==== &lt;br /&gt;
Credentialed Support (Social and Behavioral) Providers - These are professionals that required some credentialing. &lt;br /&gt;
* Home Health - Certified Nursing Assistants (CNA) / Home Health Aides (HHA)&lt;br /&gt;
* Medical Assistants &lt;br /&gt;
* Behavioral Health &lt;br /&gt;
* Patient Navigator - Recovery Navigator &lt;br /&gt;
* Health Coaches - Recovery Coaches &lt;br /&gt;
* Social Workers &lt;br /&gt;
* Legal Counselors&lt;br /&gt;
* Home Health&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Determinants''===&lt;br /&gt;
Trusted:&lt;br /&gt;
* Family Member &lt;br /&gt;
* Friend&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Determinants''===&lt;br /&gt;
'''Family Members &amp;amp; Friends''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Family_Members_.26_Friends_Insight Family Members &amp;amp; Friends Insight].&lt;br /&gt;
For each family member and friend, list their proximity, relationship (cordial, respect, etc.), regularity of social interations  &lt;br /&gt;
* '''Family''' - List of Family Members and &lt;br /&gt;
* Friends - List of Friends with their proximity &lt;br /&gt;
* Spouse or Signicant Other&lt;br /&gt;
* Parents &lt;br /&gt;
* Siblings&lt;br /&gt;
* Children&lt;br /&gt;
* In-Laws&lt;br /&gt;
* Step-Family &lt;br /&gt;
* Friends - List of Friends with their proximity&lt;br /&gt;
* Neighbors&lt;br /&gt;
&lt;br /&gt;
===Support Team ''Determinants''===&lt;br /&gt;
'''Support Team''' (Non-Clinically Credentialed) Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Team_.26_Resources_Insight Care Team &amp;amp; Resources Insight].&lt;br /&gt;
For each support team memeber, list their proximity, relationship (cordial, respect, etc.), regularity of social interations  &lt;br /&gt;
* Educators (i.e., literacy, hobbies, etc.)&lt;br /&gt;
* Financial Counselors&lt;br /&gt;
* Community Health Workers&lt;br /&gt;
* Technical Support - Technical Support and technicians&lt;br /&gt;
* Attorneys&lt;br /&gt;
* Community Resources Providers (See Community Resources)&lt;br /&gt;
* Other Services (handy man, plumber, etc.),&lt;br /&gt;
&lt;br /&gt;
===Organizations ''Determinants''===&lt;br /&gt;
'''Organizations''' Determinants can decisively affect a patient's overall health and well-being. These are communities that may support and/or influence the overall health.  See [[Organization Interventions]].&lt;br /&gt;
&lt;br /&gt;
====Communities====&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities Interventions]&lt;br /&gt;
&lt;br /&gt;
====Community and Social Services Organizations ====&lt;br /&gt;
* Food Banks&lt;br /&gt;
* Churches  &lt;br /&gt;
* Meals Delivery (Meals on Wheels), &lt;br /&gt;
* Transportation Assistance and Services &lt;br /&gt;
* Programs (Smoking Cessation, &lt;br /&gt;
* Weight Loss, Alcoholics Anonymous), &lt;br /&gt;
&lt;br /&gt;
====Employers====&lt;br /&gt;
&lt;br /&gt;
====Government Organizations====&lt;br /&gt;
* Town&lt;br /&gt;
* County&lt;br /&gt;
* State&lt;br /&gt;
* Federal&lt;br /&gt;
&lt;br /&gt;
====Health Insurers====&lt;br /&gt;
&lt;br /&gt;
====Healthcare Advocacy Organizations====&lt;br /&gt;
* Chronic Condition Advocacy (i.e., American Heart Association, American Cancer Society)&lt;br /&gt;
&lt;br /&gt;
====Healthcare Provider Organizations====&lt;br /&gt;
* Retail Pharmacies&lt;br /&gt;
* Pharmaceutical &lt;br /&gt;
* Medical Devices&lt;br /&gt;
* Hospital &lt;br /&gt;
* Medical Practices&lt;br /&gt;
* Community Health Centers - free flu shots, etc.&lt;br /&gt;
* Convenient Care (Minute Clinics, 24 hour services)&lt;br /&gt;
&lt;br /&gt;
====Support Resources Organizations====&lt;br /&gt;
* Home Maintenance Services - handy man, plumber, etc.&lt;br /&gt;
&lt;br /&gt;
====Vendor Partners====&lt;br /&gt;
Organizations that partner with healthcare providers to improve patient outcomes.&lt;br /&gt;
&lt;br /&gt;
See [[Vendor Partner Examples]]&lt;br /&gt;
&lt;br /&gt;
===Other Contributors ''Determinants''===&lt;br /&gt;
'''Other Contributors''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Other_Contributors_Insight Other Contributors Insight]. &lt;br /&gt;
* Manager or Superviosr at Work&lt;br /&gt;
* Other Key Contributers &lt;br /&gt;
* Influencers - Teacher&lt;br /&gt;
* Volunteers&lt;br /&gt;
* Other Resources of Providers&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities ''Determinants''==&lt;br /&gt;
'''Impacting Activities''' Determinants (current and history) impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_Activities_Insight Impacting Activities Insight]. &lt;br /&gt;
 &lt;br /&gt;
===Healthy Lifestyle ''Determinants''===&lt;br /&gt;
Overall '''Healthy Lifestyle''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Physically Active  &lt;br /&gt;
* Nutrition&lt;br /&gt;
* Healthy Weight&lt;br /&gt;
* Avoid Adverse Behaviors  &lt;br /&gt;
* Self Care Management of Health - Sleep, Meditation, preventitive care, medication adherence, etc.  &lt;br /&gt;
* Social &amp;amp; Passion Activities&lt;br /&gt;
* Manage Stress&lt;br /&gt;
* Manage Emotions &lt;br /&gt;
** Positive Emotions - love, affection, work satisfaction, appreciative, goal oriented, feeling good from phyical activities, calm&lt;br /&gt;
** Negative Emotions - anxiety, depression, poor health, being ignored or taking for grated, constant distrations, unhappy, unfulfilled, angry&lt;br /&gt;
* Meditation&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Determinants''===&lt;br /&gt;
'''Physical Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Exercise&lt;br /&gt;
* Activity Levels, &lt;br /&gt;
* Frequency of activity (vs. long duration of sitting)&lt;br /&gt;
* Behaviors (Always walks, always drive, always buses or subways) &lt;br /&gt;
* Work (how active), &lt;br /&gt;
* Activities (Sports, Hiking, gardening)&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities ''Determinants''===&lt;br /&gt;
'''Social &amp;amp; Passion Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Social Interactions - Engagement with others, Caregivers, Organized Communities - like [http://www.patientslikeme.com/ '''PatientsLikeMe'''], &lt;br /&gt;
* Periods of Social Isolation, &lt;br /&gt;
* Social Activities (play cards, go to lunches, Social Organizations, frequent bars), &lt;br /&gt;
* Family Activities (dinners, youth sports)&lt;br /&gt;
* Passion Activities -&lt;br /&gt;
* Sedentary Activities - Television (Watch Baseball, Drama series, News - Favorite programs, Other Sedentary Activities (Read, knit,etc.) &lt;br /&gt;
* Spectator Activities - sports, entertainment, theater, parade, or other events&lt;br /&gt;
* Travel - Visit Family, Friends, Vacation&lt;br /&gt;
* Seasonal Travel - Snowbird (summers in the North, winters in the South),&lt;br /&gt;
&lt;br /&gt;
===Nutrition ''Determinants''===&lt;br /&gt;
'''Nutrition''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Number and times of meals&lt;br /&gt;
* Number and types of snacking&lt;br /&gt;
* Nutritional value and amounts of food&lt;br /&gt;
* Behaviors - Fast Food, Take Out, Home cooked meals&lt;br /&gt;
* Diets and Dieting&lt;br /&gt;
&lt;br /&gt;
===Functional Activities ''Determinants''===&lt;br /&gt;
'''Functional Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Education Activities&lt;br /&gt;
* Income &amp;amp; Work activities&lt;br /&gt;
* Home maintenance&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* Responsibilities Activities - Care Giver Roles to kids, parents, friends&lt;br /&gt;
* Travel Activities - driving to work, store or giving a ride to a family memeber&lt;br /&gt;
* Use of technology such as internet, computers, smart phones, medical deveices, etc.&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Determinants''===&lt;br /&gt;
'''Sleep''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Total Hours of sleep each day&lt;br /&gt;
* Types of sleep - deep, REM, light, naps&lt;br /&gt;
* Number of interruptions&lt;br /&gt;
* When sleep occurs&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Determinants''===&lt;br /&gt;
'''Adverse Behaviors''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Adverse_Behaviors_Insight Adverse Behaviors Insight].&lt;br /&gt;
* Alcohol, &lt;br /&gt;
* Drugs, &lt;br /&gt;
* Falls&lt;br /&gt;
* Gambling, &lt;br /&gt;
* Unprotected sex, &lt;br /&gt;
* Smoking&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Determinants''===&lt;br /&gt;
'''Self-Management Behavior''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Self-Management_Behavior_Insight Self-Management Behavior Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - patient's management of interventions (Medical or Non-Medical), conditions, and symptoms based on the patient's [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies].&lt;br /&gt;
* History of self-management behavior &lt;br /&gt;
* Condition Management Behavior - Diabetic monitoring glucose and injecting insulin, Self-care&lt;br /&gt;
* Conscientiousness - behavior of doing a task well, being thorough, careful, and/or vigilant. &lt;br /&gt;
* Reliable and Organized - behavior as opposed to easy-going and disorderly.&lt;br /&gt;
* Treatment Adherence Behavior - Medication Adherence, Nutrition, Therapy, Physician Visits, Recommended Activity levels &lt;br /&gt;
* Medication Management - management and adherence of oral and injectable medicine&lt;br /&gt;
* Intervention Activation - Know when to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Technology Aptitude (patient or authorized care giver) - Internet and Online Usage, Education Videos, Patient Portal Usage, Use of Secure Texting, Video Conferencing, email, Use of remote monitoring devices (Blood Pressure cuff, remote diagnostic devices (ecg app), Use of tablet, computer or smartphone&lt;br /&gt;
* Online Personal Health Record - Online Electronic Health Record, Blue Button, Access Authorization (Recovery Team access), Patient Input History (Patient answer questions or inputs data into Personal Health Record)&lt;br /&gt;
* Technology Usage - Broadband Internet, Wifi Router, Telecom Network (AT&amp;amp;T, Verizon), Computer, Smartphone or Tablet, Remote Monitoring Devices (Blood pressure cuff, blood glucose monitoring), Remote Diagnostic Devices (ECG app, Accessing patient history via [http://www.healthit.gov/patients-families/blue-button/about-blue-button Blue Button]&lt;br /&gt;
===Care Planning Activities ''Determinants''===&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Determinants''===&lt;br /&gt;
'''Care Management Communications''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Management_-_Communications_Insight Care Management - Communications Insight].  &lt;br /&gt;
* Patient communication - Who? (with care team), How? (in-person, phone, email, text, apps) Frequency? (i.e., dailly, as-needed)&lt;br /&gt;
* Patient Inquiries - who? how? response time?&lt;br /&gt;
* Patient Status - Symptoms, Problem Lists, Concerns, Functional Status, risk factors, Quality of Life Opportunity&lt;br /&gt;
* Recovery Plan Activities - ensure activities are scheduled, treatments happen, prescriptions filled, Recovery Team performs function, Status of Surgeries, Procedures, Tests, Therapies, etc.  &lt;br /&gt;
* Patient Adherence - Monitoring of Medication Adherence, activity levels, other patient behaviors, etc.&lt;br /&gt;
* Patient Activation - Understand condition, capable of treating self, etc. &lt;br /&gt;
* Recovery Factors Monitored - Clinical Condition - Physiological Metrics (i.e., Blood Pressure), Pain, Wounds, etc., functional conditions, etc.  &lt;br /&gt;
* Monitoring Method - Daily Calls, Patient checks box or inputs data, Passive sensors (wifi enabled pill boxes or caps)&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Determinants''===&lt;br /&gt;
'''Care Management - Operational''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Management_-_Operational_Insight Care Management - Operational Insight]. &lt;br /&gt;
* Communication methods within care team - phone, text, portal, etc.&lt;br /&gt;
* Arranging diagnosis, second opinions, procedures, etc.&lt;br /&gt;
* Patient Navigation&lt;br /&gt;
* Triggers - Triggers Requiring Notifications - Patient Concern, Monitoring Alert (i.e., Medication adherence, blood pressure reading), Patient Dialog, Clinical Condition, Emergency, Transfer Event (i.e., Hospital to home)&lt;br /&gt;
* Notification - Who is notified based on each trigger (Patient, Care Giver, Recovery Navigator, Care Manager)? How are they notified (phone calls, text message, alerts)? When are they notified (time frame)?&lt;br /&gt;
* Associated Action - Who takes the action? What is the action? How do they take the action (phone calls, text message, alerts)? When do they take action (time frame)? Potential actions include: Patient triage, Conduct on-site assessment, Issue Escalation, Reassess Recovery Goals, Plan, Monitoring &amp;amp; Protocols, Achieve confirmation to change Recovery Goals, Plan, Monitoring and Protocols&lt;br /&gt;
* Escalation - What gets escalated? Who escalates it (nurse, patient)? Whom do they escalate to (doctor, nurse)? When do they escalate? How do they escalate?&lt;br /&gt;
* Protocol Monitoring - Who ensure notifications, actions and escalations are happening? How? When do they take action?&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Determinants''===&lt;br /&gt;
====Medical Intervention Activities ''Determinants''====&lt;br /&gt;
'''Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Interventions_Insight Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* Part A ([https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html hospital/facility interventions]), &lt;br /&gt;
* Part B ([https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html physician interventions]), &lt;br /&gt;
* Part C ([https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html Medicare Advantage Health Plans]), &lt;br /&gt;
* Part D ([https://www.medicare.gov/part-d/ medication interventions]). &lt;br /&gt;
Most health plans are based on Medicare fee schedules, so they typically reimburse for the same or similar services.&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Intervention Activities ''Determinants''====&lt;br /&gt;
'''Non-Medical Intervention Activities ''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Insight Non-Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* [[Care Management Programs]] - team-based, patient focused programs designed to meet specific needs of patients based on the program's criteria. &lt;br /&gt;
* [[Health Services]] - a specific focused health services or capabilities designed to meet specific health needs of patients based on the services's criteria. &lt;br /&gt;
* [[Support Services]] - a specific focused support services or capabilities designed to meet specific needs of patients based on the services's criteria. &lt;br /&gt;
* [[Patient/Caregiver Interventions]] - activities or actions by patients and caregivers that will likely improve health, health outcomes and reduce overall cost.&lt;br /&gt;
* [[Health Insurance Payment Models]] - these are health insurance payment models design to improve patients outcomes, health and reduce cost&lt;br /&gt;
* [[Organization Interventions]] - employers, communities and governments interventions&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence====&lt;br /&gt;
'''Health Strategy Activity Changes 7 Adherence'''  Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Outcomes_Insight Non-Medical Interventions Outcomes Insight].&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Determinants</id>
		<title>Health Determinants</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Determinants"/>
				<updated>2019-07-23T15:29:36Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Health Goals (Care Goals) Determinants */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Determinants]] can decisively affect a patient's overall health and well-being. [[Health Determinants]] include [[barriers]], [[symptoms]] and [[Functional Status|functional status]]. The [http://www.dcoe.mil/Libraries/Documents/Phase_2_IOM_Social_Behavioral_Domains_2014_18951.pdf Institute of Medicine (IOM) recommends] capturing social and behavioral determinants in Electronic Medical Records. [https://www.cdc.gov/nchhstp/socialdeterminants/faq.html CDC defines Determinants of health as factors that contribute to a person's current state of health.] &lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) ''Determinants''==&lt;br /&gt;
Health '''Mission''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See Health [http://www.patientdeterminants.org/index.php?title=Health_Insight#Mission_.28Health_Goals.29_Insight Mission (Health Goals) Insight].&lt;br /&gt;
&lt;br /&gt;
===Personal Goals (Missions) ''Determinants''===&lt;br /&gt;
'''Personal Goals (Missions)''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Health Mission &amp;amp; Care Goals Insight]. Patient specific care goals related to improving or maintaining the patient's [[Health Status|health status]].&lt;br /&gt;
* Patient's Life Goals  - non health related, responsibilities, passions, etc.&lt;br /&gt;
* Patient's Health  - that includes preventitive &amp;amp; wellness goals, managing acute and chronic conditions, end-of-life&lt;br /&gt;
&lt;br /&gt;
===Health Goals (Care Goals) ''Determinants''===&lt;br /&gt;
'''Health Goals (Care Goals)''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Health Mission &amp;amp; Care Goals Insight]. Patient specific care goals related to improving or maintaining the patient's [[Health Status|health status]].&lt;br /&gt;
* Symptoms Goals (Patient) - improvement of patient's assessment of their physical and mental symptoms. They include pain or discomfort, visual symptoms, cold or flu-like, physical abnormalities, mental health and other.&lt;br /&gt;
* Conditions Goals (Medical) - improvement or stabilizing disease and conditions (i.e., diabetes, hypertension) as well as biomarkers (i.e., blood pressure, weight, blood glucose) as documented by a medical professional in the patients Electronic Medical Record.&lt;br /&gt;
* Function Goals (Patient) - improvement of the patient's assessment of their function (i.e., walking, going to work, doing what they love).&lt;br /&gt;
* Clinical Risk Goals (Medical) - improvement of medical risks (i.e., for disease, disease progression, acute event, mortality)&lt;br /&gt;
* Behavioral Risk Goals (Patient) - improvement of the patients assessment of their behavior or ability to be compliant with the care plan based on health determinants (i.e., fiancial, transportation, housing).&lt;br /&gt;
* Well-Being Goals (Patient) - improvement in the patient's assessment of Support, Health, Basic Needs, PHQ, Purpose, Love &amp;amp; Connection, Competence&lt;br /&gt;
* Timing Goals - 2 days, 2 weeks, 2 months, 2 years&lt;br /&gt;
* Medical Interventions &amp;amp; Events Goals - Acute events, surgeries, ER visit, hospital, medication or medical treatment etc.&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) ''Determinants''==&lt;br /&gt;
'''Strategy (Health Plan)''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Strategy_.28Health_Plan.29_Insight Strategy (Health Plan) Insight]. &lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Determinants''===&lt;br /&gt;
Strategy Objectives ('''Care Plan''') Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight].&lt;br /&gt;
 &lt;br /&gt;
* Overall Strategy objectives of how each of the care goals will be achieved&lt;br /&gt;
* Specific details of how each of the care goals will be achieve&lt;br /&gt;
* Potential Barriers (Impacting Activities, People, &amp;amp; Realities) - potential barriers (health determinants) that could impact achieving the Care Goals and how each will be addressed&lt;br /&gt;
* Key People &amp;amp; Roles (Impacting People)&lt;br /&gt;
* Key Activities &amp;amp; Interventions (Impacting Activities)  &lt;br /&gt;
* Measures&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) ''Determinants''===&lt;br /&gt;
====Medical Interventions ''Determinants''====&lt;br /&gt;
'''Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Interventions_Insight Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* Part A ([https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html hospital/facility interventions]), &lt;br /&gt;
* Part B ([https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html physician interventions]), &lt;br /&gt;
* Part C ([https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html Medicare Advantage Health Plans]), &lt;br /&gt;
* Part D ([https://www.medicare.gov/part-d/ medication interventions]). &lt;br /&gt;
Most health plans are based on Medicare fee schedules, so they typically reimburse for the same or similar services. &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Medical Interventions Results can impact the strategy:  &lt;br /&gt;
* Testing - Clinical Consults, Lab, Imaging, ECG, etc.&lt;br /&gt;
* Qualified Option Development - diagnosis, progonosis and treatment options&lt;br /&gt;
* Medical Interventions&lt;br /&gt;
* Shared Decision Making - process helps to develop interventions based on care goals.&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions ''Determinants''====&lt;br /&gt;
'''Non-Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Insight Non-Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* [[Care Management Programs]] - team-based, patient focused programs designed to meet specific needs of patients based on the program's criteria. &lt;br /&gt;
* [[Health Services]] - a specific focused health services or capabilities designed to meet specific health needs of patients based on the services's criteria. &lt;br /&gt;
* [[Support Services]] - a specific focused support services or capabilities designed to meet specific needs of patients based on the services's criteria. &lt;br /&gt;
* [[Patient/Caregiver Interventions]] - activities or actions by patients and caregivers that will likely improve health, health outcomes and reduce overall cost.&lt;br /&gt;
* [[Health Insurance Payment Models]] - these are health insurance payment models design to improve patients outcomes, health and reduce cost&lt;br /&gt;
* [[Organization Interventions]] - employers, communities and governments interventions&lt;br /&gt;
&lt;br /&gt;
Non-Medical Interventions Results can impact the Care Plan&lt;br /&gt;
====Intervention Adherence ''Determinants''====&lt;br /&gt;
====Intervention Changes ''Determinants''====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures ''Determinants''===&lt;br /&gt;
Strategy '''Measures''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight].&lt;br /&gt;
* Measures - These are measures that will demonstrate progress toward achieving the health mission. This is the list of measures (i.e., pain levels, function levels, blood sugar levels) that will be used to measure progress of the startegy objectives toward achieving the health mission. &lt;br /&gt;
* Measures types:&lt;br /&gt;
** Mission (Health Goals) Measures - measure progress toward achieving the mission&lt;br /&gt;
** Strategy Objectives (Care Plan) Measures - measure the progress of the strategy objectives toward achieveing the mission&lt;br /&gt;
** Strategy Solutions (Interventions) Measures - measure the effectiveness of individual interventions in respect to achieving the missio and objective strategy &lt;br /&gt;
** Impacting Elements Measures - measure the impact of impacting people, realities and activities not included above&lt;br /&gt;
** Adherence Measures - adherence to interventions&lt;br /&gt;
** Change Measures - timing, reason codes, for changes in interventions, people, realities, activities &lt;br /&gt;
* Measurement Timeframes - These are the times when progress will be measures&lt;br /&gt;
* Measurement Baseline - This is the initial measures that will be used to measure the health outcome of the strategy objectives.&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting People ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting People''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Disciplines_.26_Resources_Insight Health Disciplines &amp;amp; Resources Insight]. &lt;br /&gt;
&lt;br /&gt;
'''List - Impacting People'''&amp;lt;br&amp;gt;&lt;br /&gt;
* Clinical Providers - These are licensed professionals. Primary Care Physicians, Physician Assistants, Nurse Practitioners, Physician Specialists, Pharmacists, Therapists (Speech, Physical, Occupational), Behavior Health (Psychologist, Psychiatrist), Nurse (Care Manager), Dietitian, Education Providers (Clinical)&lt;br /&gt;
* Support (Social and Behavioral) Providers - Care givers (family or friend), Recovery Navigator (patient navigator), Recovery Coaches (included MSW Social Workers and Health Coaches), Education (Non-Clinical), Technical Support and technicians&lt;br /&gt;
* Community (Basic Needs) Resources - Financial Counseling, Meals Delivery (Meals on Wheels), Transportation Assistance, Programs (Smoking Cessation, Weight Loss, Alcoholics Anonymous), Delivery Services, Transportation Services, Other Services (handy man, plumber, etc.), Community Health Services (Community Health Centers, free flu shots, etc.), Convenient Care (Minute Clinics, 24 hour services)&lt;br /&gt;
* Changes to Impacting People List&lt;br /&gt;
&lt;br /&gt;
'''Roles - Impacting People''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Role within Strategy (Care Plan)&lt;br /&gt;
* Role within Solution (Interventions)&lt;br /&gt;
* Frequency and types of communications&lt;br /&gt;
* Influence&lt;br /&gt;
* Activities&lt;br /&gt;
* Tasks&lt;br /&gt;
* Types of Support&lt;br /&gt;
&lt;br /&gt;
'''Behavior - Impacting People Behavior'''&lt;br /&gt;
* Adherence to Strategy&lt;br /&gt;
* Frequency and types of communications&lt;br /&gt;
* Influence&lt;br /&gt;
* Activities&lt;br /&gt;
* Tasks&lt;br /&gt;
* Support Provided&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting People'''&lt;br /&gt;
* List of potential barriers due to impacting people&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting Realities ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting Realities''' Determinants (Health Determinats) can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''List - Impacting Realities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Health Conditions&lt;br /&gt;
* Competencies&lt;br /&gt;
* Social&lt;br /&gt;
* Socioeconomic&lt;br /&gt;
* Environmental&lt;br /&gt;
* Digital Content &amp;amp; Technology&lt;br /&gt;
* Changes to Impacting Realities List&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting Realities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* List of potential barriers due to impacting realities&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting Activities ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Strategy - Impacting Activities Insight].&amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
'''List - Impacting Activities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Physical Activities&lt;br /&gt;
* Social &amp;amp; Passion Activities&lt;br /&gt;
* Nutrition&lt;br /&gt;
* Functional Activities&lt;br /&gt;
* Sleep&lt;br /&gt;
* Stress, Emotions &amp;amp; Meditation&lt;br /&gt;
* Adverse Behaviors &lt;br /&gt;
* Self-Management Behavior&lt;br /&gt;
* Care Management Communications&lt;br /&gt;
* Care Management Operational&lt;br /&gt;
* Health Strategy Activities&lt;br /&gt;
&lt;br /&gt;
'''Behavior - Impacting Activities'''&lt;br /&gt;
* Adherence to Strategy&lt;br /&gt;
* Changes to Behavior&lt;br /&gt;
* Potential Assets from Behavior&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting Activities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* List of potential barriers due to impacting activities&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities ''Determinants''==&lt;br /&gt;
'''Impacting Realities''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_Realities_Insight Impacting Realities Insight]. &lt;br /&gt;
===Health Conditions ''Determinants''===&lt;br /&gt;
'''Health Conditions''' Determinants that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Conditions_Insight Health Conditions Insight].&lt;br /&gt;
====Physical Conditions ''Determinants''====&lt;br /&gt;
'''Physical Conditions''' Determinants can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].  See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Physical_Conditions_Insight Physical Conditions Insight]. Medicare has developed a model to categorize Physical Conditions in order to risk [http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html '''risk adjust'''] health insurers that are covering patients. The [[CMS-HCC Risk Adjustments]] model adjust for patient demographics (i.e., age, disabled) and disease (i.e., diabetes, congested heart failure). &lt;br /&gt;
&lt;br /&gt;
* Allergies &amp;amp; Adverse Drug Reactions&lt;br /&gt;
* [https://en.wikipedia.org/wiki/Comorbidity Comorbidities] -  chronic disorders (or diseases) that need to be managed. Most comorbidities do not get cured.  &lt;br /&gt;
* Demographics - Age, Sex, Disabled, Long Term Institutional Status (LTI Designated Status) &lt;br /&gt;
* [http://www.cdc.gov/vaccines/vpd-vac/vaccines-list.htm Immunizations] - Flu, Tetanus&lt;br /&gt;
* Physical Impairments -  Physical Impairments (Use of limbs, arthritis, amputation, birth defects, Epilepsy), Sensory Impairments (Blind or Visually Impaired, Deaf or Hard of Hearing, loss of taste and smell)&lt;br /&gt;
* Medical History - Adverse events, Family Medical History, Medical Conditions, Surgeries&lt;br /&gt;
* Physiological Metrics - Blood glucose level, Blood pressure, Cholesterol level (HDL, LDL, etc), Heart rate&lt;br /&gt;
* Problem and Symptom lists - Pressure Ulcers, Pain, asthma, Fever, Fractures, Headache, Rash or skin infection, Shortness of Breath, Sprains, Upper respiratory tract infection, Wounds&lt;br /&gt;
* [http://www.biomedcentral.com/1471-2318/14/25 '''Frailty Index''']&lt;br /&gt;
* [[CCS Diagnostic Categories]]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Determinants''====&lt;br /&gt;
'''Mental Health Conditions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Mental_Health_Conditions_Insight Mental Health Conditions Insight].&lt;br /&gt;
* Comorbidities -  mental health disorders (or diseases) that need to be managed. Most comorbidities do not get cured.&lt;br /&gt;
* Disorders - Anxiety Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autism, Bipolar Disorder, Eating Disorder, Depression, Obsessive Compulsive Disorder (OCD), Panic Disorders, Post Traumatic Stress Disorder, Schizophrenia&lt;br /&gt;
* History&lt;br /&gt;
* Impairments - Cognitive Impairments (Delirium &amp;quot;confused state&amp;quot;, Dementia), Developmental&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Determinants''====&lt;br /&gt;
'''Functional Conditions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Functional_Conditions_Insight Functional Conditions Insight].&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* Required Devices - pacemakers, artificial limb, etc.&lt;br /&gt;
* Logistic Capabilities - Walk, Assisted Walking, Wheelchair, Equipment Requirements (Oxygen, heart device, etc.)&lt;br /&gt;
* Disabilities and Impairments as defined by the [http://www.dc37.net/about/graphics/factsheetspdf/disability_defined.pdf American Disabilities Act]&lt;br /&gt;
* Homebound - unable to travel to physician offices&lt;br /&gt;
* Work - Physically able to go back to work or enough functional ability to find a new job&lt;br /&gt;
* Passion - Physically able to go back to work or enough functional ability to find a new job&lt;br /&gt;
* Mental - Not prevented from working, pursuing passion and functional activities because of mental health challenges&lt;br /&gt;
* [[Requires Support]] - for ADLs or IADLs&lt;br /&gt;
* Functional History&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Determinants''====&lt;br /&gt;
'''Genomic Profiles''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Genomic_Profiles_Insight Genomic Profiles Insight].&lt;br /&gt;
&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Human_genome '''Human Genome'''] - complete set of genetic information encoded as DNA sequences within the 23 chromosome pairs. It includes the genomes of [http://en.wikipedia.org/wiki/Tumor '''tumors'''], the abnormal mass of tissue from abnormal growth or division of cells. &lt;br /&gt;
&lt;br /&gt;
* [https://ghr.nlm.nih.gov/handbook/howgeneswork/epigenome '''Epigenome''']  multitude of chemical compounds that have been added to the entirety of one’s DNA (genome) as a way to regulate the activity (expression) of all the genes within the genome. These chemical compounds of the epigenome are not part of the DNA sequence, but are on or attached to DNA (“epi-“ means above in Greek).&lt;br /&gt;
&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Microbiome '''Microbiome'''] - the collective genomes of the microorganisms that share our body space. The resident bacteria, viruses ([http://en.wikipedia.org/wiki/Human_virome '''virome''']) and [http://en.wikipedia.org/wiki/Eukaryote '''other microbes with genomes''']. &lt;br /&gt;
&lt;br /&gt;
* Other Genomic Profiles - [http://en.wikipedia.org/wiki/Metabolome '''Metabolome'''] - are small molecules with metabolism functions of fuel, structure, signaling, stimulatory and inhibitory effects on enzymes and other catalytic activities. [http://en.wikipedia.org/wiki/Proteome '''Proteome'''] - set of proteins expressed by a genome, cell, tissue or organism at a given time, under defined conditions.  [http://en.wikipedia.org/wiki/Transcriptome '''Transcriptome'''] - set of all molecules use to create new cells with genomes.&lt;br /&gt;
&lt;br /&gt;
====High Cost High Need Patients ''Determinants''====&lt;br /&gt;
'''High Cost High Need Patients''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Genomic_Profiles_Insight Genomic Profiles Insight].&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Determinants''===&lt;br /&gt;
'''Competencies''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Competencies_Insight Health Competencies Insight].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Determinants''====&lt;br /&gt;
Health Literacy Determinants impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Literacy_Insight Health Literacy Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - Undertands why and how to manage their health. These competencies help improve [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior].&lt;br /&gt;
* Health Risks - understand their health risks and how to manage them&lt;br /&gt;
* Health Conditions - understands their health conditions &lt;br /&gt;
* Health Condition Management Knowledge - understands how to manage their health conditions (i.e., Diabetic glucose monitoring and injecting insulin)&lt;br /&gt;
* Interventions (Medical and Non-Medical)- understands why the interventions are necessary for overall health.&lt;br /&gt;
* Assistance Engagement - Know when to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Education - Diagnosis, Prognosis, Treatments, Understand Options and onboard with the treatment plan&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Determinants''====&lt;br /&gt;
Self Management Competencies Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Self-Management_Competencies_Insight Self-Management Competency Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - demonstrates competencies to manage conditions, interventions (medical or non-medical) and is committed to the treatment. These competencies help improve [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior].&lt;br /&gt;
* Health Condition Management Competencies - demonstrates abilities to manage their health conditions (i.e., Diabetic glucose monitoring and injecting insulin)&lt;br /&gt;
* Conscientiousness - a desire to do a task well being thorough, careful, or vigilant. &lt;br /&gt;
* Reliable and Organized - as opposed to easy-going and disorderly.&lt;br /&gt;
* Intervention (Medical or Non-Medical) Competencies - Medication Adherence, Nutrition, Therapies, Physician Visits, Recommended Activity levels &lt;br /&gt;
* Medication Management Competencies - management and adherence of oral and injectable medicine&lt;br /&gt;
* Assistance Engagement - Know when and how to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Technology Competencies (patient or authorized care giver) - Internet and Online Usage, Education Videos, Patient Portal Usage, Use of Secure Texting, Video Conferencing, email, Use of remote monitoring devices (Blood Pressure cuff, remote diagnostic devices (ecg app), Use of tablet, computer or smartphone&lt;br /&gt;
* Access Online Personal Health Record - Online Electronic Health Record, Blue Button, Access Authorization (Care Team access), Patient Provided Input History (Patient answer questions or inputs data into Personal Health Record)&lt;br /&gt;
* Technology Access - Broadband Internet, Wifi Router, Telecom Network (AT&amp;amp;T, Verizon), Computer, Smartphone or Tablet, Remote Monitoring Devices&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Determinants''====&lt;br /&gt;
'''Functional Competencies''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Competencies_Insight Competencies Insight]. &lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* [[Education and Literacy Determinants|Literacy]] - ICD Codes&lt;br /&gt;
* Languages - Speaking &amp;amp; Reading&lt;br /&gt;
* Technology Usage - Smart Phone, Google, Online Patient Portals&lt;br /&gt;
&lt;br /&gt;
====Education ''Determinants''====&lt;br /&gt;
'''Education''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Education_Insight Education Insight]. &lt;br /&gt;
* [[Education and Literacy Determinants|Education]] - ICD Codes&lt;br /&gt;
* [[Educational Attainment]] - Completed levels of formal education,&lt;br /&gt;
* Vocational Training&lt;br /&gt;
* Certifications, Licenses or degrees (diplomas)&lt;br /&gt;
&lt;br /&gt;
===Social ''Determinants''===&lt;br /&gt;
'''Social''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Social_Insight Social Insight].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Determinants''====&lt;br /&gt;
'''Patient (About &amp;amp; History)''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Patient_.28About_.26_History.29_Insight Patient (About &amp;amp; History) Insight].&lt;br /&gt;
* About - Narrative/Story, Photos&lt;br /&gt;
* [[Marital Status]]&lt;br /&gt;
* [[Childhood Events Determinants|Childhood events]] &lt;br /&gt;
* [[Childhood Upbringing Determinants|Childhood upbringing]]&lt;br /&gt;
* Military Service&lt;br /&gt;
* [[Psychosocial Circumstances Determinants|Psychosocial Circumstances]] &lt;br /&gt;
* Passions/Goals - Sports Teams, Television, reading, social media, Activities - Walking, shopping, etc.&lt;br /&gt;
* Sexual Orientation&lt;br /&gt;
* [[Race &amp;amp; Ethnicity]]&lt;br /&gt;
* Country of Origin/US Born or Non-US Born&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Determinants''====&lt;br /&gt;
'''Adverse Events''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Adverse_Events_Insight Adverse Events Insight].&lt;br /&gt;
* [http://www.cdc.gov/violenceprevention/acestudy/ '''Adverse Childhood Experiences (ACE)''']&lt;br /&gt;
* Victim of physical or verbal abuse&lt;br /&gt;
* Victim of crime &lt;br /&gt;
* Compelling Events - death, loss of home, job, &lt;br /&gt;
* Adversity Exposure - Violence, crime, verbal abuse, death, poverty, financial stress, depression, anxiety&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Determinants''====&lt;br /&gt;
'''Beliefs''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Beliefs_Insight Beliefs Insight].&lt;br /&gt;
* Health Literacy Beliefs&lt;br /&gt;
* Religion and faith&lt;br /&gt;
* Perspectives - politics, lifestyle, culture&lt;br /&gt;
* Trust and faith in Institutions - Healthcare, Education, Government&lt;br /&gt;
* Trust and faith in Physicians, nurses and the medical professions&lt;br /&gt;
* Beliefs about impacting people, caregivers, family, friends, care team&lt;br /&gt;
* Beliefs in whether the current care plan will work&lt;br /&gt;
* Beliefs about current health conditions&lt;br /&gt;
* Beliefs about physicial activity, nutrition and sleep&lt;br /&gt;
* Beliefs about adverse behavior&lt;br /&gt;
* Beliefs about self-management of health&lt;br /&gt;
&lt;br /&gt;
====Determination ''Determinants''====&lt;br /&gt;
'''Determination''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Determination_Insight Determination Insight].&lt;br /&gt;
* Willingness to change or do something different&lt;br /&gt;
* Desire to make change happen&lt;br /&gt;
* Eagerness to learn how to improve health&lt;br /&gt;
* Desire to improve health&lt;br /&gt;
* Detrmination to stick to a plan to achieve the desired outcome&lt;br /&gt;
* Desire to make something happen&lt;br /&gt;
* Enthusiasm to make something happen&lt;br /&gt;
* Personal goals and dreams&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Determinants''====&lt;br /&gt;
'''Relationships''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Resilience_Insight Relationships Insight]. A patient with good or functional relationships with the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People] can have a positive effect on patient outcomes. The [http://wikidreams.org/index.php?title=Relationships relationship type], type and frequency of communication as well as what is recieved from the relationship. &lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team] members&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family &amp;amp; Friends]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Other_Contributors_Determinants Other Contributors]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Determinants'' - (Psychological Fitness)====&lt;br /&gt;
'''Resilience''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Resilience_Insight Resilience Insight]. A patient that is psychologically fit can have a positive effect on patient outcomes. &lt;br /&gt;
* ''Emotional Fitness'' -positive and negative emotions, optimism, flexible thinking, coping, character strengths &lt;br /&gt;
* ''Social Fitness'' - trust, friendships, balance between privacy and loneliness&lt;br /&gt;
* ''Family Fitness'' - trust, friendship, intimacy, supportive dialog, manage conflict, avoid escalation&lt;br /&gt;
* ''Spiritual Fitness'' - religious and non-religious, what provides purpose and meaning&lt;br /&gt;
* ''Socioeconomic fitness'' - income, marketable job skills, savings, sources of money, &lt;br /&gt;
* Stress Factors - Recent Stressful Events, Ongoing Stressful Challenge, Potential Stressful Events&lt;br /&gt;
* Optimism and Self-Efficacy - belief in ability to succeed in specific situations or accomplish a task which can play a major role in how one approaches goals, tasks, and challenges.&lt;br /&gt;
* Support system&lt;br /&gt;
* Sentiment - related to health, social, socioeconomic, environmental and care management [[Health Determinants|determinants]].&lt;br /&gt;
* Change Acceptance and Determination - Acceptance to '''change''' to Behavior, Lifestyle, address Problem (Stress), Patient Activation, Patient Technology Adoption. Determination to make '''change''' happen. University of Rhode Island Change Assessment Scale [http://www.umbc.edu/psyc/habits/content/ttm_measures/urica/  '''(URICA)''']&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Determinants''====&lt;br /&gt;
'''Responsibilities''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Responsibilities_Insight Responsibilities Insight].&lt;br /&gt;
* Family - Dependent Children, sick family member&lt;br /&gt;
* Caregiver role - for family members or friend&lt;br /&gt;
* Community Commitments - that helps other people&lt;br /&gt;
* Employment Income - that provides income, health insurance that is critical to support family&lt;br /&gt;
* Other Demands - pressing demands such as finish school, sell a house, resolve a legal issue.&lt;br /&gt;
* Personal Commitments - go to Church on Sunday, go to granddaughters soccer game&lt;br /&gt;
* Legal Responsibilities - criminal, civil, divorce decree, immigration, etc&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Determinants''====&lt;br /&gt;
'''Social Well-Being''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Social_Well-Being_Insight Social Well-Being Insight].&lt;br /&gt;
* [[Social Environment Determinants|Social Environment]] &lt;br /&gt;
* Goals&lt;br /&gt;
* '''Purpose &amp;amp; Meaning''' - ''Spiritual Fitness'', part of something bigger than self, responsibilities &lt;br /&gt;
* '''Competence &amp;amp; Success''' - ''Emotional Fitness'', Life Satisfaction, responsibilities &lt;br /&gt;
* '''Passion Engagement'''  - engaging in passions, activities, social, career, religious beliefs, mindfulness, hobbies, etc.&lt;br /&gt;
* Perspectives&lt;br /&gt;
* Dignity - feeling worthy of acceptance, feeling you have something to contribute, you can accomplish things without help&lt;br /&gt;
* '''Connection &amp;amp; Love''' - feeling love or feeling meaningful connections that you believe the other person really understands you.&lt;br /&gt;
* ''Family'' - a sense of belonging to and having a role in a family, group of friends or community, having meaningful connections that you believe the other person really understands you. &lt;br /&gt;
* '''Friendships''' - people you feel comfortable talking to, spending time with or sharing a passion with&lt;br /&gt;
* '''Social Status''' - how we believe we are scene within family, friends, community, work, etc.&lt;br /&gt;
* ''Spouse''&lt;br /&gt;
&lt;br /&gt;
====Support ''Determinants''====&lt;br /&gt;
'''Support''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Support_Insight Support Insight]. &lt;br /&gt;
* [[Social Support Group Determinants|Social support group]]&lt;br /&gt;
* Caregiver&lt;br /&gt;
* Emotional support - from family and friends, provider&lt;br /&gt;
* Physical support - someone who can be there physically to help&lt;br /&gt;
* Influential support - people who the patient trusts to help with decision making&lt;br /&gt;
&lt;br /&gt;
===Socioeconomic ''Determinants''===&lt;br /&gt;
'''Socioeconomic''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Socioeconomic_Insight Socioeconomic Insight].&lt;br /&gt;
====Can't Afford Treatments ''Determinants''====&lt;br /&gt;
'''Can't Afford Treatments''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Can.27t_Afford_Treatments_Insight Can't Afford Treatments Insight]. &lt;br /&gt;
* Delaying medical care&lt;br /&gt;
* Not filling prescribtion because of cost&lt;br /&gt;
* Not beliveing the treatment cost is worth the value&lt;br /&gt;
&lt;br /&gt;
====Financial ''Determinants''====&lt;br /&gt;
'''Financial''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Financial_Insight Financial Insight].&lt;br /&gt;
* Credit Rating&lt;br /&gt;
* Bankruptcy Threat&lt;br /&gt;
* [[Economic Circumstances Determinants|Economic circumstances]] - ICD Codes&lt;br /&gt;
* [[Financial Concerns]]&lt;br /&gt;
* Financial Health - Income, Wealth, Patient Contributions Capabilities, Financial Constraints (Debt, family commitments)  &lt;br /&gt;
* Financial History&lt;br /&gt;
&lt;br /&gt;
====Food Insecurity ''Determinants''====&lt;br /&gt;
'''Food Insecurity''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Food_Insecurity_Insight Food Insecurity Insight]. &lt;br /&gt;
* Missed Meals&lt;br /&gt;
* Low nutrition food due to cost&lt;br /&gt;
* Low nutrition food due to food desert&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Determinants''====&lt;br /&gt;
'''Health Insurance''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Insurance_Insight Health Insurance Insight].&lt;br /&gt;
* Employer Health Insurance, Cobra, etc. &lt;br /&gt;
* Medicare, Medicaid, private plan&lt;br /&gt;
* Health Plan Terms - Deductibles, co-payments, provider network, etc.&lt;br /&gt;
* Potential eligibility for Medicaid, disability or other subsidized insurance program&lt;br /&gt;
&lt;br /&gt;
====Income &amp;amp; Work ''Determinants''====&lt;br /&gt;
'''Income &amp;amp; Work''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Income_.26_Work_Insight Income &amp;amp; Work Insight].&lt;br /&gt;
* [[Employment Determinants|Employment challenges]] - ICD Codes&lt;br /&gt;
* Employment Flexibility - Sick Days/Leave Availability, Occupation&lt;br /&gt;
* [[Employment Level]] - ICD Codes&lt;br /&gt;
* [[Employment Status]] - ICD Codes&lt;br /&gt;
* [[Household Income]] - ICD Codes&lt;br /&gt;
* Income History&lt;br /&gt;
* Income Sources&lt;br /&gt;
* Income Stability - via employment, retirement or other&lt;br /&gt;
* Occupation&lt;br /&gt;
* [[Occupational Exposures Determinants|Occupational exposures]] - ICD Codes&lt;br /&gt;
&lt;br /&gt;
====Legal ''Determinants''====&lt;br /&gt;
'''Legal''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Legal_Insight Legal Insight]. &lt;br /&gt;
* Financial or Legal judgments&lt;br /&gt;
* Legal obligations&lt;br /&gt;
* [[Legal or Criminal Determinants|Legal or criminal]] - ICD Codes&lt;br /&gt;
* Legal Status - citizen status&lt;br /&gt;
* Pending Legal Challenges - criminal, civil, traffice violation, divorce decree, immigration, etc&lt;br /&gt;
&lt;br /&gt;
===Environmental ''Determinants''===&lt;br /&gt;
'''Environmental''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Environmental_Insight Environmental Insight]. The top unmet basic needs that effect clinical outcomes are: housing, food, finances, transportation and literacy. (See: [http://www.health3-0.com/reimbursement/addressing-social-and-basic-needs/ ''Improving Clinical Outcomes By Addressing Social And Basic Needs''])&lt;br /&gt;
&lt;br /&gt;
====Access &amp;amp; Logistics ''Determinants''====&lt;br /&gt;
'''Access &amp;amp; Logistics''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Access_.26_Logistics_Insight  Access &amp;amp; Logistics Insight]. &lt;br /&gt;
* Necessities Access (via delivery or going to the store) - Medicines, Food (via delivery or going to the store), Other&lt;br /&gt;
* Public Transportation, pedestrian and bike infrastructure to promote physical activity&lt;br /&gt;
* Unsafe pedestrian crossings increase risk of injury&lt;br /&gt;
* Transportation - Physician Offices, shopping, activities, Special Transportation Needs (Wheel Chair Vehicle)&lt;br /&gt;
* Clinical Services Access - Same day access to Physicians, Nights &amp;amp; Weekend Access to providers, Clinical Care in area, region (i.e., dialysis)&lt;br /&gt;
&lt;br /&gt;
====Communication ''Determinants''====&lt;br /&gt;
'''Communication''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Communication_Insight Communication Insight].&lt;br /&gt;
&lt;br /&gt;
The physical form of available communications.&lt;br /&gt;
* Phone&lt;br /&gt;
* Internet&lt;br /&gt;
* Text Messaging&lt;br /&gt;
* Mail&lt;br /&gt;
* Face-to-face&lt;br /&gt;
* Mobile Apps&lt;br /&gt;
* Through caregiver&lt;br /&gt;
&lt;br /&gt;
====Community ''Determinants''====&lt;br /&gt;
'''Community''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Community_Insight Community Insight]. &lt;br /&gt;
* [[Physical Environment Determinants|Physical environment]]&lt;br /&gt;
* Neighborhood - safe, places to walk, amenities within walking distance, &lt;br /&gt;
* Supportive Neighbors - friendly, quiet at night (able to get restful sleep), someone to check in nearby &lt;br /&gt;
* Amenities - proximity to groceries, pharmacy, parks, etc., density of liquor stores can increase use&lt;br /&gt;
* Proximity to child care, clinics and jobs &lt;br /&gt;
* Transportation Access&lt;br /&gt;
* Social events&lt;br /&gt;
* Food deserts - lack of fresh foods&lt;br /&gt;
* Clinical Care Services&lt;br /&gt;
* Air Quality - pollution may degrade indoor air quality and increase risk of asthma, heart disease and other illnesses&lt;br /&gt;
* Crime &lt;br /&gt;
* Noise - from roadways, industry and airports can degrade quality of sleep&lt;br /&gt;
&lt;br /&gt;
====Home ''Determinants''====&lt;br /&gt;
'''Home''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Home_Insight Home Insight]. &lt;br /&gt;
* [[Physical Environment Determinants|Physical environment]] - exposure to noise, air pollution, water pollution, soil pollution, radiation, other pollution, inadequate drinking-water supply, tobacco smoke (passive smoking)&lt;br /&gt;
* [[Housing Circumstances Determinants|Housing circumstances]] - Homelessness, Inadequate housing (Lack of heating, Restriction of space, Technical defects), Discord with neighbors, lodgers and landlord, Problems related to living in residential institution (Boarding-school resident), problems related to housing and economic circumstances (Foreclosure on loan, Isolated dwelling, Problems with creditors) &lt;br /&gt;
* Housing Costs - affect ability to afford food and other essential basic needs&lt;br /&gt;
* Housing Structure - Old Carpet and mold can trigger asthma, Structural problems increase the risk of falls and burns, stairway design can promote exercise, safety amenities (banisters, smoke alarms, etc.), Accessibility (Wheel Chair accessible)&lt;br /&gt;
* Home Furnishing - Throw rugs (falls, recent hip replacements) &lt;br /&gt;
* Home - Environmental (Heat, Air conditioner, water, hot water)&lt;br /&gt;
* Place to store medications to keep cold&lt;br /&gt;
* Exposure to firearms&lt;br /&gt;
* Exposure to opioids  &lt;br /&gt;
* Household members - disruptive/supportive family member, Onsite Care Giver Support or from family members&lt;br /&gt;
* Living Arrangement - living alone, congregate living, etc.&lt;br /&gt;
* Private Facility - Apartment, House, Room, etc.&lt;br /&gt;
* Institution Facility (Supportive) - Facility type (Nursing home, senior living center, etc.), Onsite staff (match needs of patients), Onsite resources (food, outdoors, etc.), Accessible (Wheel Chair ramps), Safety (Safety Bathrooms, smoke alarms), Environmental (Heat, A/C, Mold), &lt;br /&gt;
* Temporary Housing - Homelessness, Homeless Shelters, friend or family members home, Halfway House (after recent prison term), Victim Shelters (domestic and sexual violence, disaster relief)&lt;br /&gt;
&lt;br /&gt;
====Security ''Determinants''====&lt;br /&gt;
'''Security''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Security_Insight Security Insight]. &lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Determinants''===&lt;br /&gt;
'''Digital Content &amp;amp; Technology''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Content_Insight Digital Content &amp;amp; Technology Insight].&lt;br /&gt;
&lt;br /&gt;
====Medical Records Determinants==== &lt;br /&gt;
'''Medical Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Records_Insight Medical Records Insight].&lt;br /&gt;
* Comprehensive Medical Record - Ensure one location has combined medical records from multiple providers, such as a Primary Care Physician office. &lt;br /&gt;
* Accurate - Ensure the Medical Record ion accurate&lt;br /&gt;
* Preventitive Care - Ensure recommended Home Technology - wifi, broadband internet, cable TV, phone &lt;br /&gt;
* No Care Gaps - Ensure their are no open care gaps (i.e., diabetic, yet no hA1C test in past 6 months&lt;br /&gt;
* Diagnosis Codes (ICD-10 Codes)&lt;br /&gt;
* Physical and Mental Health Biomarkers - Blood Pressure, HbA1C blood test, cholesterol, Depression, Anxiety, etc.&lt;br /&gt;
* [[Symptoms]] &lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions]&lt;br /&gt;
* Quality of Life Limitations - [http://www.patientdeterminants.org/index.php?title=Determinants#Activity_Determinants Activity], [http://www.patientdeterminants.org/index.php?title=Determinants#Socioeconomic_Determinants Socioeconomic] and [http://www.patientdeterminants.org/index.php?title=Determinants#Social_Determinants Social]&lt;br /&gt;
* Advanced Directives&lt;br /&gt;
* Preferences - Authorizations, Living Will, etc.&lt;br /&gt;
* [[Medical Interventions]] and [[Non-Medical Interventions]]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records==== &lt;br /&gt;
'''Health Determinants Records''' can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Determinants_Records_Insight Health Determinants Records Insight].&lt;br /&gt;
* Methods of capturing Health Determinants&lt;br /&gt;
* Record of Health Determinants&lt;br /&gt;
* Patient Generated Data&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records Determinants====&lt;br /&gt;
'''Health Interventions Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Interventions_Records_Insight Health Interventions Records Insight].&lt;br /&gt;
* History of Interventions (Medical and Non-Medical)&lt;br /&gt;
* Current Health Interventions&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records Determinants====&lt;br /&gt;
'''Health Outcomes Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Outcomes_Records_Insight Health Outcomes Records Insight].&lt;br /&gt;
* Health Outcomes tied to Health Determinants and Health Interventions&lt;br /&gt;
* Current Health Outcome Plans&lt;br /&gt;
* History of Health Outcomes&lt;br /&gt;
* Patient Reported Outcomes&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Determinants''====&lt;br /&gt;
'''Technology &amp;amp; Apps''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Technology_.26_Apps_Insight Technology &amp;amp; Apps Insight]. &lt;br /&gt;
* Apps - mobile, computer applications &lt;br /&gt;
* Durable Medical Equipment - Oxygen equipment, nebulizers, Continuous positive airway pressure (CPAP) devices, single and bi-level, manual and power wheelchairs, scooters, and walkers&lt;br /&gt;
* Home Technology - wifi, broadband internet, cable TV, phone &lt;br /&gt;
* Mobile - cell phone, cell phone service&lt;br /&gt;
* Passive Sensors (wifi enabled weight scale, blue tooth enabled blood pressure cuff)&lt;br /&gt;
&lt;br /&gt;
==Impacting People ''Determinants''==&lt;br /&gt;
'''Impacting People''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight Impacting People Insight]. &lt;br /&gt;
&lt;br /&gt;
===Physicians===&lt;br /&gt;
* Primary Care Physicians &lt;br /&gt;
* Physician Specialists &lt;br /&gt;
* Advanced Practice Professional (APPs)  - Physician Assistants, Nurse Practitioners,&lt;br /&gt;
* Behavior Health (Psychologist, Psychiatrist)&lt;br /&gt;
&lt;br /&gt;
===Care Team ''Determinants''===&lt;br /&gt;
'''Care Team''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Team_.26_Resources_Insight Care Team &amp;amp; Resources Insight].&lt;br /&gt;
====Credentialed Care Specialists ''Determinants''====&lt;br /&gt;
Credentialed Care Specialists providers that could influence health outcomes &lt;br /&gt;
* Pharmacists, &lt;br /&gt;
* Therapists - Physical Therapists (PT) / Occupational Therapists (OT) / Speech Therapists (ST)&lt;br /&gt;
* Behavior Health (Psychologist, Psychiatrist), &lt;br /&gt;
* Clinical Social Worker - Licensed Social Workers (LSW) or Medical Social Workers (MSW)&lt;br /&gt;
* Nurses (Care Manager) Registered Nurses (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN)&lt;br /&gt;
* Dietitians &lt;br /&gt;
* Clinical Educators Providers&lt;br /&gt;
====Credentialed Support Providers ''Determinants''==== &lt;br /&gt;
Credentialed Support (Social and Behavioral) Providers - These are professionals that required some credentialing. &lt;br /&gt;
* Home Health - Certified Nursing Assistants (CNA) / Home Health Aides (HHA)&lt;br /&gt;
* Medical Assistants &lt;br /&gt;
* Behavioral Health &lt;br /&gt;
* Patient Navigator - Recovery Navigator &lt;br /&gt;
* Health Coaches - Recovery Coaches &lt;br /&gt;
* Social Workers &lt;br /&gt;
* Legal Counselors&lt;br /&gt;
* Home Health&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Determinants''===&lt;br /&gt;
Trusted:&lt;br /&gt;
* Family Member &lt;br /&gt;
* Friend&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Determinants''===&lt;br /&gt;
'''Family Members &amp;amp; Friends''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Family_Members_.26_Friends_Insight Family Members &amp;amp; Friends Insight].&lt;br /&gt;
For each family member and friend, list their proximity, relationship (cordial, respect, etc.), regularity of social interations  &lt;br /&gt;
* '''Family''' - List of Family Members and &lt;br /&gt;
* Friends - List of Friends with their proximity &lt;br /&gt;
* Spouse or Signicant Other&lt;br /&gt;
* Parents &lt;br /&gt;
* Siblings&lt;br /&gt;
* Children&lt;br /&gt;
* In-Laws&lt;br /&gt;
* Step-Family &lt;br /&gt;
* Friends - List of Friends with their proximity&lt;br /&gt;
* Neighbors&lt;br /&gt;
&lt;br /&gt;
===Support Team ''Determinants''===&lt;br /&gt;
'''Support Team''' (Non-Clinically Credentialed) Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Team_.26_Resources_Insight Care Team &amp;amp; Resources Insight].&lt;br /&gt;
For each support team memeber, list their proximity, relationship (cordial, respect, etc.), regularity of social interations  &lt;br /&gt;
* Educators (i.e., literacy, hobbies, etc.)&lt;br /&gt;
* Financial Counselors&lt;br /&gt;
* Community Health Workers&lt;br /&gt;
* Technical Support - Technical Support and technicians&lt;br /&gt;
* Attorneys&lt;br /&gt;
* Community Resources Providers (See Community Resources)&lt;br /&gt;
* Other Services (handy man, plumber, etc.),&lt;br /&gt;
&lt;br /&gt;
===Organizations ''Determinants''===&lt;br /&gt;
'''Organizations''' Determinants can decisively affect a patient's overall health and well-being. These are communities that may support and/or influence the overall health.  See [[Organization Interventions]].&lt;br /&gt;
&lt;br /&gt;
====Communities====&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities Interventions]&lt;br /&gt;
&lt;br /&gt;
====Community and Social Services Organizations ====&lt;br /&gt;
* Food Banks&lt;br /&gt;
* Churches  &lt;br /&gt;
* Meals Delivery (Meals on Wheels), &lt;br /&gt;
* Transportation Assistance and Services &lt;br /&gt;
* Programs (Smoking Cessation, &lt;br /&gt;
* Weight Loss, Alcoholics Anonymous), &lt;br /&gt;
&lt;br /&gt;
====Employers====&lt;br /&gt;
&lt;br /&gt;
====Government Organizations====&lt;br /&gt;
* Town&lt;br /&gt;
* County&lt;br /&gt;
* State&lt;br /&gt;
* Federal&lt;br /&gt;
&lt;br /&gt;
====Health Insurers====&lt;br /&gt;
&lt;br /&gt;
====Healthcare Advocacy Organizations====&lt;br /&gt;
* Chronic Condition Advocacy (i.e., American Heart Association, American Cancer Society)&lt;br /&gt;
&lt;br /&gt;
====Healthcare Provider Organizations====&lt;br /&gt;
* Retail Pharmacies&lt;br /&gt;
* Pharmaceutical &lt;br /&gt;
* Medical Devices&lt;br /&gt;
* Hospital &lt;br /&gt;
* Medical Practices&lt;br /&gt;
* Community Health Centers - free flu shots, etc.&lt;br /&gt;
* Convenient Care (Minute Clinics, 24 hour services)&lt;br /&gt;
&lt;br /&gt;
====Support Resources Organizations====&lt;br /&gt;
* Home Maintenance Services - handy man, plumber, etc.&lt;br /&gt;
&lt;br /&gt;
====Vendor Partners====&lt;br /&gt;
Organizations that partner with healthcare providers to improve patient outcomes.&lt;br /&gt;
&lt;br /&gt;
See [[Vendor Partner Examples]]&lt;br /&gt;
&lt;br /&gt;
===Other Contributors ''Determinants''===&lt;br /&gt;
'''Other Contributors''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Other_Contributors_Insight Other Contributors Insight]. &lt;br /&gt;
* Manager or Superviosr at Work&lt;br /&gt;
* Other Key Contributers &lt;br /&gt;
* Influencers - Teacher&lt;br /&gt;
* Volunteers&lt;br /&gt;
* Other Resources of Providers&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities ''Determinants''==&lt;br /&gt;
'''Impacting Activities''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_Activities_Insight Impacting Activities Insight]. &lt;br /&gt;
 &lt;br /&gt;
===Healthy Lifestyle ''Determinants''===&lt;br /&gt;
Overall '''Healthy Lifestyle''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Physically Active  &lt;br /&gt;
* Nutrition&lt;br /&gt;
* Healthy Weight&lt;br /&gt;
* Avoid Adverse Behaviors  &lt;br /&gt;
* Self Care Management of Health - Sleep, Meditation, preventitive care, medication adherence, etc.  &lt;br /&gt;
* Social &amp;amp; Passion Activities&lt;br /&gt;
* Manage Stress&lt;br /&gt;
* Manage Emotions &lt;br /&gt;
** Positive Emotions - love, affection, work satisfaction, appreciative, goal oriented, feeling good from phyical activities, calm&lt;br /&gt;
** Negative Emotions - anxiety, depression, poor health, being ignored or taking for grated, constant distrations, unhappy, unfulfilled, angry&lt;br /&gt;
* Meditation&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Determinants''===&lt;br /&gt;
'''Physical Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Exercise&lt;br /&gt;
* Activity Levels, &lt;br /&gt;
* Frequency of activity (vs. long duration of sitting)&lt;br /&gt;
* Behaviors (Always walks, always drive, always buses or subways) &lt;br /&gt;
* Work (how active), &lt;br /&gt;
* Activities (Sports, Hiking, gardening)&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities ''Determinants''===&lt;br /&gt;
'''Social &amp;amp; Passion Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Social Interactions - Engagement with others, Caregivers, Organized Communities - like [http://www.patientslikeme.com/ '''PatientsLikeMe'''], &lt;br /&gt;
* Periods of Social Isolation, &lt;br /&gt;
* Social Activities (play cards, go to lunches, Social Organizations, frequent bars), &lt;br /&gt;
* Family Activities (dinners, youth sports)&lt;br /&gt;
* Passion Activities -&lt;br /&gt;
* Sedentary Activities - Television (Watch Baseball, Drama series, News - Favorite programs, Other Sedentary Activities (Read, knit,etc.) &lt;br /&gt;
* Spectator Activities - sports, entertainment, theater, parade, or other events&lt;br /&gt;
* Travel - Visit Family, Friends, Vacation&lt;br /&gt;
* Seasonal Travel - Snowbird (summers in the North, winters in the South),&lt;br /&gt;
&lt;br /&gt;
===Nutrition ''Determinants''===&lt;br /&gt;
'''Nutrition''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Number and times of meals&lt;br /&gt;
* Number and types of snacking&lt;br /&gt;
* Nutritional value and amounts of food&lt;br /&gt;
* Behaviors - Fast Food, Take Out, Home cooked meals&lt;br /&gt;
* Diets and Dieting&lt;br /&gt;
&lt;br /&gt;
===Functional Activities ''Determinants''===&lt;br /&gt;
'''Functional Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Education Activities&lt;br /&gt;
* Income &amp;amp; Work activities&lt;br /&gt;
* Home maintenance&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* Responsibilities Activities - Care Giver Roles to kids, parents, friends&lt;br /&gt;
* Travel Activities - driving to work, store or giving a ride to a family memeber&lt;br /&gt;
* Use of technology such as internet, computers, smart phones, medical deveices, etc.&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Determinants''===&lt;br /&gt;
'''Sleep''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Total Hours of sleep each day&lt;br /&gt;
* Types of sleep - deep, REM, light, naps&lt;br /&gt;
* Number of interruptions&lt;br /&gt;
* When sleep occurs&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Determinants''===&lt;br /&gt;
'''Adverse Behaviors''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Adverse_Behaviors_Insight Adverse Behaviors Insight].&lt;br /&gt;
* Alcohol, &lt;br /&gt;
* Drugs, &lt;br /&gt;
* Falls&lt;br /&gt;
* Gambling, &lt;br /&gt;
* Unprotected sex, &lt;br /&gt;
* Smoking&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Determinants''===&lt;br /&gt;
'''Self-Management Behavior''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Self-Management_Behavior_Insight Self-Management Behavior Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - patient's management of interventions (Medical or Non-Medical), conditions, and symptoms based on the patient's [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies].&lt;br /&gt;
* History of self-management behavior &lt;br /&gt;
* Condition Management Behavior - Diabetic monitoring glucose and injecting insulin, Self-care&lt;br /&gt;
* Conscientiousness - behavior of doing a task well, being thorough, careful, and/or vigilant. &lt;br /&gt;
* Reliable and Organized - behavior as opposed to easy-going and disorderly.&lt;br /&gt;
* Treatment Adherence Behavior - Medication Adherence, Nutrition, Therapy, Physician Visits, Recommended Activity levels &lt;br /&gt;
* Medication Management - management and adherence of oral and injectable medicine&lt;br /&gt;
* Intervention Activation - Know when to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Technology Aptitude (patient or authorized care giver) - Internet and Online Usage, Education Videos, Patient Portal Usage, Use of Secure Texting, Video Conferencing, email, Use of remote monitoring devices (Blood Pressure cuff, remote diagnostic devices (ecg app), Use of tablet, computer or smartphone&lt;br /&gt;
* Online Personal Health Record - Online Electronic Health Record, Blue Button, Access Authorization (Recovery Team access), Patient Input History (Patient answer questions or inputs data into Personal Health Record)&lt;br /&gt;
* Technology Usage - Broadband Internet, Wifi Router, Telecom Network (AT&amp;amp;T, Verizon), Computer, Smartphone or Tablet, Remote Monitoring Devices (Blood pressure cuff, blood glucose monitoring), Remote Diagnostic Devices (ECG app, Accessing patient history via [http://www.healthit.gov/patients-families/blue-button/about-blue-button Blue Button]&lt;br /&gt;
===Care Planning Activities ''Determinants''===&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Determinants''===&lt;br /&gt;
'''Care Management Communications''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Management_-_Communications_Insight Care Management - Communications Insight].  &lt;br /&gt;
* Patient communication - Who? (with care team), How? (in-person, phone, email, text, apps) Frequency? (i.e., dailly, as-needed)&lt;br /&gt;
* Patient Inquiries - who? how? response time?&lt;br /&gt;
* Patient Status - Symptoms, Problem Lists, Concerns, Functional Status, risk factors, Quality of Life Opportunity&lt;br /&gt;
* Recovery Plan Activities - ensure activities are scheduled, treatments happen, prescriptions filled, Recovery Team performs function, Status of Surgeries, Procedures, Tests, Therapies, etc.  &lt;br /&gt;
* Patient Adherence - Monitoring of Medication Adherence, activity levels, other patient behaviors, etc.&lt;br /&gt;
* Patient Activation - Understand condition, capable of treating self, etc. &lt;br /&gt;
* Recovery Factors Monitored - Clinical Condition - Physiological Metrics (i.e., Blood Pressure), Pain, Wounds, etc., functional conditions, etc.  &lt;br /&gt;
* Monitoring Method - Daily Calls, Patient checks box or inputs data, Passive sensors (wifi enabled pill boxes or caps)&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Determinants''===&lt;br /&gt;
'''Care Management - Operational''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Management_-_Operational_Insight Care Management - Operational Insight]. &lt;br /&gt;
* Communication methods within care team - phone, text, portal, etc.&lt;br /&gt;
* Arranging diagnosis, second opinions, procedures, etc.&lt;br /&gt;
* Patient Navigation&lt;br /&gt;
* Triggers - Triggers Requiring Notifications - Patient Concern, Monitoring Alert (i.e., Medication adherence, blood pressure reading), Patient Dialog, Clinical Condition, Emergency, Transfer Event (i.e., Hospital to home)&lt;br /&gt;
* Notification - Who is notified based on each trigger (Patient, Care Giver, Recovery Navigator, Care Manager)? How are they notified (phone calls, text message, alerts)? When are they notified (time frame)?&lt;br /&gt;
* Associated Action - Who takes the action? What is the action? How do they take the action (phone calls, text message, alerts)? When do they take action (time frame)? Potential actions include: Patient triage, Conduct on-site assessment, Issue Escalation, Reassess Recovery Goals, Plan, Monitoring &amp;amp; Protocols, Achieve confirmation to change Recovery Goals, Plan, Monitoring and Protocols&lt;br /&gt;
* Escalation - What gets escalated? Who escalates it (nurse, patient)? Whom do they escalate to (doctor, nurse)? When do they escalate? How do they escalate?&lt;br /&gt;
* Protocol Monitoring - Who ensure notifications, actions and escalations are happening? How? When do they take action?&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Determinants''===&lt;br /&gt;
====Medical Intervention Activities ''Determinants''====&lt;br /&gt;
'''Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Interventions_Insight Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* Part A ([https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html hospital/facility interventions]), &lt;br /&gt;
* Part B ([https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html physician interventions]), &lt;br /&gt;
* Part C ([https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html Medicare Advantage Health Plans]), &lt;br /&gt;
* Part D ([https://www.medicare.gov/part-d/ medication interventions]). &lt;br /&gt;
Most health plans are based on Medicare fee schedules, so they typically reimburse for the same or similar services.&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Intervention Activities ''Determinants''====&lt;br /&gt;
'''Non-Medical Intervention Activities ''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Insight Non-Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* [[Care Management Programs]] - team-based, patient focused programs designed to meet specific needs of patients based on the program's criteria. &lt;br /&gt;
* [[Health Services]] - a specific focused health services or capabilities designed to meet specific health needs of patients based on the services's criteria. &lt;br /&gt;
* [[Support Services]] - a specific focused support services or capabilities designed to meet specific needs of patients based on the services's criteria. &lt;br /&gt;
* [[Patient/Caregiver Interventions]] - activities or actions by patients and caregivers that will likely improve health, health outcomes and reduce overall cost.&lt;br /&gt;
* [[Health Insurance Payment Models]] - these are health insurance payment models design to improve patients outcomes, health and reduce cost&lt;br /&gt;
* [[Organization Interventions]] - employers, communities and governments interventions&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence====&lt;br /&gt;
'''Health Strategy Activity Changes 7 Adherence'''  Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Outcomes_Insight Non-Medical Interventions Outcomes Insight].&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Determinants</id>
		<title>Health Determinants</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Determinants"/>
				<updated>2019-07-23T15:29:10Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Personal Goals (Missions) Determinants */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Determinants]] can decisively affect a patient's overall health and well-being. [[Health Determinants]] include [[barriers]], [[symptoms]] and [[Functional Status|functional status]]. The [http://www.dcoe.mil/Libraries/Documents/Phase_2_IOM_Social_Behavioral_Domains_2014_18951.pdf Institute of Medicine (IOM) recommends] capturing social and behavioral determinants in Electronic Medical Records. [https://www.cdc.gov/nchhstp/socialdeterminants/faq.html CDC defines Determinants of health as factors that contribute to a person's current state of health.] &lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) ''Determinants''==&lt;br /&gt;
Health '''Mission''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See Health [http://www.patientdeterminants.org/index.php?title=Health_Insight#Mission_.28Health_Goals.29_Insight Mission (Health Goals) Insight].&lt;br /&gt;
&lt;br /&gt;
===Personal Goals (Missions) ''Determinants''===&lt;br /&gt;
'''Personal Goals (Missions)''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Health Mission &amp;amp; Care Goals Insight]. Patient specific care goals related to improving or maintaining the patient's [[Health Status|health status]].&lt;br /&gt;
* Patient's Life Goals  - non health related, responsibilities, passions, etc.&lt;br /&gt;
* Patient's Health  - that includes preventitive &amp;amp; wellness goals, managing acute and chronic conditions, end-of-life&lt;br /&gt;
&lt;br /&gt;
===Health Goals (Care Goals) ''Determinants''===&lt;br /&gt;
'''Health Goals (Care Goals)''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Health Mission &amp;amp; Care Goals Insight]. Patient specific care goals realted to improving or maintaining the patient's [[Health Status|health status]].&lt;br /&gt;
* Symptoms Goals (Patient) - improvement of patient's assessment of their physical and mental symptoms. They include pain or discomfort, visual symptoms, cold or flu-like, physical abnormalities, mental health and other.&lt;br /&gt;
* Conditions Goals (Medical) - improvement or stabilizing disease and conditions (i.e., diabetes, hypertension) as well as biomarkers (i.e., blood pressure, weight, blood glucose) as documented by a medical professional in the patients Electronic Medical Record.&lt;br /&gt;
* Function Goals (Patient) - improvement of the patient's assessment of their function (i.e., walking, going to work, doing what they love).&lt;br /&gt;
* Clinical Risk Goals (Medical) - improvement of medical risks (i.e., for disease, disease progression, acute event, mortality)&lt;br /&gt;
* Behavioral Risk Goals (Patient) - improvement of the patients assessment of their behavior or ability to be compliant with the care plan based on health determinants (i.e., fiancial, transportation, housing).&lt;br /&gt;
* Well-Being Goals (Patient) - improvement in the patient's assessment of Support, Health, Basic Needs, PHQ, Purpose, Love &amp;amp; Connection, Competence&lt;br /&gt;
* Timing Goals - 2 days, 2 weeks, 2 months, 2 years&lt;br /&gt;
* Medical Interventions &amp;amp; Events Goals - Acute events, surgeries, ER visit, hospital, medication or medical treatment etc.&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) ''Determinants''==&lt;br /&gt;
'''Strategy (Health Plan)''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Strategy_.28Health_Plan.29_Insight Strategy (Health Plan) Insight]. &lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Determinants''===&lt;br /&gt;
Strategy Objectives ('''Care Plan''') Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight].&lt;br /&gt;
 &lt;br /&gt;
* Overall Strategy objectives of how each of the care goals will be achieved&lt;br /&gt;
* Specific details of how each of the care goals will be achieve&lt;br /&gt;
* Potential Barriers (Impacting Activities, People, &amp;amp; Realities) - potential barriers (health determinants) that could impact achieving the Care Goals and how each will be addressed&lt;br /&gt;
* Key People &amp;amp; Roles (Impacting People)&lt;br /&gt;
* Key Activities &amp;amp; Interventions (Impacting Activities)  &lt;br /&gt;
* Measures&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) ''Determinants''===&lt;br /&gt;
====Medical Interventions ''Determinants''====&lt;br /&gt;
'''Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Interventions_Insight Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* Part A ([https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html hospital/facility interventions]), &lt;br /&gt;
* Part B ([https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html physician interventions]), &lt;br /&gt;
* Part C ([https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html Medicare Advantage Health Plans]), &lt;br /&gt;
* Part D ([https://www.medicare.gov/part-d/ medication interventions]). &lt;br /&gt;
Most health plans are based on Medicare fee schedules, so they typically reimburse for the same or similar services. &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Medical Interventions Results can impact the strategy:  &lt;br /&gt;
* Testing - Clinical Consults, Lab, Imaging, ECG, etc.&lt;br /&gt;
* Qualified Option Development - diagnosis, progonosis and treatment options&lt;br /&gt;
* Medical Interventions&lt;br /&gt;
* Shared Decision Making - process helps to develop interventions based on care goals.&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions ''Determinants''====&lt;br /&gt;
'''Non-Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Insight Non-Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* [[Care Management Programs]] - team-based, patient focused programs designed to meet specific needs of patients based on the program's criteria. &lt;br /&gt;
* [[Health Services]] - a specific focused health services or capabilities designed to meet specific health needs of patients based on the services's criteria. &lt;br /&gt;
* [[Support Services]] - a specific focused support services or capabilities designed to meet specific needs of patients based on the services's criteria. &lt;br /&gt;
* [[Patient/Caregiver Interventions]] - activities or actions by patients and caregivers that will likely improve health, health outcomes and reduce overall cost.&lt;br /&gt;
* [[Health Insurance Payment Models]] - these are health insurance payment models design to improve patients outcomes, health and reduce cost&lt;br /&gt;
* [[Organization Interventions]] - employers, communities and governments interventions&lt;br /&gt;
&lt;br /&gt;
Non-Medical Interventions Results can impact the Care Plan&lt;br /&gt;
====Intervention Adherence ''Determinants''====&lt;br /&gt;
====Intervention Changes ''Determinants''====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures ''Determinants''===&lt;br /&gt;
Strategy '''Measures''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight].&lt;br /&gt;
* Measures - These are measures that will demonstrate progress toward achieving the health mission. This is the list of measures (i.e., pain levels, function levels, blood sugar levels) that will be used to measure progress of the startegy objectives toward achieving the health mission. &lt;br /&gt;
* Measures types:&lt;br /&gt;
** Mission (Health Goals) Measures - measure progress toward achieving the mission&lt;br /&gt;
** Strategy Objectives (Care Plan) Measures - measure the progress of the strategy objectives toward achieveing the mission&lt;br /&gt;
** Strategy Solutions (Interventions) Measures - measure the effectiveness of individual interventions in respect to achieving the missio and objective strategy &lt;br /&gt;
** Impacting Elements Measures - measure the impact of impacting people, realities and activities not included above&lt;br /&gt;
** Adherence Measures - adherence to interventions&lt;br /&gt;
** Change Measures - timing, reason codes, for changes in interventions, people, realities, activities &lt;br /&gt;
* Measurement Timeframes - These are the times when progress will be measures&lt;br /&gt;
* Measurement Baseline - This is the initial measures that will be used to measure the health outcome of the strategy objectives.&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting People ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting People''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Disciplines_.26_Resources_Insight Health Disciplines &amp;amp; Resources Insight]. &lt;br /&gt;
&lt;br /&gt;
'''List - Impacting People'''&amp;lt;br&amp;gt;&lt;br /&gt;
* Clinical Providers - These are licensed professionals. Primary Care Physicians, Physician Assistants, Nurse Practitioners, Physician Specialists, Pharmacists, Therapists (Speech, Physical, Occupational), Behavior Health (Psychologist, Psychiatrist), Nurse (Care Manager), Dietitian, Education Providers (Clinical)&lt;br /&gt;
* Support (Social and Behavioral) Providers - Care givers (family or friend), Recovery Navigator (patient navigator), Recovery Coaches (included MSW Social Workers and Health Coaches), Education (Non-Clinical), Technical Support and technicians&lt;br /&gt;
* Community (Basic Needs) Resources - Financial Counseling, Meals Delivery (Meals on Wheels), Transportation Assistance, Programs (Smoking Cessation, Weight Loss, Alcoholics Anonymous), Delivery Services, Transportation Services, Other Services (handy man, plumber, etc.), Community Health Services (Community Health Centers, free flu shots, etc.), Convenient Care (Minute Clinics, 24 hour services)&lt;br /&gt;
* Changes to Impacting People List&lt;br /&gt;
&lt;br /&gt;
'''Roles - Impacting People''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Role within Strategy (Care Plan)&lt;br /&gt;
* Role within Solution (Interventions)&lt;br /&gt;
* Frequency and types of communications&lt;br /&gt;
* Influence&lt;br /&gt;
* Activities&lt;br /&gt;
* Tasks&lt;br /&gt;
* Types of Support&lt;br /&gt;
&lt;br /&gt;
'''Behavior - Impacting People Behavior'''&lt;br /&gt;
* Adherence to Strategy&lt;br /&gt;
* Frequency and types of communications&lt;br /&gt;
* Influence&lt;br /&gt;
* Activities&lt;br /&gt;
* Tasks&lt;br /&gt;
* Support Provided&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting People'''&lt;br /&gt;
* List of potential barriers due to impacting people&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting Realities ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting Realities''' Determinants (Health Determinats) can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Care Plan Insight]. &amp;lt;br&amp;gt;&lt;br /&gt;
'''List - Impacting Realities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Health Conditions&lt;br /&gt;
* Competencies&lt;br /&gt;
* Social&lt;br /&gt;
* Socioeconomic&lt;br /&gt;
* Environmental&lt;br /&gt;
* Digital Content &amp;amp; Technology&lt;br /&gt;
* Changes to Impacting Realities List&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting Realities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* List of potential barriers due to impacting realities&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
===Strategy - Impacting Activities ''Determinants''===&lt;br /&gt;
'''Strategy - Impacting Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Mission_.26_Care_Goals_Insight Strategy - Impacting Activities Insight].&amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
'''List - Impacting Activities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* Physical Activities&lt;br /&gt;
* Social &amp;amp; Passion Activities&lt;br /&gt;
* Nutrition&lt;br /&gt;
* Functional Activities&lt;br /&gt;
* Sleep&lt;br /&gt;
* Stress, Emotions &amp;amp; Meditation&lt;br /&gt;
* Adverse Behaviors &lt;br /&gt;
* Self-Management Behavior&lt;br /&gt;
* Care Management Communications&lt;br /&gt;
* Care Management Operational&lt;br /&gt;
* Health Strategy Activities&lt;br /&gt;
&lt;br /&gt;
'''Behavior - Impacting Activities'''&lt;br /&gt;
* Adherence to Strategy&lt;br /&gt;
* Changes to Behavior&lt;br /&gt;
* Potential Assets from Behavior&lt;br /&gt;
&lt;br /&gt;
'''Potential Barriers - Impacting Activities''' &amp;lt;br&amp;gt;&lt;br /&gt;
* List of potential barriers due to impacting activities&lt;br /&gt;
* Potential Impact of Potential Barriers&lt;br /&gt;
* How potential barriers can be addressed&lt;br /&gt;
* Strategy to address potential barriers&lt;br /&gt;
* Effectiveness of potential barriers being addressed&lt;br /&gt;
* Changes to how potential barriers are being addressed&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities ''Determinants''==&lt;br /&gt;
'''Impacting Realities''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_Realities_Insight Impacting Realities Insight]. &lt;br /&gt;
===Health Conditions ''Determinants''===&lt;br /&gt;
'''Health Conditions''' Determinants that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Conditions_Insight Health Conditions Insight].&lt;br /&gt;
====Physical Conditions ''Determinants''====&lt;br /&gt;
'''Physical Conditions''' Determinants can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].  See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Physical_Conditions_Insight Physical Conditions Insight]. Medicare has developed a model to categorize Physical Conditions in order to risk [http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html '''risk adjust'''] health insurers that are covering patients. The [[CMS-HCC Risk Adjustments]] model adjust for patient demographics (i.e., age, disabled) and disease (i.e., diabetes, congested heart failure). &lt;br /&gt;
&lt;br /&gt;
* Allergies &amp;amp; Adverse Drug Reactions&lt;br /&gt;
* [https://en.wikipedia.org/wiki/Comorbidity Comorbidities] -  chronic disorders (or diseases) that need to be managed. Most comorbidities do not get cured.  &lt;br /&gt;
* Demographics - Age, Sex, Disabled, Long Term Institutional Status (LTI Designated Status) &lt;br /&gt;
* [http://www.cdc.gov/vaccines/vpd-vac/vaccines-list.htm Immunizations] - Flu, Tetanus&lt;br /&gt;
* Physical Impairments -  Physical Impairments (Use of limbs, arthritis, amputation, birth defects, Epilepsy), Sensory Impairments (Blind or Visually Impaired, Deaf or Hard of Hearing, loss of taste and smell)&lt;br /&gt;
* Medical History - Adverse events, Family Medical History, Medical Conditions, Surgeries&lt;br /&gt;
* Physiological Metrics - Blood glucose level, Blood pressure, Cholesterol level (HDL, LDL, etc), Heart rate&lt;br /&gt;
* Problem and Symptom lists - Pressure Ulcers, Pain, asthma, Fever, Fractures, Headache, Rash or skin infection, Shortness of Breath, Sprains, Upper respiratory tract infection, Wounds&lt;br /&gt;
* [http://www.biomedcentral.com/1471-2318/14/25 '''Frailty Index''']&lt;br /&gt;
* [[CCS Diagnostic Categories]]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Determinants''====&lt;br /&gt;
'''Mental Health Conditions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Mental_Health_Conditions_Insight Mental Health Conditions Insight].&lt;br /&gt;
* Comorbidities -  mental health disorders (or diseases) that need to be managed. Most comorbidities do not get cured.&lt;br /&gt;
* Disorders - Anxiety Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autism, Bipolar Disorder, Eating Disorder, Depression, Obsessive Compulsive Disorder (OCD), Panic Disorders, Post Traumatic Stress Disorder, Schizophrenia&lt;br /&gt;
* History&lt;br /&gt;
* Impairments - Cognitive Impairments (Delirium &amp;quot;confused state&amp;quot;, Dementia), Developmental&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Determinants''====&lt;br /&gt;
'''Functional Conditions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Functional_Conditions_Insight Functional Conditions Insight].&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* Required Devices - pacemakers, artificial limb, etc.&lt;br /&gt;
* Logistic Capabilities - Walk, Assisted Walking, Wheelchair, Equipment Requirements (Oxygen, heart device, etc.)&lt;br /&gt;
* Disabilities and Impairments as defined by the [http://www.dc37.net/about/graphics/factsheetspdf/disability_defined.pdf American Disabilities Act]&lt;br /&gt;
* Homebound - unable to travel to physician offices&lt;br /&gt;
* Work - Physically able to go back to work or enough functional ability to find a new job&lt;br /&gt;
* Passion - Physically able to go back to work or enough functional ability to find a new job&lt;br /&gt;
* Mental - Not prevented from working, pursuing passion and functional activities because of mental health challenges&lt;br /&gt;
* [[Requires Support]] - for ADLs or IADLs&lt;br /&gt;
* Functional History&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Determinants''====&lt;br /&gt;
'''Genomic Profiles''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Genomic_Profiles_Insight Genomic Profiles Insight].&lt;br /&gt;
&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Human_genome '''Human Genome'''] - complete set of genetic information encoded as DNA sequences within the 23 chromosome pairs. It includes the genomes of [http://en.wikipedia.org/wiki/Tumor '''tumors'''], the abnormal mass of tissue from abnormal growth or division of cells. &lt;br /&gt;
&lt;br /&gt;
* [https://ghr.nlm.nih.gov/handbook/howgeneswork/epigenome '''Epigenome''']  multitude of chemical compounds that have been added to the entirety of one’s DNA (genome) as a way to regulate the activity (expression) of all the genes within the genome. These chemical compounds of the epigenome are not part of the DNA sequence, but are on or attached to DNA (“epi-“ means above in Greek).&lt;br /&gt;
&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Microbiome '''Microbiome'''] - the collective genomes of the microorganisms that share our body space. The resident bacteria, viruses ([http://en.wikipedia.org/wiki/Human_virome '''virome''']) and [http://en.wikipedia.org/wiki/Eukaryote '''other microbes with genomes''']. &lt;br /&gt;
&lt;br /&gt;
* Other Genomic Profiles - [http://en.wikipedia.org/wiki/Metabolome '''Metabolome'''] - are small molecules with metabolism functions of fuel, structure, signaling, stimulatory and inhibitory effects on enzymes and other catalytic activities. [http://en.wikipedia.org/wiki/Proteome '''Proteome'''] - set of proteins expressed by a genome, cell, tissue or organism at a given time, under defined conditions.  [http://en.wikipedia.org/wiki/Transcriptome '''Transcriptome'''] - set of all molecules use to create new cells with genomes.&lt;br /&gt;
&lt;br /&gt;
====High Cost High Need Patients ''Determinants''====&lt;br /&gt;
'''High Cost High Need Patients''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Genomic_Profiles_Insight Genomic Profiles Insight].&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Determinants''===&lt;br /&gt;
'''Competencies''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Competencies_Insight Health Competencies Insight].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Determinants''====&lt;br /&gt;
Health Literacy Determinants impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Literacy_Insight Health Literacy Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - Undertands why and how to manage their health. These competencies help improve [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior].&lt;br /&gt;
* Health Risks - understand their health risks and how to manage them&lt;br /&gt;
* Health Conditions - understands their health conditions &lt;br /&gt;
* Health Condition Management Knowledge - understands how to manage their health conditions (i.e., Diabetic glucose monitoring and injecting insulin)&lt;br /&gt;
* Interventions (Medical and Non-Medical)- understands why the interventions are necessary for overall health.&lt;br /&gt;
* Assistance Engagement - Know when to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Education - Diagnosis, Prognosis, Treatments, Understand Options and onboard with the treatment plan&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Determinants''====&lt;br /&gt;
Self Management Competencies Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Self-Management_Competencies_Insight Self-Management Competency Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - demonstrates competencies to manage conditions, interventions (medical or non-medical) and is committed to the treatment. These competencies help improve [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior].&lt;br /&gt;
* Health Condition Management Competencies - demonstrates abilities to manage their health conditions (i.e., Diabetic glucose monitoring and injecting insulin)&lt;br /&gt;
* Conscientiousness - a desire to do a task well being thorough, careful, or vigilant. &lt;br /&gt;
* Reliable and Organized - as opposed to easy-going and disorderly.&lt;br /&gt;
* Intervention (Medical or Non-Medical) Competencies - Medication Adherence, Nutrition, Therapies, Physician Visits, Recommended Activity levels &lt;br /&gt;
* Medication Management Competencies - management and adherence of oral and injectable medicine&lt;br /&gt;
* Assistance Engagement - Know when and how to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Technology Competencies (patient or authorized care giver) - Internet and Online Usage, Education Videos, Patient Portal Usage, Use of Secure Texting, Video Conferencing, email, Use of remote monitoring devices (Blood Pressure cuff, remote diagnostic devices (ecg app), Use of tablet, computer or smartphone&lt;br /&gt;
* Access Online Personal Health Record - Online Electronic Health Record, Blue Button, Access Authorization (Care Team access), Patient Provided Input History (Patient answer questions or inputs data into Personal Health Record)&lt;br /&gt;
* Technology Access - Broadband Internet, Wifi Router, Telecom Network (AT&amp;amp;T, Verizon), Computer, Smartphone or Tablet, Remote Monitoring Devices&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Determinants''====&lt;br /&gt;
'''Functional Competencies''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Competencies_Insight Competencies Insight]. &lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* [[Education and Literacy Determinants|Literacy]] - ICD Codes&lt;br /&gt;
* Languages - Speaking &amp;amp; Reading&lt;br /&gt;
* Technology Usage - Smart Phone, Google, Online Patient Portals&lt;br /&gt;
&lt;br /&gt;
====Education ''Determinants''====&lt;br /&gt;
'''Education''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Education_Insight Education Insight]. &lt;br /&gt;
* [[Education and Literacy Determinants|Education]] - ICD Codes&lt;br /&gt;
* [[Educational Attainment]] - Completed levels of formal education,&lt;br /&gt;
* Vocational Training&lt;br /&gt;
* Certifications, Licenses or degrees (diplomas)&lt;br /&gt;
&lt;br /&gt;
===Social ''Determinants''===&lt;br /&gt;
'''Social''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Social_Insight Social Insight].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Determinants''====&lt;br /&gt;
'''Patient (About &amp;amp; History)''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Patient_.28About_.26_History.29_Insight Patient (About &amp;amp; History) Insight].&lt;br /&gt;
* About - Narrative/Story, Photos&lt;br /&gt;
* [[Marital Status]]&lt;br /&gt;
* [[Childhood Events Determinants|Childhood events]] &lt;br /&gt;
* [[Childhood Upbringing Determinants|Childhood upbringing]]&lt;br /&gt;
* Military Service&lt;br /&gt;
* [[Psychosocial Circumstances Determinants|Psychosocial Circumstances]] &lt;br /&gt;
* Passions/Goals - Sports Teams, Television, reading, social media, Activities - Walking, shopping, etc.&lt;br /&gt;
* Sexual Orientation&lt;br /&gt;
* [[Race &amp;amp; Ethnicity]]&lt;br /&gt;
* Country of Origin/US Born or Non-US Born&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Determinants''====&lt;br /&gt;
'''Adverse Events''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Adverse_Events_Insight Adverse Events Insight].&lt;br /&gt;
* [http://www.cdc.gov/violenceprevention/acestudy/ '''Adverse Childhood Experiences (ACE)''']&lt;br /&gt;
* Victim of physical or verbal abuse&lt;br /&gt;
* Victim of crime &lt;br /&gt;
* Compelling Events - death, loss of home, job, &lt;br /&gt;
* Adversity Exposure - Violence, crime, verbal abuse, death, poverty, financial stress, depression, anxiety&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Determinants''====&lt;br /&gt;
'''Beliefs''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Beliefs_Insight Beliefs Insight].&lt;br /&gt;
* Health Literacy Beliefs&lt;br /&gt;
* Religion and faith&lt;br /&gt;
* Perspectives - politics, lifestyle, culture&lt;br /&gt;
* Trust and faith in Institutions - Healthcare, Education, Government&lt;br /&gt;
* Trust and faith in Physicians, nurses and the medical professions&lt;br /&gt;
* Beliefs about impacting people, caregivers, family, friends, care team&lt;br /&gt;
* Beliefs in whether the current care plan will work&lt;br /&gt;
* Beliefs about current health conditions&lt;br /&gt;
* Beliefs about physicial activity, nutrition and sleep&lt;br /&gt;
* Beliefs about adverse behavior&lt;br /&gt;
* Beliefs about self-management of health&lt;br /&gt;
&lt;br /&gt;
====Determination ''Determinants''====&lt;br /&gt;
'''Determination''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Determination_Insight Determination Insight].&lt;br /&gt;
* Willingness to change or do something different&lt;br /&gt;
* Desire to make change happen&lt;br /&gt;
* Eagerness to learn how to improve health&lt;br /&gt;
* Desire to improve health&lt;br /&gt;
* Detrmination to stick to a plan to achieve the desired outcome&lt;br /&gt;
* Desire to make something happen&lt;br /&gt;
* Enthusiasm to make something happen&lt;br /&gt;
* Personal goals and dreams&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Determinants''====&lt;br /&gt;
'''Relationships''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Resilience_Insight Relationships Insight]. A patient with good or functional relationships with the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People] can have a positive effect on patient outcomes. The [http://wikidreams.org/index.php?title=Relationships relationship type], type and frequency of communication as well as what is recieved from the relationship. &lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Physicians Physicians]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_Determinants Care Team] members&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Caregivers_Determinants Caregivers]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family &amp;amp; Friends]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Team_Determinants Support Team]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Organizations_Determinants Organizations]&lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Other_Contributors_Determinants Other Contributors]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Determinants'' - (Psychological Fitness)====&lt;br /&gt;
'''Resilience''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Resilience_Insight Resilience Insight]. A patient that is psychologically fit can have a positive effect on patient outcomes. &lt;br /&gt;
* ''Emotional Fitness'' -positive and negative emotions, optimism, flexible thinking, coping, character strengths &lt;br /&gt;
* ''Social Fitness'' - trust, friendships, balance between privacy and loneliness&lt;br /&gt;
* ''Family Fitness'' - trust, friendship, intimacy, supportive dialog, manage conflict, avoid escalation&lt;br /&gt;
* ''Spiritual Fitness'' - religious and non-religious, what provides purpose and meaning&lt;br /&gt;
* ''Socioeconomic fitness'' - income, marketable job skills, savings, sources of money, &lt;br /&gt;
* Stress Factors - Recent Stressful Events, Ongoing Stressful Challenge, Potential Stressful Events&lt;br /&gt;
* Optimism and Self-Efficacy - belief in ability to succeed in specific situations or accomplish a task which can play a major role in how one approaches goals, tasks, and challenges.&lt;br /&gt;
* Support system&lt;br /&gt;
* Sentiment - related to health, social, socioeconomic, environmental and care management [[Health Determinants|determinants]].&lt;br /&gt;
* Change Acceptance and Determination - Acceptance to '''change''' to Behavior, Lifestyle, address Problem (Stress), Patient Activation, Patient Technology Adoption. Determination to make '''change''' happen. University of Rhode Island Change Assessment Scale [http://www.umbc.edu/psyc/habits/content/ttm_measures/urica/  '''(URICA)''']&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Determinants''====&lt;br /&gt;
'''Responsibilities''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Responsibilities_Insight Responsibilities Insight].&lt;br /&gt;
* Family - Dependent Children, sick family member&lt;br /&gt;
* Caregiver role - for family members or friend&lt;br /&gt;
* Community Commitments - that helps other people&lt;br /&gt;
* Employment Income - that provides income, health insurance that is critical to support family&lt;br /&gt;
* Other Demands - pressing demands such as finish school, sell a house, resolve a legal issue.&lt;br /&gt;
* Personal Commitments - go to Church on Sunday, go to granddaughters soccer game&lt;br /&gt;
* Legal Responsibilities - criminal, civil, divorce decree, immigration, etc&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Determinants''====&lt;br /&gt;
'''Social Well-Being''' Determinants can impact a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Social_Well-Being_Insight Social Well-Being Insight].&lt;br /&gt;
* [[Social Environment Determinants|Social Environment]] &lt;br /&gt;
* Goals&lt;br /&gt;
* '''Purpose &amp;amp; Meaning''' - ''Spiritual Fitness'', part of something bigger than self, responsibilities &lt;br /&gt;
* '''Competence &amp;amp; Success''' - ''Emotional Fitness'', Life Satisfaction, responsibilities &lt;br /&gt;
* '''Passion Engagement'''  - engaging in passions, activities, social, career, religious beliefs, mindfulness, hobbies, etc.&lt;br /&gt;
* Perspectives&lt;br /&gt;
* Dignity - feeling worthy of acceptance, feeling you have something to contribute, you can accomplish things without help&lt;br /&gt;
* '''Connection &amp;amp; Love''' - feeling love or feeling meaningful connections that you believe the other person really understands you.&lt;br /&gt;
* ''Family'' - a sense of belonging to and having a role in a family, group of friends or community, having meaningful connections that you believe the other person really understands you. &lt;br /&gt;
* '''Friendships''' - people you feel comfortable talking to, spending time with or sharing a passion with&lt;br /&gt;
* '''Social Status''' - how we believe we are scene within family, friends, community, work, etc.&lt;br /&gt;
* ''Spouse''&lt;br /&gt;
&lt;br /&gt;
====Support ''Determinants''====&lt;br /&gt;
'''Support''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Support_Insight Support Insight]. &lt;br /&gt;
* [[Social Support Group Determinants|Social support group]]&lt;br /&gt;
* Caregiver&lt;br /&gt;
* Emotional support - from family and friends, provider&lt;br /&gt;
* Physical support - someone who can be there physically to help&lt;br /&gt;
* Influential support - people who the patient trusts to help with decision making&lt;br /&gt;
&lt;br /&gt;
===Socioeconomic ''Determinants''===&lt;br /&gt;
'''Socioeconomic''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Socioeconomic_Insight Socioeconomic Insight].&lt;br /&gt;
====Can't Afford Treatments ''Determinants''====&lt;br /&gt;
'''Can't Afford Treatments''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Can.27t_Afford_Treatments_Insight Can't Afford Treatments Insight]. &lt;br /&gt;
* Delaying medical care&lt;br /&gt;
* Not filling prescribtion because of cost&lt;br /&gt;
* Not beliveing the treatment cost is worth the value&lt;br /&gt;
&lt;br /&gt;
====Financial ''Determinants''====&lt;br /&gt;
'''Financial''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Financial_Insight Financial Insight].&lt;br /&gt;
* Credit Rating&lt;br /&gt;
* Bankruptcy Threat&lt;br /&gt;
* [[Economic Circumstances Determinants|Economic circumstances]] - ICD Codes&lt;br /&gt;
* [[Financial Concerns]]&lt;br /&gt;
* Financial Health - Income, Wealth, Patient Contributions Capabilities, Financial Constraints (Debt, family commitments)  &lt;br /&gt;
* Financial History&lt;br /&gt;
&lt;br /&gt;
====Food Insecurity ''Determinants''====&lt;br /&gt;
'''Food Insecurity''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Food_Insecurity_Insight Food Insecurity Insight]. &lt;br /&gt;
* Missed Meals&lt;br /&gt;
* Low nutrition food due to cost&lt;br /&gt;
* Low nutrition food due to food desert&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Determinants''====&lt;br /&gt;
'''Health Insurance''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Insurance_Insight Health Insurance Insight].&lt;br /&gt;
* Employer Health Insurance, Cobra, etc. &lt;br /&gt;
* Medicare, Medicaid, private plan&lt;br /&gt;
* Health Plan Terms - Deductibles, co-payments, provider network, etc.&lt;br /&gt;
* Potential eligibility for Medicaid, disability or other subsidized insurance program&lt;br /&gt;
&lt;br /&gt;
====Income &amp;amp; Work ''Determinants''====&lt;br /&gt;
'''Income &amp;amp; Work''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Income_.26_Work_Insight Income &amp;amp; Work Insight].&lt;br /&gt;
* [[Employment Determinants|Employment challenges]] - ICD Codes&lt;br /&gt;
* Employment Flexibility - Sick Days/Leave Availability, Occupation&lt;br /&gt;
* [[Employment Level]] - ICD Codes&lt;br /&gt;
* [[Employment Status]] - ICD Codes&lt;br /&gt;
* [[Household Income]] - ICD Codes&lt;br /&gt;
* Income History&lt;br /&gt;
* Income Sources&lt;br /&gt;
* Income Stability - via employment, retirement or other&lt;br /&gt;
* Occupation&lt;br /&gt;
* [[Occupational Exposures Determinants|Occupational exposures]] - ICD Codes&lt;br /&gt;
&lt;br /&gt;
====Legal ''Determinants''====&lt;br /&gt;
'''Legal''' Determinants can impact are a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Legal_Insight Legal Insight]. &lt;br /&gt;
* Financial or Legal judgments&lt;br /&gt;
* Legal obligations&lt;br /&gt;
* [[Legal or Criminal Determinants|Legal or criminal]] - ICD Codes&lt;br /&gt;
* Legal Status - citizen status&lt;br /&gt;
* Pending Legal Challenges - criminal, civil, traffice violation, divorce decree, immigration, etc&lt;br /&gt;
&lt;br /&gt;
===Environmental ''Determinants''===&lt;br /&gt;
'''Environmental''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Environmental_Insight Environmental Insight]. The top unmet basic needs that effect clinical outcomes are: housing, food, finances, transportation and literacy. (See: [http://www.health3-0.com/reimbursement/addressing-social-and-basic-needs/ ''Improving Clinical Outcomes By Addressing Social And Basic Needs''])&lt;br /&gt;
&lt;br /&gt;
====Access &amp;amp; Logistics ''Determinants''====&lt;br /&gt;
'''Access &amp;amp; Logistics''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Access_.26_Logistics_Insight  Access &amp;amp; Logistics Insight]. &lt;br /&gt;
* Necessities Access (via delivery or going to the store) - Medicines, Food (via delivery or going to the store), Other&lt;br /&gt;
* Public Transportation, pedestrian and bike infrastructure to promote physical activity&lt;br /&gt;
* Unsafe pedestrian crossings increase risk of injury&lt;br /&gt;
* Transportation - Physician Offices, shopping, activities, Special Transportation Needs (Wheel Chair Vehicle)&lt;br /&gt;
* Clinical Services Access - Same day access to Physicians, Nights &amp;amp; Weekend Access to providers, Clinical Care in area, region (i.e., dialysis)&lt;br /&gt;
&lt;br /&gt;
====Communication ''Determinants''====&lt;br /&gt;
'''Communication''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Communication_Insight Communication Insight].&lt;br /&gt;
&lt;br /&gt;
The physical form of available communications.&lt;br /&gt;
* Phone&lt;br /&gt;
* Internet&lt;br /&gt;
* Text Messaging&lt;br /&gt;
* Mail&lt;br /&gt;
* Face-to-face&lt;br /&gt;
* Mobile Apps&lt;br /&gt;
* Through caregiver&lt;br /&gt;
&lt;br /&gt;
====Community ''Determinants''====&lt;br /&gt;
'''Community''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Community_Insight Community Insight]. &lt;br /&gt;
* [[Physical Environment Determinants|Physical environment]]&lt;br /&gt;
* Neighborhood - safe, places to walk, amenities within walking distance, &lt;br /&gt;
* Supportive Neighbors - friendly, quiet at night (able to get restful sleep), someone to check in nearby &lt;br /&gt;
* Amenities - proximity to groceries, pharmacy, parks, etc., density of liquor stores can increase use&lt;br /&gt;
* Proximity to child care, clinics and jobs &lt;br /&gt;
* Transportation Access&lt;br /&gt;
* Social events&lt;br /&gt;
* Food deserts - lack of fresh foods&lt;br /&gt;
* Clinical Care Services&lt;br /&gt;
* Air Quality - pollution may degrade indoor air quality and increase risk of asthma, heart disease and other illnesses&lt;br /&gt;
* Crime &lt;br /&gt;
* Noise - from roadways, industry and airports can degrade quality of sleep&lt;br /&gt;
&lt;br /&gt;
====Home ''Determinants''====&lt;br /&gt;
'''Home''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Home_Insight Home Insight]. &lt;br /&gt;
* [[Physical Environment Determinants|Physical environment]] - exposure to noise, air pollution, water pollution, soil pollution, radiation, other pollution, inadequate drinking-water supply, tobacco smoke (passive smoking)&lt;br /&gt;
* [[Housing Circumstances Determinants|Housing circumstances]] - Homelessness, Inadequate housing (Lack of heating, Restriction of space, Technical defects), Discord with neighbors, lodgers and landlord, Problems related to living in residential institution (Boarding-school resident), problems related to housing and economic circumstances (Foreclosure on loan, Isolated dwelling, Problems with creditors) &lt;br /&gt;
* Housing Costs - affect ability to afford food and other essential basic needs&lt;br /&gt;
* Housing Structure - Old Carpet and mold can trigger asthma, Structural problems increase the risk of falls and burns, stairway design can promote exercise, safety amenities (banisters, smoke alarms, etc.), Accessibility (Wheel Chair accessible)&lt;br /&gt;
* Home Furnishing - Throw rugs (falls, recent hip replacements) &lt;br /&gt;
* Home - Environmental (Heat, Air conditioner, water, hot water)&lt;br /&gt;
* Place to store medications to keep cold&lt;br /&gt;
* Exposure to firearms&lt;br /&gt;
* Exposure to opioids  &lt;br /&gt;
* Household members - disruptive/supportive family member, Onsite Care Giver Support or from family members&lt;br /&gt;
* Living Arrangement - living alone, congregate living, etc.&lt;br /&gt;
* Private Facility - Apartment, House, Room, etc.&lt;br /&gt;
* Institution Facility (Supportive) - Facility type (Nursing home, senior living center, etc.), Onsite staff (match needs of patients), Onsite resources (food, outdoors, etc.), Accessible (Wheel Chair ramps), Safety (Safety Bathrooms, smoke alarms), Environmental (Heat, A/C, Mold), &lt;br /&gt;
* Temporary Housing - Homelessness, Homeless Shelters, friend or family members home, Halfway House (after recent prison term), Victim Shelters (domestic and sexual violence, disaster relief)&lt;br /&gt;
&lt;br /&gt;
====Security ''Determinants''====&lt;br /&gt;
'''Security''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Security_Insight Security Insight]. &lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Determinants''===&lt;br /&gt;
'''Digital Content &amp;amp; Technology''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Content_Insight Digital Content &amp;amp; Technology Insight].&lt;br /&gt;
&lt;br /&gt;
====Medical Records Determinants==== &lt;br /&gt;
'''Medical Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Records_Insight Medical Records Insight].&lt;br /&gt;
* Comprehensive Medical Record - Ensure one location has combined medical records from multiple providers, such as a Primary Care Physician office. &lt;br /&gt;
* Accurate - Ensure the Medical Record ion accurate&lt;br /&gt;
* Preventitive Care - Ensure recommended Home Technology - wifi, broadband internet, cable TV, phone &lt;br /&gt;
* No Care Gaps - Ensure their are no open care gaps (i.e., diabetic, yet no hA1C test in past 6 months&lt;br /&gt;
* Diagnosis Codes (ICD-10 Codes)&lt;br /&gt;
* Physical and Mental Health Biomarkers - Blood Pressure, HbA1C blood test, cholesterol, Depression, Anxiety, etc.&lt;br /&gt;
* [[Symptoms]] &lt;br /&gt;
* [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions]&lt;br /&gt;
* Quality of Life Limitations - [http://www.patientdeterminants.org/index.php?title=Determinants#Activity_Determinants Activity], [http://www.patientdeterminants.org/index.php?title=Determinants#Socioeconomic_Determinants Socioeconomic] and [http://www.patientdeterminants.org/index.php?title=Determinants#Social_Determinants Social]&lt;br /&gt;
* Advanced Directives&lt;br /&gt;
* Preferences - Authorizations, Living Will, etc.&lt;br /&gt;
* [[Medical Interventions]] and [[Non-Medical Interventions]]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records==== &lt;br /&gt;
'''Health Determinants Records''' can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Determinants_Records_Insight Health Determinants Records Insight].&lt;br /&gt;
* Methods of capturing Health Determinants&lt;br /&gt;
* Record of Health Determinants&lt;br /&gt;
* Patient Generated Data&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records Determinants====&lt;br /&gt;
'''Health Interventions Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Interventions_Records_Insight Health Interventions Records Insight].&lt;br /&gt;
* History of Interventions (Medical and Non-Medical)&lt;br /&gt;
* Current Health Interventions&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records Determinants====&lt;br /&gt;
'''Health Outcomes Records''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Health_Outcomes_Records_Insight Health Outcomes Records Insight].&lt;br /&gt;
* Health Outcomes tied to Health Determinants and Health Interventions&lt;br /&gt;
* Current Health Outcome Plans&lt;br /&gt;
* History of Health Outcomes&lt;br /&gt;
* Patient Reported Outcomes&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Determinants''====&lt;br /&gt;
'''Technology &amp;amp; Apps''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Technology_.26_Apps_Insight Technology &amp;amp; Apps Insight]. &lt;br /&gt;
* Apps - mobile, computer applications &lt;br /&gt;
* Durable Medical Equipment - Oxygen equipment, nebulizers, Continuous positive airway pressure (CPAP) devices, single and bi-level, manual and power wheelchairs, scooters, and walkers&lt;br /&gt;
* Home Technology - wifi, broadband internet, cable TV, phone &lt;br /&gt;
* Mobile - cell phone, cell phone service&lt;br /&gt;
* Passive Sensors (wifi enabled weight scale, blue tooth enabled blood pressure cuff)&lt;br /&gt;
&lt;br /&gt;
==Impacting People ''Determinants''==&lt;br /&gt;
'''Impacting People''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight Impacting People Insight]. &lt;br /&gt;
&lt;br /&gt;
===Physicians===&lt;br /&gt;
* Primary Care Physicians &lt;br /&gt;
* Physician Specialists &lt;br /&gt;
* Advanced Practice Professional (APPs)  - Physician Assistants, Nurse Practitioners,&lt;br /&gt;
* Behavior Health (Psychologist, Psychiatrist)&lt;br /&gt;
&lt;br /&gt;
===Care Team ''Determinants''===&lt;br /&gt;
'''Care Team''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Team_.26_Resources_Insight Care Team &amp;amp; Resources Insight].&lt;br /&gt;
====Credentialed Care Specialists ''Determinants''====&lt;br /&gt;
Credentialed Care Specialists providers that could influence health outcomes &lt;br /&gt;
* Pharmacists, &lt;br /&gt;
* Therapists - Physical Therapists (PT) / Occupational Therapists (OT) / Speech Therapists (ST)&lt;br /&gt;
* Behavior Health (Psychologist, Psychiatrist), &lt;br /&gt;
* Clinical Social Worker - Licensed Social Workers (LSW) or Medical Social Workers (MSW)&lt;br /&gt;
* Nurses (Care Manager) Registered Nurses (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN)&lt;br /&gt;
* Dietitians &lt;br /&gt;
* Clinical Educators Providers&lt;br /&gt;
====Credentialed Support Providers ''Determinants''==== &lt;br /&gt;
Credentialed Support (Social and Behavioral) Providers - These are professionals that required some credentialing. &lt;br /&gt;
* Home Health - Certified Nursing Assistants (CNA) / Home Health Aides (HHA)&lt;br /&gt;
* Medical Assistants &lt;br /&gt;
* Behavioral Health &lt;br /&gt;
* Patient Navigator - Recovery Navigator &lt;br /&gt;
* Health Coaches - Recovery Coaches &lt;br /&gt;
* Social Workers &lt;br /&gt;
* Legal Counselors&lt;br /&gt;
* Home Health&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Determinants''===&lt;br /&gt;
Trusted:&lt;br /&gt;
* Family Member &lt;br /&gt;
* Friend&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Determinants''===&lt;br /&gt;
'''Family Members &amp;amp; Friends''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Family_Members_.26_Friends_Insight Family Members &amp;amp; Friends Insight].&lt;br /&gt;
For each family member and friend, list their proximity, relationship (cordial, respect, etc.), regularity of social interations  &lt;br /&gt;
* '''Family''' - List of Family Members and &lt;br /&gt;
* Friends - List of Friends with their proximity &lt;br /&gt;
* Spouse or Signicant Other&lt;br /&gt;
* Parents &lt;br /&gt;
* Siblings&lt;br /&gt;
* Children&lt;br /&gt;
* In-Laws&lt;br /&gt;
* Step-Family &lt;br /&gt;
* Friends - List of Friends with their proximity&lt;br /&gt;
* Neighbors&lt;br /&gt;
&lt;br /&gt;
===Support Team ''Determinants''===&lt;br /&gt;
'''Support Team''' (Non-Clinically Credentialed) Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Team_.26_Resources_Insight Care Team &amp;amp; Resources Insight].&lt;br /&gt;
For each support team memeber, list their proximity, relationship (cordial, respect, etc.), regularity of social interations  &lt;br /&gt;
* Educators (i.e., literacy, hobbies, etc.)&lt;br /&gt;
* Financial Counselors&lt;br /&gt;
* Community Health Workers&lt;br /&gt;
* Technical Support - Technical Support and technicians&lt;br /&gt;
* Attorneys&lt;br /&gt;
* Community Resources Providers (See Community Resources)&lt;br /&gt;
* Other Services (handy man, plumber, etc.),&lt;br /&gt;
&lt;br /&gt;
===Organizations ''Determinants''===&lt;br /&gt;
'''Organizations''' Determinants can decisively affect a patient's overall health and well-being. These are communities that may support and/or influence the overall health.  See [[Organization Interventions]].&lt;br /&gt;
&lt;br /&gt;
====Communities====&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities Interventions]&lt;br /&gt;
&lt;br /&gt;
====Community and Social Services Organizations ====&lt;br /&gt;
* Food Banks&lt;br /&gt;
* Churches  &lt;br /&gt;
* Meals Delivery (Meals on Wheels), &lt;br /&gt;
* Transportation Assistance and Services &lt;br /&gt;
* Programs (Smoking Cessation, &lt;br /&gt;
* Weight Loss, Alcoholics Anonymous), &lt;br /&gt;
&lt;br /&gt;
====Employers====&lt;br /&gt;
&lt;br /&gt;
====Government Organizations====&lt;br /&gt;
* Town&lt;br /&gt;
* County&lt;br /&gt;
* State&lt;br /&gt;
* Federal&lt;br /&gt;
&lt;br /&gt;
====Health Insurers====&lt;br /&gt;
&lt;br /&gt;
====Healthcare Advocacy Organizations====&lt;br /&gt;
* Chronic Condition Advocacy (i.e., American Heart Association, American Cancer Society)&lt;br /&gt;
&lt;br /&gt;
====Healthcare Provider Organizations====&lt;br /&gt;
* Retail Pharmacies&lt;br /&gt;
* Pharmaceutical &lt;br /&gt;
* Medical Devices&lt;br /&gt;
* Hospital &lt;br /&gt;
* Medical Practices&lt;br /&gt;
* Community Health Centers - free flu shots, etc.&lt;br /&gt;
* Convenient Care (Minute Clinics, 24 hour services)&lt;br /&gt;
&lt;br /&gt;
====Support Resources Organizations====&lt;br /&gt;
* Home Maintenance Services - handy man, plumber, etc.&lt;br /&gt;
&lt;br /&gt;
====Vendor Partners====&lt;br /&gt;
Organizations that partner with healthcare providers to improve patient outcomes.&lt;br /&gt;
&lt;br /&gt;
See [[Vendor Partner Examples]]&lt;br /&gt;
&lt;br /&gt;
===Other Contributors ''Determinants''===&lt;br /&gt;
'''Other Contributors''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Other_Contributors_Insight Other Contributors Insight]. &lt;br /&gt;
* Manager or Superviosr at Work&lt;br /&gt;
* Other Key Contributers &lt;br /&gt;
* Influencers - Teacher&lt;br /&gt;
* Volunteers&lt;br /&gt;
* Other Resources of Providers&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities ''Determinants''==&lt;br /&gt;
'''Impacting Activities''' Determinants can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]]. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_Activities_Insight Impacting Activities Insight]. &lt;br /&gt;
 &lt;br /&gt;
===Healthy Lifestyle ''Determinants''===&lt;br /&gt;
Overall '''Healthy Lifestyle''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Physically Active  &lt;br /&gt;
* Nutrition&lt;br /&gt;
* Healthy Weight&lt;br /&gt;
* Avoid Adverse Behaviors  &lt;br /&gt;
* Self Care Management of Health - Sleep, Meditation, preventitive care, medication adherence, etc.  &lt;br /&gt;
* Social &amp;amp; Passion Activities&lt;br /&gt;
* Manage Stress&lt;br /&gt;
* Manage Emotions &lt;br /&gt;
** Positive Emotions - love, affection, work satisfaction, appreciative, goal oriented, feeling good from phyical activities, calm&lt;br /&gt;
** Negative Emotions - anxiety, depression, poor health, being ignored or taking for grated, constant distrations, unhappy, unfulfilled, angry&lt;br /&gt;
* Meditation&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Determinants''===&lt;br /&gt;
'''Physical Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Exercise&lt;br /&gt;
* Activity Levels, &lt;br /&gt;
* Frequency of activity (vs. long duration of sitting)&lt;br /&gt;
* Behaviors (Always walks, always drive, always buses or subways) &lt;br /&gt;
* Work (how active), &lt;br /&gt;
* Activities (Sports, Hiking, gardening)&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities ''Determinants''===&lt;br /&gt;
'''Social &amp;amp; Passion Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Social Interactions - Engagement with others, Caregivers, Organized Communities - like [http://www.patientslikeme.com/ '''PatientsLikeMe'''], &lt;br /&gt;
* Periods of Social Isolation, &lt;br /&gt;
* Social Activities (play cards, go to lunches, Social Organizations, frequent bars), &lt;br /&gt;
* Family Activities (dinners, youth sports)&lt;br /&gt;
* Passion Activities -&lt;br /&gt;
* Sedentary Activities - Television (Watch Baseball, Drama series, News - Favorite programs, Other Sedentary Activities (Read, knit,etc.) &lt;br /&gt;
* Spectator Activities - sports, entertainment, theater, parade, or other events&lt;br /&gt;
* Travel - Visit Family, Friends, Vacation&lt;br /&gt;
* Seasonal Travel - Snowbird (summers in the North, winters in the South),&lt;br /&gt;
&lt;br /&gt;
===Nutrition ''Determinants''===&lt;br /&gt;
'''Nutrition''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Number and times of meals&lt;br /&gt;
* Number and types of snacking&lt;br /&gt;
* Nutritional value and amounts of food&lt;br /&gt;
* Behaviors - Fast Food, Take Out, Home cooked meals&lt;br /&gt;
* Diets and Dieting&lt;br /&gt;
&lt;br /&gt;
===Functional Activities ''Determinants''===&lt;br /&gt;
'''Functional Activities''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Education Activities&lt;br /&gt;
* Income &amp;amp; Work activities&lt;br /&gt;
* Home maintenance&lt;br /&gt;
* [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Activities of Daily Living (ADL’s)'''] or the ten variables in the [http://en.wikipedia.org/wiki/Barthel_scale '''Barthel scale''']&lt;br /&gt;
* Basic Life Activities or the [http://en.wikipedia.org/wiki/Activities_of_daily_living '''Instrumental Activities of Daily Living (IADLs)'''] - Clean home or setting, drive, laundry, Prepare food and/or cook, Shopping (Food, Medicines, necessities, etc., Use Public Transportation,&lt;br /&gt;
* Responsibilities Activities - Care Giver Roles to kids, parents, friends&lt;br /&gt;
* Travel Activities - driving to work, store or giving a ride to a family memeber&lt;br /&gt;
* Use of technology such as internet, computers, smart phones, medical deveices, etc.&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Determinants''===&lt;br /&gt;
'''Sleep''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Activity_Insight Activity Insight].&lt;br /&gt;
* Total Hours of sleep each day&lt;br /&gt;
* Types of sleep - deep, REM, light, naps&lt;br /&gt;
* Number of interruptions&lt;br /&gt;
* When sleep occurs&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Determinants''===&lt;br /&gt;
'''Adverse Behaviors''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Adverse_Behaviors_Insight Adverse Behaviors Insight].&lt;br /&gt;
* Alcohol, &lt;br /&gt;
* Drugs, &lt;br /&gt;
* Falls&lt;br /&gt;
* Gambling, &lt;br /&gt;
* Unprotected sex, &lt;br /&gt;
* Smoking&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Determinants''===&lt;br /&gt;
'''Self-Management Behavior''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Self-Management_Behavior_Insight Self-Management Behavior Insight].&lt;br /&gt;
* Activation Level - [http://www.insigniahealth.com/products/pam.html Patient Activation Measures] - patient's management of interventions (Medical or Non-Medical), conditions, and symptoms based on the patient's [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies].&lt;br /&gt;
* History of self-management behavior &lt;br /&gt;
* Condition Management Behavior - Diabetic monitoring glucose and injecting insulin, Self-care&lt;br /&gt;
* Conscientiousness - behavior of doing a task well, being thorough, careful, and/or vigilant. &lt;br /&gt;
* Reliable and Organized - behavior as opposed to easy-going and disorderly.&lt;br /&gt;
* Treatment Adherence Behavior - Medication Adherence, Nutrition, Therapy, Physician Visits, Recommended Activity levels &lt;br /&gt;
* Medication Management - management and adherence of oral and injectable medicine&lt;br /&gt;
* Intervention Activation - Know when to ask for help, Comfortable asking for help, Know who to ask for help&lt;br /&gt;
* Technology Aptitude (patient or authorized care giver) - Internet and Online Usage, Education Videos, Patient Portal Usage, Use of Secure Texting, Video Conferencing, email, Use of remote monitoring devices (Blood Pressure cuff, remote diagnostic devices (ecg app), Use of tablet, computer or smartphone&lt;br /&gt;
* Online Personal Health Record - Online Electronic Health Record, Blue Button, Access Authorization (Recovery Team access), Patient Input History (Patient answer questions or inputs data into Personal Health Record)&lt;br /&gt;
* Technology Usage - Broadband Internet, Wifi Router, Telecom Network (AT&amp;amp;T, Verizon), Computer, Smartphone or Tablet, Remote Monitoring Devices (Blood pressure cuff, blood glucose monitoring), Remote Diagnostic Devices (ECG app, Accessing patient history via [http://www.healthit.gov/patients-families/blue-button/about-blue-button Blue Button]&lt;br /&gt;
===Care Planning Activities ''Determinants''===&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Determinants''===&lt;br /&gt;
'''Care Management Communications''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Management_-_Communications_Insight Care Management - Communications Insight].  &lt;br /&gt;
* Patient communication - Who? (with care team), How? (in-person, phone, email, text, apps) Frequency? (i.e., dailly, as-needed)&lt;br /&gt;
* Patient Inquiries - who? how? response time?&lt;br /&gt;
* Patient Status - Symptoms, Problem Lists, Concerns, Functional Status, risk factors, Quality of Life Opportunity&lt;br /&gt;
* Recovery Plan Activities - ensure activities are scheduled, treatments happen, prescriptions filled, Recovery Team performs function, Status of Surgeries, Procedures, Tests, Therapies, etc.  &lt;br /&gt;
* Patient Adherence - Monitoring of Medication Adherence, activity levels, other patient behaviors, etc.&lt;br /&gt;
* Patient Activation - Understand condition, capable of treating self, etc. &lt;br /&gt;
* Recovery Factors Monitored - Clinical Condition - Physiological Metrics (i.e., Blood Pressure), Pain, Wounds, etc., functional conditions, etc.  &lt;br /&gt;
* Monitoring Method - Daily Calls, Patient checks box or inputs data, Passive sensors (wifi enabled pill boxes or caps)&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Determinants''===&lt;br /&gt;
'''Care Management - Operational''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Care_Management_-_Operational_Insight Care Management - Operational Insight]. &lt;br /&gt;
* Communication methods within care team - phone, text, portal, etc.&lt;br /&gt;
* Arranging diagnosis, second opinions, procedures, etc.&lt;br /&gt;
* Patient Navigation&lt;br /&gt;
* Triggers - Triggers Requiring Notifications - Patient Concern, Monitoring Alert (i.e., Medication adherence, blood pressure reading), Patient Dialog, Clinical Condition, Emergency, Transfer Event (i.e., Hospital to home)&lt;br /&gt;
* Notification - Who is notified based on each trigger (Patient, Care Giver, Recovery Navigator, Care Manager)? How are they notified (phone calls, text message, alerts)? When are they notified (time frame)?&lt;br /&gt;
* Associated Action - Who takes the action? What is the action? How do they take the action (phone calls, text message, alerts)? When do they take action (time frame)? Potential actions include: Patient triage, Conduct on-site assessment, Issue Escalation, Reassess Recovery Goals, Plan, Monitoring &amp;amp; Protocols, Achieve confirmation to change Recovery Goals, Plan, Monitoring and Protocols&lt;br /&gt;
* Escalation - What gets escalated? Who escalates it (nurse, patient)? Whom do they escalate to (doctor, nurse)? When do they escalate? How do they escalate?&lt;br /&gt;
* Protocol Monitoring - Who ensure notifications, actions and escalations are happening? How? When do they take action?&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Determinants''===&lt;br /&gt;
====Medical Intervention Activities ''Determinants''====&lt;br /&gt;
'''Medical Interventions''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Medical_Interventions_Insight Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* Part A ([https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html hospital/facility interventions]), &lt;br /&gt;
* Part B ([https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html physician interventions]), &lt;br /&gt;
* Part C ([https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html Medicare Advantage Health Plans]), &lt;br /&gt;
* Part D ([https://www.medicare.gov/part-d/ medication interventions]). &lt;br /&gt;
Most health plans are based on Medicare fee schedules, so they typically reimburse for the same or similar services.&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Intervention Activities ''Determinants''====&lt;br /&gt;
'''Non-Medical Intervention Activities ''' Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Insight Non-Medical Interventions Insight].&lt;br /&gt;
Healthcare treatments and services that are typically reimbursed by healthcare insurances like Medicare. &lt;br /&gt;
* [[Care Management Programs]] - team-based, patient focused programs designed to meet specific needs of patients based on the program's criteria. &lt;br /&gt;
* [[Health Services]] - a specific focused health services or capabilities designed to meet specific health needs of patients based on the services's criteria. &lt;br /&gt;
* [[Support Services]] - a specific focused support services or capabilities designed to meet specific needs of patients based on the services's criteria. &lt;br /&gt;
* [[Patient/Caregiver Interventions]] - activities or actions by patients and caregivers that will likely improve health, health outcomes and reduce overall cost.&lt;br /&gt;
* [[Health Insurance Payment Models]] - these are health insurance payment models design to improve patients outcomes, health and reduce cost&lt;br /&gt;
* [[Organization Interventions]] - employers, communities and governments interventions&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence====&lt;br /&gt;
'''Health Strategy Activity Changes 7 Adherence'''  Determinants can decisively affect a patient's overall health and well-being. See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Non-Medical_Interventions_Outcomes_Insight Non-Medical Interventions Outcomes Insight].&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T22:12:06Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Therapeutic Services */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated Devices - continuous glucose monitoring (CGM)&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Digital_Therapeutics_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/What_Works%3F</id>
		<title>What Works?</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/What_Works%3F"/>
				<updated>2019-07-16T22:11:21Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Therapeutic Services - What Works? */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday we get a new understanding of which [[Non-Medical Interventions]] work to impact patient health.  With most healthcare research, sites and journals primarily dedicated to which [[Medical Interventions]] work, this page will now duplicate it.  This page will begin to catalog the [[Non-Medical Interventions]] that work. While these are typically not peer reviewed articles, links are provided for people or organizations interested in further evaluating their efficacy and context to managing health.&lt;br /&gt;
&lt;br /&gt;
==[[Care Management Programs]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Behavioral_Health_.26_Primary_Care_Integration Behavioral Health &amp;amp; Primary Care Integration] - ''What Works?''=== &lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/intermountain-cuts-costs-improves-care-by-integrating-mental-health-into-primary-care Intermountain cuts costs, improves care by integrating mental health into primary care (8/25/17)]&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/alaskan-health-center-model-to-integrate-mental-health-into-primary-care Alaskan health center integration of mental health into primary careh as lowered hospital admissions and visits to the emergency room by more than a third between 2000 and 2015 (8/10/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/montefiore-health-system-sees-improvement-anxiety-depression-patients-using-valera-healths Montefiore Health System integrated mental health treatment with primary care and used the Valera Health smartphone app and platform to improve treatment of anxiety and depression. (5/24/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/integrating-behavioral-and-primary-care-can-improve-care-quality-study-finds.html Patients who received integrated primary care and behavioral health treatments had fewer emergency department visits, hospital admissions, ambulatory care sensitive visits and primary care physician encounters. (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/8/1487.abstract UCLA Health combines primary care with behavioral health to reduce emergency room use by 13% for patients in program. (8/16/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/transforming-care/2016/june/profile Care Oregon has a Health Resilience Specialist program that increased behavioral health visits by 16 percent, while E.D. visits and hospitalizations dropped by roughly 20 percent. (6/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/ny-health-system-s-collaborative-care-program-helps-patients-battle-depression NY health system's collaborative care program helps patients battle depression through screening and outreach (5/25/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/04/intermountain-behavioral-health-primary-care/ It costs Intermountain Health’s SelectHealth insurance subsidiary $22 per member per year to embed mental health workers in primary care clinics and processes, and SelectHealth gets an annual return on investment of $115 per member. (4/12/16)]&lt;br /&gt;
&lt;br /&gt;
Binge Eating Disorder (BED) &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/health/archive/2017/08/how-therapy-can-cure-overeating/537537/ Nearly 80 percent of patients abstain from bingeing after 20 sessions of cognitive behavioral therapy (8/23/17)]&lt;br /&gt;
Dementia Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/613.abstract?rss=1 A memory care clinic for older adults suffering from dementia and depression generates an annual net cost savings of up to $2,856 per patient (4/2014)]&lt;br /&gt;
Suicide Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1672 Zero Suicide, a model for better identification and treatment of patients at risk for suicide. (6/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Chronic_Care_Management Chronic Care Management] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/value-based-care-alone-wont-reduce-health-spending-and-improve-patient-outcomes Nemours Children’s Health System pilot program to improve asthma outcomes saw a 60% reduction of asthma-related ER visits, a 44% reduction in asthma-related hospital admissions, and more than a $2,100 reduction in annual medical costs per child after three years. (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/47153/smart-inhaler-boosts-medication-adherence-144-percent-in-small-study/ Smart inhaler boosts medication adherence 144 percent in small study (9/30/15)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2630810 Study of Memorial Sloan Kettering Cancer Center cancer patients demonstrated a Patient Reported Outcome (PRO) group had a better quality of life and lived an average of 5.2 months longer than an randomly assigned usual care group. The PRO group self-report 12 common symptoms at and between visits via a web-based PRO questionnaire platform. (6/4/17)]&lt;br /&gt;
&lt;br /&gt;
Elderly &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rand.org/news/press/2014/03/17/index1.html Improving Continuity of Care for Elderly Patients with Chronic Diseases Cuts Costs and Complications (3/17/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.full Medicare Coordinated Care Demonstration reduced hospitalizations by 8–33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches were: telephone calls to patients; meeting with providers; acting as a communications hub for providers; delivering education to patients; providing medication management; and comprehensive transitional care after hospitalizations. (6/2012)]&lt;br /&gt;
&lt;br /&gt;
End-Stage Renal Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/preventive-care-specialists-key-to-controlling-kidney-failure-treatment-costs/amp/ Preventive Care, Specialists Key To Controlling Kidney Failure Treatment Costs (8/22/16)]&lt;br /&gt;
&lt;br /&gt;
Hypertension &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/6-ways-to-improve-hypertension-control.html 6 best practices for managing hypertension under population health models (5/27/14)]&lt;br /&gt;
&lt;br /&gt;
Pediatrics&lt;br /&gt;
* [https://healthitanalytics.com/news/chronic-care-management-improves-pediatric-outcomes-by-20 Chronic care management program at Cincinnati Children's Hospital helped care teams improve pediatric outcomes for certain conditions by up to 20 percent. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Episode_Management Episode Management] - ''What Works?''===&lt;br /&gt;
* [https://healthpayerintelligence.com/news/population-health-approach-to-prenatal-care-cuts-payer-costs Taking a population health approach to prenatal care and high-risk pregnancies can cut costs for payers and improve outcomes, AHIP says. (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/how-10-more-hospitals-upgraded-their-total-joint-replacement-programs-and-saved-300k.html How 10 more hospitals upgraded their total joint replacement programs and saved $300k+ (11/4/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/bpci-hospitals-drove-down-medicare-payments-for-lower-extremity-joint-replacement-by-1-166.html BPCI hospitals drove down Medicare payments for lower extremity joint replacement by $1,166 (9/20/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/aug/baptist-health-bundled-payment Baptist Health System generate $6.1 million in savings on joint replacement with a bundled payment program that creates incentives for physicians, hospitals, and post-acute care providers to collaborate to drive down costs and improve quality. (8/3/16)]&lt;br /&gt;
* [http://www.ihatoday.org/uploadDocs/1/raisingthebar2014.pdf Illinois hospitals participating in the Hospital Engagement Network (HEN) from January 2012 through March 2014 prevented 15,887 patient harms, with an associated cost savings of $161.8 million. (10/2014)]&lt;br /&gt;
&lt;br /&gt;
Navigators &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/patient-navigators-track-social-determinants-through-ehrs-positive-results 'Patient navigators' track social determinants through EHRs with positive results. 98/7/17)] Kaiser uses a [http://res.cloudinary.com/bdy4ger4/image/upload/v1499804346/Patient_Questionnaire_for_OPB_ckqqld.pdf Current Life Situation Form]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-patient-centered-care-helped-arkansas-hospital-cut-readmissions-by-90 CHI St. Vincent's readmission rate fell by 90%, due largely to the heightened scrutiny of individual patients' processes of care and needs such as transportation gaps, lack of social support or financial obstacles. (11/25/15)]&lt;br /&gt;
* [http://www3.ccc.uab.edu/index.php/newsroom/preliminary-uab-study-shows-dramatic-trend-of-cost-savings-in-lay-navigation-program-for-cancer-patients/ Preliminary UAB study shows dramatic trend of cost savings in lay navigation program for cancer patients. (7/7/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-navigators-reduced-readmissions-overuse-er-pilot-program 'Patient navigators' reduced readmissions, overuse of ER in pilot program (1/27/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Education about Procedures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/educate-patients-and-they-have-better-surgical-outcomes-study-finds Informed patients have better surgical outcomes. Only 36% of patients met the criteria for an informed patient-centered decision. Informed patients were significantly more likely to report being extremely satisfied with their treatment. (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#ER_Case_Management ER Case Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/presbyterian-healthcare-services-finds-success-patient-navigation Presbyterian Healthcare Services patient navigation program screens all emergency department patients, they transfer non-emergency patients to a more appropriate setting, like an urgent care center or primary care facility. Program helped drop ER overuse, improved patient engagement and decreased in treatment or diagnosis delays. (3/21/17)]&lt;br /&gt;
* [http://m.startribune.com/state-deploys-powerful-tool-to-rein-in-medicaid-waste-costly-er-use/404506396/ Minnesota system flags patients who visited hospital ERs as much as 150 times in a single year and people who routinely hop from one physician to the next searching for prescription painkillers. By limiting these “high use” patients to a single primary care provider, along with a hospital and one pharmacy, the program is saving taxpayers at least $7 million a year in unnecessary medical costs (12/3/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/kaiser-permanente-s-takes-new-approach-to-redirect-er-superusers Patient Navigators in the ER helps reduce returns by 55% among the 254 patients that navigators are managing. Navigators help with non-medical problems sucah as housing, food insecurity and lack of transportation. (6/17/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/frequent-flyer-er-visits-drop-coordinated-care 'Frequent flyer' ER visits drop with coordinated care (7/11/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Exercise_.26_Nutrition Exercise &amp;amp; Nutrition] - ''What Works?'' ===&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-prevention-how-one-ymca-program-is-changing-the-game.html A small diabetes prevention program based out of a YMCA in Indianapolis (3/31/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-health-diabetes-prevention-idUSKCN0PN2K720150713 Organized programs help prevent or delay diabetes (7/13/15)]&lt;br /&gt;
* [http://circ.ahajournals.org/content/125/9/1157.short Participants in a lifestyle intervention of reduced calorie, low-fat diet of conventional foods and 150 min/wk of physical activity (typically brisk walking), with the goal of losing 7% of initial weight. After an average of 2.8 years, participants in the lifestyle intervention lost 5.6 kg in comparison to 0.1 kg in the placebo group. The risk of the lifestyle group developing type 2 diabetes was reduced by 58% in comparison with placebo group. (3/5/12)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Health_Coaching Health Coaching] - ''What Works?''===&lt;br /&gt;
Care Goal Setting and Motivational Interviewing &lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-virtas-monitoring-app-plus-low-carb-diet-reverses-diabetes-progression Monitoring app, health coaching plus low-carb diet reverses diabetes progression by lowering average HbA1c from 7.6% to 6.3% and weight reduction of 12% (2/8/18)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/johns-hopkins-study-coaching-app-sweetch-can-increase-weight-loss-activity-prediabetes Johns Hopkins study: coaching app can increase weight loss, activity in prediabetes patients (3/8/18)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481661/ Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction. Participants lost an average of 3.23% total body weight (TBW) at 4 months of coaching. (6/8/17)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/oby.21723/full Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. (1/26/17)]&lt;br /&gt;
* [http://www.annfammed.org/content/14/3/200.full Health coaching is effective for chronic disease self-management in the primary care safety-net setting. Most clinical outcomes improvements persisted 1 year after the completion of the health coaching intervention. (5/2016)]&lt;br /&gt;
* [http://medcitynews.com/2014/03/patient-navigators-helped-diabetics-improve-blood-glucose-control-32-cleveland-clinic-pilot/ Diabetics + patient navigators improved blood glucose control by 32% in Cleveland Clinic pilot (3/18/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/05/your-patient-should-get-a-health-coach-heres-why.html Health coaching improves the management of chronic diseases. It is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care. (5/15/16)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=The+effects+of+health+coaching+on+adult+patients+with+chronic+diseases:+a+systematic+review Health coaching improves the management of chronic diseases (11/2014)]&lt;br /&gt;
Diabetes Prevention&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/417.abstract YMCA Of The USA Diabetes Prevention Program saved $278 per member per quarter during the first three years of the intervention period. Nine fewer ED visits per 1,000 participants per quarter. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Virtual Programs&lt;br /&gt;
* [http://mhealth.jmir.org/2017/6/e80/ App-based health coaching program demonstrated an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% of the participants achieved a clinically significant weight loss of 5% (7/2017)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-shows-seniors-risk-diabetes-and-heart-disease-lose-weight-reduce-healthcare-costs Digital behavioral health coaching program from Omada Health has been shown to reduce overweight and obese seniors' risk of developing type 2 diabetes and heart disease by helping them lose weight and adopt healthier behaviors. (10/13/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-health-coaching-app-nooms-weight-loss-outcomes-comparable-traditional-diabetes 64% of the 43 overweight or obese adult participants, with a diagnosis of prediabetes, people using health coaching app during 24 week program lost more than 5 percent of their weight, which is comparable to the Centers for Disease Control’s findings from traditional diabetes prevention programs. (9/8/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-canary-health%E2%80%99s-digital-diabetes-management-program-helpful-across-five-key Digital health diabetes program that help people with diabetes self-manage their health through online workshops, coaching, and medication adherence and emotional support showed improvement across five key indicators – blood sugar levels, medication adherence and exercise all improved, hypoglycemic symptoms decreased in frequency, and depression symptoms improved. (8/31/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mhn-2016-how-ochsner-used-connected-devices-text-messages-bring-two-thirds-hypertension  Ochsner used connected devices, text messages, health coaching and medication management assistance to bring two-thirds of hypertension patients within range (6/22/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#High_Need_High_Cost High Need High Cost] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/441.abstract Initiative to reduce avoidable hospitalizations among nursing facility residents reduced per resident average of $60–$2,248 for all-cause hospitalizations and by $98–$577 for potentially avoidable hospitalizations. (3/2017)]&lt;br /&gt;
* [http://khn.org/news/tackling-patients-social-problems-can-cut-health-costs/amp/ Houston’s Patient Care Intervention Center program has reduce patient costs in program by 83% and hospital visits by 70%. The program developed by the Camden Coalition led by Dr. Jeffrey Brenner uses social workers who seek out high-need-high-cost patients to address social needs such as securing stable housing. (1/23/17)]&lt;br /&gt;
* [http://m.startribune.com/apartment-job-it-s-just-what-the-doctor-ordered/408873365/ Hennepin Health's outreach efforts helps clients find a job or an apartment — the project has shown it can improve patients’ health while saving money and greatly reducing the number of times they turn up at the ER in crisis. (12/30/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/coordinated-care-clinic-cuts-super-user-hospitalizations-by-a-quarter A strategy focused on team-based care and listening to “super-users” helped a Florida health system cut hospitalizations of such patients by a quarter while also driving down uninsured admissions (8/24/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/care-coordinators-work-high-needs-patients-medical-practices  Intensive Outpatient Care Program (IOCP), which embeds care coordinators in medical practices. Care coordinators work with high-needs patients in medical practice where patients, emergency room visits declined 59 percent and admissions declined 29 percent. (8/22/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/project-echo Complex Care Initiative: Building Capacity to Help “Superutilizers” in Underserved Communities. Number of hospitalizations among participants fell by 27% and emergency department visits dropped by 32%. (8/9/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients  Study compares the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. (8/7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/intensive-care-coordination-saves-14m-super-user-costs 'Intensive care coordination' saves $14M in superuser costs (6/27/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/02/02/using-the-intensive-outpatient-care-program-to-lower-costs-and-improve-care-for-high-cost-patients/ Intensive Outpatient Care Program (IOCP) in commercial populations show a reduction in costs among the medically complex by up to 20 percent. (2/2/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/nation/2014/09/16/focus-on-super-utilizers-cuts-costs/14648069/ Programs focus on high-risk patients to reduce spending (9/16/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.abstract Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients (6/2012)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Home_Care Home Care] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/member-engagement/paramedic-house-calls-help-blue-cross-and-blue-shield-new-mexico-reduce-er-usage How paramedics helped Blue Cross Blue Shield of New Mexico reduce ER usage, readmissions (8/9/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/hospital-at-home Hospital at Home Model: Bringing hospital-level care to the patient results in lower readmissions, better outcomes and lower costs. 92% of patients offered the service took it. It has high patient satisfaction, as patients remained close to their support networks and had less disruption to their lives. (8/22/16)]&lt;br /&gt;
* [http://www.healthleadersmedia.com/quality/front-loaded-home-care-and-office-visits-may-reduce-heart-failure-readmissions A new study finds that front-loaded home care combined with physician office visits shows promise in reducing HF readmissions. (8/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-at-home-model-gains-steam-as-mt-sinai-program-cuts-costs-readmissions Mt. Sinai Hospital's Mobile Acute Care Team (MACT) program delivers hospital-quality home care for patients who are at high risk for readmission. The pilot program cut costs by nearly 20 percent (6/6/16)]&lt;br /&gt;
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Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/sep/sweden-senior-alert-case-study Senior Alert program resulting in 30% reduction in falls, decline in pressure ulcers from 14.3% to 9.4%, and a decline in the incidence of weight losses greater than 5 percent of total body weight from 14.3% of patients to 12.5%. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/study-finds-benefits-when-seniors-call-shots-to-help-them/amp/ Aging in place program asks low-income seniors with disabilities how their lives at home could be better. At the end of the program, 75% of participants were able to perform more daily activities than they could before and symptoms of depression also improved. (9/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/minnesota-health-systems-telehealth-program-seniors-leads-better-outcomes-engagement Telehealth program for seniors leads to better outcomes (86.7% reduction in realized versus expected hospitalization rates) and better engagement (94% of patients interact with the technology and report in their vital signs every day, compared to less than 25% percent in a 2014 national survey of patients in telehealth programs). (8/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/9/1558.abstract?=right Home-Based Care Program Reduces Disability And Promotes Aging In Place. 75% of participants improved their performance of activities of daily living (ADLs)after completing the five-month program. (9/2016)]&lt;br /&gt;
* [http://www.pbs.org/newshour/updates/coordinated-care-gives-patients-freedom-stay-home/ How coordinated care gives patients the freedom to stay at home (7/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/spain-offers-telemedicine-connect-elderly-population-medical-care/ The Basque region of Spain saved $55 million and eliminated 55,000 visits with a telemedicine program aimed at the elderly. (11/15/13)]&lt;br /&gt;
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Falls Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/6/971.abstract In the three years after The LIFT (Living Independently and Falls-free Together) Wellness Program, that included a comprehensive in-home assessment by a registered nurse, participants had a 33% lower incidence of claims for long-term care services and supports (6/2015)]&lt;br /&gt;
&lt;br /&gt;
Home-Based Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/overview-home-based-primary-care Medicare’s Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program (6/7/17)]&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/425.short Study finds 5 innovative Home Visit models associated with reductions in costs, hospitalizations, and emergency department use (3/2017)]&lt;br /&gt;
* Home Visits - [http://www.fiercehealthcare.com/healthcare/hospital-workers-visit-patient-homes-to-reduce-er-visits?utm_source=feedly Children's Hospital of Philadelphia (CHOP) sends home visitors to high-risk asthma patients in inner-city Philadelphia (7/29/13)]&lt;br /&gt;
*  [http://content.healthaffairs.org/content/35/1/28.abstract House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care (1/2016)]&lt;br /&gt;
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Medical House Calls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/jul/medstar-washington-hospital-center Medical House Call Program reduced Medicare spending by 20 percent relative to expected spending for that population ($4,060 vs. $5,076) (7/27/16)]&lt;br /&gt;
* [http://khn.org/news/doctors-house-calls-saving-money-for-medicare/ Doctors’ house calls saving Medicare an average of almost $13,600 for each patient in a pilot project. (5/23/16)]&lt;br /&gt;
* [http://www.npr.org/2015/11/08/448406540/doctor-treats-homebound-patients-often-unseen-even-by-neighbors Doctor Treats Homebound Patients, Often Unseen Even By Neighbors (11/8/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2138.abstract Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits (12/2015)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2014/08/07/338393136/house-calls-keep-people-out-of-nursing-homes-and-save-money House Calls Keep People Out Of Nursing Homes And Save Money (8/7/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medical_Home Medical Home] - ''What Works?''===&lt;br /&gt;
Ensuring followup on referrals and recommended preventive screening completed based on [https://www.uspreventiveservicestaskforce.org/BrowseRec/Index USPSTF] recommendations.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-home-model-improves-care-but-not-costs-among-safety-net-providers.html Medical home model improves care, but not costs among safety-net providers (6/27/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/mar/review-of-medical-homes Review of Medical Homes Shows Reduction in Spending for High-Risk Patients, But Design and Implementation Matter (3/28/17)]&lt;br /&gt;
* [http://www.startribune.com/health-care-homes-save-minnesota-1-billion/368187001/ Health care 'homes' save Minnesota $1 billion (2/9/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/11/1985.abstract A “medical village” of providers and community-based resources for patients with diabetes, asthma, and congestive heart failure reduced ED visits by 29.7% percent and hospitalizations by 28.5% (11/2014)]&lt;br /&gt;
&lt;br /&gt;
Care Gaps &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.healthcareitnews.com/news/population-health-done-three-ways?single-page=true 3 Healthcare systems explain the technology, process and grit they used to close care gaps needed to improve patient care. (11/3/15)]&lt;br /&gt;
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Care Plan Development &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1627.abstract?rss=1 Moving paradigm from determining “what is the matter?” to discovering “what matters to you?” improves health outcomes (9/2014)]&lt;br /&gt;
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Oncology &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/433.abstract?=right Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending (3/2017)]&lt;br /&gt;
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Preventive Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/prevention/index.html If everyone in the country received recommended clinical care, we could save over 100,000 lives a year. (5/31/17)]&lt;br /&gt;
* [http://m.startribune.com/don-t-smoke-get-your-shots-minnesota-researchers-say-in-influential-study/410159785/ Comparing 28 recommended preventive services, HealthPartners researchers found that tobacco counseling and pediatric immunizations outranked the others in cost-effectiveness and the potential to save lives. (1/9/17)]&lt;br /&gt;
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Patient Centered Medical Homes (PCMH) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/report-pcmh-programs-cut-costs-improve-quality-but-collaboration-key-to-success PCMH programs cut costs and improve quality. Collaboration is the key to their success (7/11/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/patient-centered-medical-homes-systematic-differences A study of 11 PCMH initiatives showed little improvement in costs, utilization, or quality. (3/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/bcbs-michigan-marks-further-expansion-pcmh-model Blue Cross Blue Shield of Michigan's Patient Centered Medical Home (PCMH) program for primary care practices reduced medical costs by $427 million, in part due to lower healthcare utilization. 2016 data show BCBSM-designated PCMH practices had a 15.2% lower rate of adult emergency department visits and 21.4% lower rate of hospital admissions for certain conditions. (9/13/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/study-patient-centered-medical-homes-reduce-er-visits-among-chronically-ill/ Study: Patient-centered medical homes reduce ER visits among chronically ill (9/3/14)]&lt;br /&gt;
* [https://ehrintelligence.com/news/pcmhs-produce-21-lower-healthcare-costs-for-chronically-ill/ Patient-centered medical homes (PCMH) can cut more than 20% off the treatment cost for a chronically ill patient (7/24/13)]&lt;br /&gt;
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Primary Care Practices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/study-primary-care-continuity-could-help-reduce-hospital-admissions.html Patients with high continuity of care were admitted to the hospital 12.49% fewer times than those with low continuity of care (2/2/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/greater-primary-care-involvement-leads-to-lower-end-of-life-care-costs-study-finds.html Patients who resided in regions with the most primary care involvement accrued roughly $4,000 less in Medicare spending in their last two years of life, spent nearly 1.4 fewer days in the intensive care unit in their last six months of life and were less likely to be enrolled in hospice. (1/9/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/study-continuity-care-reduces-risk-ed-visits Seniors that consistently see the same physician in an outpatient setting are 20% less likely to go to the emergency department (8/25/16)]&lt;br /&gt;
* [https://www.bostonglobe.com/business/2015/05/03/iora-health-pioneers-new-primary-care-model/kc7V4W5V8OJ0gxFqY4zBrK/story.html Primary Care Physicians deliver 12% lower healthcare costs, 37% lower hospitalization at one site (5/4/2015)]&lt;br /&gt;
* [http://www.annfammed.org/content/13/3/206 Increasing family physician comprehensiveness of care is associated with decreasing Medicare costs and hospitalizations. (5/2015)]&lt;br /&gt;
* [http://www.prnewswire.com/news-releases/new-primary-care-model-delivers-20-percent-lower-overall-healthcare-costs-increases-patient-satisfaction-and-delivers-better-care-300021116.html Primary Care Physicians deliver 20% lower overall healthcare costs, increase patient satisfaction (1/15/2015)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/how-an-aco-led-by-doctors-helped-cut-the-cost-of-care-in-texas-town/ How an ACO led by doctors helped cut the cost of care in Texas town (9/24/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf Evidence shows that primary care helps prevent illness and death (2005).]&lt;br /&gt;
Virtual Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/population-health-lessons-from-banner-health-s-telemedicine-program When Banner Health launched its iCare telemedicine program, patients didn't use it because it required them to replace their primary care physician. Once they changed that rule, very few patients have left the program voluntarily, and Banner Health saw costs per beneficiary drop by 27% while hospitalizations were reduced by 45%. (12/5/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medication_Management Medication Management] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/3-ways-to-improve-patients-medication-adherence 3 ways to improve patients’ medication adherence (8/25/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/childrens-health-uses-ingestible-sensor-improve-adherence-adolescent-transplant-patients Children's Health uses ingestible sensor to improve adherence in adolescent transplant patients (2/22/17)]&lt;br /&gt;
* [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170905 Pharmacogenetic testing of polypharmacy home health patients aged 50 and older considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare. (2/2/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/walgreens-pill-reminder-activity-tracking-both-improved-medication-adherence-study Walgreens pill reminder, activity tracking both improved medication adherence in study (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/study-quantifies-healthcare-costs-for-medication-adherence-and-non-adherence Patients with multiple medical conditions who adhered to their prescription schedules who had diabetes saved $5,341 annually in medical costs; those who had hypertension saved $4,423, while those who had high cholesterol saved $2,081  (8/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/interventions-to-keep-chronic-illness-patients-on-their-meds-could-save-billions.html  Interventions to keep chronic illness patients on their meds could save billions (8/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/08/medacheck-double-medication-adherence/ The study of 35 patients aged 12-20 with a baseline medication adherence of 42-43%. After 6 months, those with mobile app only increased to 60% and those with the app and reminder calls 85.4% (8/22/16)]&lt;br /&gt;
* [http://khn.org/news/syncing-up-drug-refills-a-way-to-get-patients-to-take-their-medicine/amp/ Syncing Up Drug Refills: A Way To Get Patients To Take Their Medicine (8/8/16)]&lt;br /&gt;
&lt;br /&gt;
* [https://ehrintelligence.com/news/how-pharmacy-patient-engagement-boosted-medication-adherence Study shows that the use of a high-touch pharmacy patient engagement system made patients 2.57 times more likely to stay adherent to their medications. (10/27/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1444.abstract Pennsylvania Pharmacist Project significantly improved adherence for all medication classes, from 4.8% for oral diabetes medications to 3.1% for beta-blockers. It also helped reduce per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). (8/2014)]&lt;br /&gt;
During Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/study-medication-reconciliation-programs-halve-hospital-readmissions-6.html Hospital readmission decreased 50 percent when pharmacists reviewed patients' medication regimens and provided counseling during transitions from hospital to home (7/15/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1222.abstract Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs. The program saved $2 for every $1 spent. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/prescription-assistance-programs-lead-to-drop-er-visits Prescription assistance programs lead to drop in ER visits (4/7/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Palliative_Care Palliative Care] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/pre-hospice-saves-money-by-keeping-people-at-home-near-the-end-of-life/amp/ ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life (3/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/community-based-palliative-care-may-decrease-ed-visits-study-finds.html Dying patients who received community-based palliative care visited the emergency department half as much in their last year of life, according to a study. (2/22/17)]&lt;br /&gt;
* [http://www.managedcaremag.com/archives/2016/7/palliative-care-improves-quality-care-lowers-costs Aetna’s Compassionate Care Program resulted in improved member satisfaction, an 81% decrease in inpatient days, and net savings of $12,000 per participating member (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/early-palliative-care-can-save-money-reduce-patient-stay-hospital Early palliative care can save money, reduce patient stay in hospital (7/1/15)]&lt;br /&gt;
* [http://healthleadersmedia.com/page-3/LED-283076/Hospitals-Opting-for-Palliative-Care University of Rochester Medical Centers in 2007 found the palliative care intervention saved about 1,400 ICU patient days, at an average of about $450 a day. (8/6/12)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Transitional_Care_Management Transitional Care Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/christiana-care-uses-analytics-for-better-care-coordination-post-discharge Christiana uses its CareLink CareNow infrastructure to help coordinating care for close to 75,000 Medicare beneficiaries beyond discharge. The system has seen a 30% reduction in 90-day readmission rates. (6/19/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/involving-patient-s-family-in-discharge-process-linked-to-25-reduction-in-hospital-readmissions.html Involving patient's family in discharge process linked to 25% reduction in hospital readmissions (4/4/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/a-focused-primary-care-visit-after-hospital-stay-lowers-risk-readmission Patients who had one or more primary care visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician. (11/22/16)]&lt;br /&gt;
* [http://khn.org/news/gaps-in-care-persist-during-transition-from-hospital-to-home/amp/ San Diego County program saved Medicare an estimated $13.8 million (reduced hospital readmissions) over a two-year period with a care transition program that sends nurses and social workers into homes to ensure transitions go smoothly, checking medications one by one, making sure they know how to take them, walking through the house looking things that could cause a fall, asking about caregivers to help with bathing and dressing. (9/6/16)]&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20151205/MAGAZINE/312059995 Hospitals with the lowest readmission rates. Roper St. Francis Healthcare's Care Transitions Program helps elderly patients recognize symptoms of health decline and assists them in managing their medications.  University of Colorado Health's Memorial Hospital assigns a case manager to follow up with patients at risk of heart failure, stroke, pneumonia or heart attack. Hospital for Special Surgery in New York City is developing a mobile application that will allow staff to interact with patients remotely post-discharge. (12/5/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-intervention-cuts-readmissions-for-patients-at-risk-for-delirium-suicide Hospital intervention cuts readmissions for patients at risk for delirium, suicide (7/1/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1531.abstract?rss=1 Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses (9/2014)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/10-recent-stories-studies-on-reducing-readmissions.html 10 stories, studies on reducing readmissions (8/18/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-ritz-carlton-helped-one-hospital-reduce-readmissions-to-74-percent How Ritz-Carlton helped one hospital reduce readmissions to .74 percent for knee and hip replacements (7/15/14)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=1868538 JAMA Studies 18 Activities That Are Preventing 30-Day Hospital Readmissions (7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/beth-israel-deaconess-lowers-readmissions-post-discharge-program Beth Israel Deaconess lowers readmissions with post-discharge program (4/4/14)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/study-social-work-interventions-reduce-readmission-rates-half/2013-07-05?utm_source=rss&amp;amp;utm_medium=rss study] demonstrated high risk patients being discharged from the hospital that receive social work interventions reduce readmission rates to 7% as compared to the 15 percent readmission rate for the control group--patients discharged (7/5/13)&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/reduce-readmissions-by-giving-transitional-care-a-personal-touch Three nonprofit hospitals in the Bronx, N.Y. significantly dropped readmission rates thanks to personal contact with patients before and after discharge (6/28/13)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/hospital-community-collaboration-reduced-readmissions-4570/2013-05-30?utm_source=rss&amp;amp;utm_medium=rss collaborative initiative involving 83 hospitals and 93 community partners in Minnesota] saw 4,570 fewer avoidable hospital readmissions over 24 months, saving more than $40 million by using comprehensive discharge planning, medication management, patient engagement, transition care support, and transition communications. (5/30/13)&lt;br /&gt;
* [http://circoutcomes.ahajournals.org/content/6/4/444.full Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure (5/15/13)]&lt;br /&gt;
Post Surgical Follow-up &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-app-based-visits-seem-viable-post-surgical-follow-ups App-based visits seem viable for post-surgical follow-ups (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
==[[Health Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Consumer_Diagnostic_Services Consumer Diagnostic Services] - ''What Works?''===&lt;br /&gt;
DNA Testing &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Convenient_Access Convenient Access] - ''What Works?''===&lt;br /&gt;
24x7 Managing Health Services &amp;lt;br&amp;gt;&lt;br /&gt;
Hot Spotters&lt;br /&gt;
* [http://www.newyorker.com/magazine/2011/01/24/the-hot-spotters Dr. Jeffrey Brenner analyzed data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million. Dr. Brenner secured funding and approvals to begin a Wellness Program at Northgate II tower that housed the high cost high need patients. (1/24/11)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://apps.bostonglobe.com/spotlight/the-desperate-and-the-dead/series/solutions/ San Antonio built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless that resembles a community college. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/11/16)]&lt;br /&gt;
* [http://www.khi.org/news/article/leader-of-kck-mental-health-center-touts-savings-from-care Mental health crisis center saved $6 million last year by stabilizing people in crisis who otherwise would have ended up in state hospitals, local emergency rooms or jails and prisons. (11/15/16)]&lt;br /&gt;
Same Day Appointments &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/01/toby-cosgrove-cleveland-clinic-felt-urgency-day-appointments/ In 2016, Cleveland Clinic had 1.3 million same-day appointments. CEO Toby Cosgrove stated that every patient who calls the Clinic is asked whether he or she would like to see a doctor that same day. 98% of the people who asked to be seen the same day was successful in doing so. (1/10/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Education Education] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/west-virginia-hospital-system-sees-readmission-reductions-patient-education-initiative Charleston Area Medical Center was able to reduce readmission rates for Congestive Heart Failure by over 22% and COPD by almost 30% with educational videos to help patients self-manage their health. (2/9/17)]&lt;br /&gt;
* [http://www.choosingwisely.org/doctor-patient-lists/ '''Choosing Wisely'''] provides decision making education for physicians and patients on over 135 tests and treatments that they say are overused or inappropriate.&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/holistic-education-led-to-dramatic-improvements-for-diabetes-patients Holistic education led to dramatic improvements for diabetes patients (8/11/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/south-carolina-initiative-cuts-readmissions-through-cooperation-education South Carolina initiative cuts readmissions through cooperation, education (7/8/15)]&lt;br /&gt;
&lt;br /&gt;
Behavioral&lt;br /&gt;
* [http://oregonstate.edu/ua/ncs/archives/2015/nov/changing-habits-improve-health-new-study-indicates-behavior-changes-work More than 80 percent of the randomized clinical trials that included a behavioral intervention reported a significant improvement for the targeted behavior and a significant physiological impact such a reduction in weight or blood pressure. (11/10/15)]&lt;br /&gt;
&lt;br /&gt;
Self-Administer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care Parkland Health &amp;amp; Hospital System trained over 1,000 patients to self-administer IV antibiotics in their homes. In the first four years of this effort, these patients experienced a 47% lower 30-day hospital-readmission rate than those receiving treatments in an outpatient facility while the mortality rates of both groups were similar. (6/2/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Decision_Making Decision Making] - ''What Works?''===&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/shared-decision-making-improves-outcomes-satisfaction-for-orthopedic-patients Study: Shared decision-making boosts patient outcomes, leads to higher satisfaction rates (3/15/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Digital_Therapeutics Digital Therapeutics] - ''What Works?''===&lt;br /&gt;
Behavioral Health&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/05/valera-health-app-shows-boost-in-engagement-from-patients-with-depression-anxiety/ Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)]&lt;br /&gt;
* [http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs/ 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/06/telepsychiatry-reduces-wait-times-psyciatric-exams-4-days-10-hours-sc-hospital/ In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)]&lt;br /&gt;
* [http://khn.org/news/telephone-therapy-helps-older-people-in-underserved-rural-areas-study-finds/ Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)]&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/study-real-time-symptom-reporting-helps-cancer-patients-live-longer Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)]&lt;br /&gt;
Cardiac Rehab &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/veterans-respond-well-home-based-cardiac-rehab-app-va-study-shows Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)] &lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2016-03/acoc-dht032216.php Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)]&lt;br /&gt;
* [http://newsnetwork.mayoclinic.org/discussion/cardiac-rehab-patients-who-use-smartphone-app-recover-better-mayo-clinic-research-shows Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092 To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/04/11/well/live/tackling-weight-loss-and-diabetes-with-video-chats.html Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)] &lt;br /&gt;
* [http://www.mobihealthnews.com/content/one-drop-shares-data-showing-app-reduces-a1c-1-percent One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)]&lt;br /&gt;
* [https://www.imedicalapps.com/2017/04/omada-humana-diabetes-study/ Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2017/03/diabetes-online-intervention-study/ Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)]&lt;br /&gt;
* [http://medcitynews.com/2016/09/mississippi-telehealth-remote-monitoring/ Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article116582423.html Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mobile-diabetes-intervention-reduced-hba1c-2-percentage-points-more-standard-care Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)]&lt;br /&gt;
Parkinson &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/nhs-study-finds-mobile-app-improves-management-quality-doctor-visits-people-parkinsons NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)]&lt;br /&gt;
Physical Therapy &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://medcitynews.com/2017/03/virtual-rehab-gain-ground-orthopedics-bundled-payments-take-hold/ Virtual rehab to gain ground in orthopedics as bundled payments take hold (3/14/17)]&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170823.061630/full/ Over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population (8/23/17)]&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0454-y Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/webmds-app-enabled-weight-loss-pilot-helped-800-verizon-employees-lose-weight App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/11/medicare-patients-lose-weight/ A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)]&lt;br /&gt;
* [http://medcitynews.com/2015/06/pwc-infograph-virtual-care-cuts-down-diabetes-costs/ Virtual care reduces diabetes costs by 9% (6/26/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Home Home] - ''What Works?''===&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/home-visits-help-new-parents-overcome-tough-histories-raise-healthy-children/amp/ Home Visits Help New Parents Overcome Tough Histories, Raise Healthy Children (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Housing and Healthcare Integration &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/new-integrated-model-care-for-seniors-lowers-hospitalizations-readmissions-emergency Clinical outcomes of an integrated model of care for frail seniors that bridges housing and healthcare. 50% lower inpatient hospitalization rates, 80% lower readmission rates, 15% lower rate of emergency department use (3/23/17)]&lt;br /&gt;
Medication Reconciliation &amp;lt;br&amp;gt;&lt;br /&gt;
Paramedic Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1111/jgs.14484/full Only 22% of Paramedic responses required transport; 78% were evaluated and treated in the home. Paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals’ homes. (8-30-16)]&lt;br /&gt;
Passive Data Analysis &amp;lt;br&amp;gt;&lt;br /&gt;
Passive Data Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
*  [http://www.cnn.com/2014/08/25/tech/innovation/alzheimers-smart-home/ Sensors let Alzheimer's patients stay at home, safely (10/12/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Virtual_Medical_Services Virtual Medical Services] - ''What Works?''===&lt;br /&gt;
Tele-Health Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/04/how-to-measure-roi-of-telemedicine/ INTEGRIS reduced cost of treating low acuity, non-emergent medical conditions such as upper respiratory infections (URI). In 2016, the cost for onsite visits to treat URIs was $383,702. During the first three months of 2017, costs to treat URI patients virtually was only $9,744. It is expected to save hundreds of thousands of dollars annually (4/20/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-shows-telemedicine-can-improve-screening-access-efficiency-diabetes-caused JAMA study shows telemedicine can improve screening access, efficiency for diabetes-caused blindness in LA County safety net populations (4/11/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/26/519543337/telehealth-doctor-visits-may-be-handy-but-arent-cheaper-overall Telehealth Doctor Visits May Be Handy, But Aren't Cheaper Overall (3/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/how-mercy-created-a-54m-virtual-hospital-in-st-louis.html Virtual Care Center has led to a more than 33 percent decrease in Mercy's emergency room visits and hospitalizations. (9/15/16)]&lt;br /&gt;
Virtual Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/whatsapp-second-medical-opinion-diagnosing/ 20 oral pathologists gathered virtually using the WhatsApp Broadcast functionality to get a second opinions. The accuracy of the 4,940 second opinion diagnoses (SOD) was 98% correctly diagnosed. (11/22/16)]&lt;br /&gt;
&lt;br /&gt;
==[[Digital Health Technology]] - ''What Works?''==&lt;br /&gt;
[[Digital Health Technology]] that enable [[Medical Interventions]] and [[Non-Medical Interventions]] to more efficiently and effectively help improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Devices Devices] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-wearables-may-help-detect-serious-illness Study finds wearables may help detect serious illness (1/12/17)]&lt;br /&gt;
* [http://www.healthcareitnews.com/news/va-study-wearables-ai-shows-promise-heart-failure-patients VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)]&lt;br /&gt;
Activity Trackers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://mobihealthnews.com/content/study-walkadoo-increased-employee-activity-nearly-1000-steps-day Activity platform with adaptable, tailored reminders and activity trackers increased employee activity by an average of 970 steps per day compared to control group with just the trackers. (2/9/16)]&lt;br /&gt;
Continuous Glucose Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.mobihealthnews.com/content/study-dexcom-finds-cgms-can-benefit-type-2-patients-too A study published in Annals of Internal Medicine and sponsored by Dexcom shows that a continuous glucose monitor could lower the HbA1c scores of people with Type 2 diabetes (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Communications Digital Communications] - ''What Works?''===&lt;br /&gt;
* [http://www.mercurynews.com/2016/11/28/elders-who-use-tech-tools-feel-less-lonely-more-physically-fit-stanford-study-finds/ Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)]&lt;br /&gt;
* [http://stateofreform.com/wp-content/uploads/2015/12/AJMC_12_2015_Reed-final.pdf Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)]&lt;br /&gt;
* [http://www.cityam.stfi.re/230372/digital-health-wearables-and-apps-9-in-10-brazilian-doctors-use-whatsapp-to-talk-to-patients?sf=vkrgwp 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/12/mobile-health-company-offers-way-to-improve-interactions-between-medicaid-care-managers-and-patients/ Mobile health company offers way to improve interactions with Medicaid patients, care managers by demonstrating a 12% increase in prescription refills, a 40% increase in attending health appointments and a 22% increase in their knowledge of the recommended lifestyle changes for their care plan. (12/5/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/the-doctor-will-email-you-now.html Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/8/1361.abstract Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Regulating_Therapies Digital Regulating Therapies] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Mobile_Apps Mobile Apps] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Patient_Provided_Data Patient Provided Data] - ''What Works?''===&lt;br /&gt;
* [http://careathand.com/assets/attachments/Avalere-18Nov2015.pdf Three-minute surveys on mobile device by frontline personnel helped detect clinically relevant alerts for intervention. Medicare beneficiaries with 3 or more admissions in the prior year had 29.2% decrease in inpatient admissions and $28,656 reduction in Medicare A inpatient expenditures per beneficiary per year. (11/18/15)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/07/28/century-house-call/tdupWvOQI6b3dKdKcEgdGM/story.html Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Monitoring_and_Management Monitoring &amp;amp; Management] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Text_Messaging Text Messaging] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-texting-improve-medication-adherence-shows-high-engagement Study: Texting to improve medication adherence shows high engagement (5/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/using-patient-engagement-strategies-to-increase-colon-cancer-screenings Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)]&lt;br /&gt;
* [http://www.denverpost.com/2016/10/13/denver-health-text-messages/ Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2495276%20 A text-based smoking cessation intervention improve outcomes among young people. (3/2016)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2484905 Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-patients-who-receive-texts-from-physicians-more-likely-to-exercise.html Study: Patients who receive texts from physicians more likely to exercise (12/14/15)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=Feasibility+of+a+Text+Messaging+Intervention+to+Promote+Self-Management+for+Patients+Prescribed+Oral+Anticancer+Agents. Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2442937 Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)]&lt;br /&gt;
* [http://talkspace.com/online-therapy/wp-content/uploads/2015/06/Talkspace-Preliminary-Research-Study.pdf 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Virtual_Visits_Technology Virtual Visits Technology] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
==[[Support Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Caregiver_Support Caregiver Support] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/boot-camp-helps-alzheimers-dementia-caregivers-take-care-of-themselves-too/ ‘Boot Camp’ Helps Alzheimer’s, Dementia Caregivers Take Care Of Themselves, Too (5/9/17)]&lt;br /&gt;
* [http://khn.org/news/teaching-in-home-caregivers-seems-to-pay-off/amp/ Teaching In-Home Caregivers results in emergency room visits declining by 24% in the first year after caregivers were trained and 41% in the second year (8/11/16)]&lt;br /&gt;
* [http://in.reuters.com/article/us-dementia-caregivers-stress-idINKBN0GJ21920140819 More evidence adult daycare eases stress on dementia caregivers (8/20/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/605.abstract?rss=1 North Dakota Assistance Program For Dementia Caregivers Lowered Utilization, Produced Savings, And Increased Empowerment (4/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/596.abstract?rss=1 Enhanced support services for caregivers of people with dementia have been shown to improve caregivers’ capabilities and well-being and delay patients’ institutionalization (4/2014)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_Health_Worker Community Health Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.uphs.upenn.edu/news/News_Releases/2014/02/kangovi/ Penn's Innovative Community Health Worker Model Improves Outcomes for High-Risk Patients (2/10/14)]&lt;br /&gt;
* [http://medcitynews.com/2014/04/new-idea-extending-reach-care-team-hiring-training-grandparents/ A not-for-profit trains grandparents to work as grand-aides, helps reduce readmissions by over 50% and get medication adherence of 91%. (4/8/14)]&lt;br /&gt;
* [http://www.latimes.com/nation/la-na-healthcare-collaboration-20140319-dto-htmlstory.html#ixzz2wQzyYytp Northern Maine - coordination among businesses and health workers helped to improve health outcomes. (3/19/14)]&lt;br /&gt;
* [http://khn.org/news/volunteers-assist-seniors-by-taking-notes-during-medical-appointments/ Note Takers Help The Elderly At The Doctor (2/28/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_and_Social_Services Community &amp;amp; Social Services] - ''What Works?''===&lt;br /&gt;
* [http://www.dispatch.com/content/stories/local/2016/08/07/medicaid-insurer-provides-life-services-to-connect-clients-with-education-jobs.html Medicaid insurer provides ‘life services’ to connect clients with education, jobs (8/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/faithhealthnc-offers-spiritual-emotional-support-after-discharge Faith Health program has helped to reduce readmissions through a volunteer initiative aimed at helping patients get the emotional support they need after discharge. (6/27/16)] &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/5/760.abstract States with a higher ratio of social to health spending (social spending divided by Medicare and Medicaid spending) had better subsequent health outcome, including for: adult obesity, asthma, mentally unhealthy days, days with activity limitation, mortality rates for lung cancer, acute myocardial infarction and type 2 diabetes. (5/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-one-health-system-addressed-2-000-patients-social-needs-in-2-years.html  Health system addressed 2,000 patients' social needs in 2 years. Undergraduate students from local universities, called advocates, connect patients with resources for food stamps, subsidized child care or housing or payment plans and discounts for their electricity bills. (6/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/3/544.abstract Strong Social Support Services, Such As Transportation And Help For Caregivers, Can Lead To Lower Health Care Use And Costs (3/2013)]&lt;br /&gt;
* [http://www.spokesman.com/stories/2014/may/19/hospitals-say-online-language-services-help-reduce/ Providence turns to online interpreters to improve health outcomes (5/19/14)]&lt;br /&gt;
* [http://www.communityplans.net/LinkClick.aspx?fileticket=wcPKMzqiacQ%3d&amp;amp;tabid=214&amp;amp;mid=718&amp;amp;forcedownload=true Positively Impacting Social Determinants of Health - How Safety Net Health Plans Lead the Way (6/2014)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/02/12/oregon-bridges-the-gap-between-health-care-and-community-based-health/ Oregon is showing success in integrating of health care with social services and public health (2/12/15)]&lt;br /&gt;
* [http://healthyamericans.org/report/110/ 79 evidence-based disease and injury prevention programs that have saved lives and improved health. (11/2013)]&lt;br /&gt;
* [https://uwphi.pophealth.wisc.edu/programs/match/healthiest-state/what-works-rural-report-july-2015.pdf What Works? Strategies to Improve Rural Health (7/2015)]&lt;br /&gt;
* [https://www.icsi.org/_asset/pvr9ot/lessonslearned.pdf Lessons Learned: Leaders Successfully Stepping Out to Transform Health and Health Care (4/2015]&lt;br /&gt;
* [http://www.bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Research provide evidence that addressing social determinants of health can improve health and reduce health care costs. Study describes effective interventions 7 Housing examples, 5 Nutrition Assistance examples, 2 Income Support examples, public safety and education examples. (6/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Employment_Support Employment] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1098.abstract Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives. Yet funding is lacking. (6/2016)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Financial_Counseling Financial Counseling] - ''What Works?''===&lt;br /&gt;
* [http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ Insured patients can save money by pretending to be uninsured (1/3/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Home_Support Home Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Housing_Support Housing Support] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/this-hospital-is-giving-free-housing-to-frequent-er-patients.html Hospital provides free housing to frequent ER patients. $3,000 per day to care for patients who frequently visit the emergency room or approximately $33 per day for an apartment. (6/30/16)]&lt;br /&gt;
* [http://khn.org/news/old-motels-get-new-life-helping-homeless-heal/amp/Old Motels Get New Life Helping Homeless Heal (6/29/16)]&lt;br /&gt;
* [http://www.npr.org/2015/12/10/459100751/utah-reduced-chronic-homelessness-by-91-percent-heres-how Utah Reduced Chronic Homelessness By 91 Percent; HUD estimates that annual cost of homelessness is between $30,000 and $50,000 per person because of services like emergency room visits and jail time. (12/10/15)]&lt;br /&gt;
* [http://www.leadingage.org/Affordable_Senior_Housing_Plus_Services_Program_Slows_Growth_in_Medicare_Costs.aspx Affordable Senior Housing Plus Services Program Slows Growth in Medicare Costs (12/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/homeless-navigators-help-reduce-er-use-readmissions?utm_source=feedly 'Homeless navigators' help reduce ER use, readmissions (10/25/13)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/20.abstract Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing (1/2016)]&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Housing First program for people experiencing chronic homelessness in Seattle and Boston results in $29,388 per person per year in net savings, and $8,949 per person per year in net savings, respectively (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Special Homeless Initiative (HI) Adults with serious mental illness in Boston results in 93% reduction in hospital costs, $18 million reduction in health care costs annually (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf 10th Decile Project for high-need homeless in Los Angeles 72% reduction in total health care costs; positive rate of return as every $1 invested in housing and support was estimated to reduce public and hospital costs by $2 the following year and $6 in subsequent years (6/2015])&lt;br /&gt;
* [http://www.communityplans.net/Portals/0/Fact%20Sheets/ACAP_Plans_and_Social_Determinants_of_Health.pdf UPMC developed a “shelter plus care” program through a multi-party partnership including primary care practice, local government and community services. A 23% reduction in overall per-member-per-month (PMPM) claims costs. Roughly $4,100 before program to roughly $3,200 while in program (6/2014)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Legal_Support Legal Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Medication_Support Medication Support] - ''What Works?''===&lt;br /&gt;
* [http://www.bizjournals.com/washington/news/2017/05/08/the-simple-way-medstar-just-found-to-get-patient.html MedStar and CVS Health may have found a simple solution. The pharmacy pre-packages and labels patients' medications in multi-dose pouches. A group of 10 primary care offices recently improved medication compliance among patients taking six or more drugs a day from 60% to more than 90%. (5/8/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Nutrition_Support Nutrition Support] - ''What Works?''===&lt;br /&gt;
* [https://www.beckershospitalreview.com/finance/study-advocate-hospitals-saved-nearly-4-9m-by-implementing-nutrition-care-program.html Advocate Health Care saved nearly $4.9 million dollars by reducing readmission rates and shortening inpatient stays after implementing a nutrition care program at four Chicago hospitals (8/11/18)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/09/20/how-community-partnerships-can-help-end-food-insecurity-part-1/ How Community Partnerships Can Help End Food Insecurity - Part 1 (9/20/16)] [http://healthaffairs.org/blog/2016/09/21/how-community-partnerships-can-help-end-food-insecurity-part-2/ Part 2 (9/21/16)]&lt;br /&gt;
* [http://www.marketplace.org/2015/06/22/health-care/new-math-healthcare-make-money-saving-money Healthy foods delivered to 5% of the patients spending 50% of money can save money (6/22/2015)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001076/ Study found that if every state were to provide home-delivered meals to an additional 1 percent of its population of adults ages sixty-five and older, would save state Medicaid programs over $109 million for the country. (10/2013)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/06/09/hospitals-reach-into-patients-homes-deliver-healthy-smoked-tofu-but-also-bbq-shrimp-scampi/QSqNQiycZUNxa9qbRWzs8I/story.html Steward Health Care] delivers three low-sodium meals and two snacks to selected heart failure patient's home each day hoping healthy food will reduce trips to the hospital. (6/10/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Prison_to_Community_Transitions Prison to Community Transitions] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1006.abstract People returning to communities from prison that were referred by correctional partners to an enhanced primary care Transitions Clinic Network (TCN) had fewer acute care visits than people referred later. (6/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Social_Workers Social Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27119772 Social-work conducted transitional care reduced all cause readmissions among all home-going Medicare FFS beneficiaries by 20%. (5/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-based-clinic-helped-reduce-ed-super-user-visits Hospital-based clinic used social workers to reduce ED super-users risk of ED use by 22% and hospitalizations by 30% (5/9/14)]&lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2013-09-26/obamacare-incentives-push-hospitals-to-keep-medicare-patients-healthy Social workers are the new frontline of the accountable-care model (9/26/13)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/10/23/451154605/a-hospital-reduces-repeat-er-visits-by-providing-social-workers Hospital Reduces Repeat ER Visits By Providing Social Workers. In four months, visits by 39 people to the ER fell by 68 percent, cost fell from $1.5 million to $440,000. (10/23/15).]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Support_Communities Support Communities] - ''What Works?''===&lt;br /&gt;
* [http://www.imedicalapps.com/2016/08/web-based-support-group-tbi-caregivers/ Online-video support group could aid in the care of patients with traumatic brain injuries (TBI). (8/5/16)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/167056/mhealth-comes-patient-support-groups Mobile Health Comes to Patient Support Groups (6/3/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/152556/one-one-cancer-support-empowers-patients One-on-One Cancer Support Empowers Patients (3/10/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/5-advantages-online-patient-communities.html 5 advantages of online patient communities (8/2/13)]&lt;br /&gt;
* [http://davidleescher.com/2013/07/11/why-online-patient-communities-are-better-than-real-life-support-groups/ Online Patient Communities] can provide many potential benefits, such as improving coping skills, reducing anxiety, depression, isolation, ignorance about the condition and finding others that are experience common conditions. (7/11/13)&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Transportation Transportation] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/caremore-lyft-collaboration-reduces-medical-transportation-waits-by-30.html CareMore, Lyft collaboration reduces medical transportation waits by 30% (9/6/16)]&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/495476/ Hospitals Are Partnering With Uber to Get Patients to Checkups (8/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] - ''What Works?''==&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Caregiver_Activity Caregiver Activity] - ''What Works?''===&lt;br /&gt;
* Caregivers - [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers States are focusing on activating them (6/22/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activation Patient Activation] - ''What Works?''===&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/06/22/these-few-things-may-stave-off-dementia-scientists-say/103119512/ There is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (6/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/22/well/live/back-pain-try-yoga.html A study of people with low to moderate lower back pain found they could use yoga to reduce back pain and functional limitations (6/22/17)] &lt;br /&gt;
* [http://www.hhnmag.com/articles/8230-Patients-increasingly-providing-self-care-improving-outcomes-reducing-cost DIY Medicine Helps Improve Outcomes, Reduce Cost. Patients avoid long inpatient stays by learning to self-administer care for chronic conditions (5/16/17)]&lt;br /&gt;
* [http://khn.org/news/with-chronic-illness-you-are-your-own-best-friend/amp/ What patients with chronic illnesses do outside the doctor’s office affect their health conditions (exercise, diet, taking their medication). Diabetic patients who participated in a online self-management program had lower blood sugar levels and took their medication more regularly (9/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-activation-influences-readmission-rates?utm_source=feedly Patient activation influences readmission rates (10/11/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activity Patient Activity] - ''What Works?''===&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-brain-training-dementia-20160724-snap-story.html Specialized brain training can help prevent Alzheimer’s Disease and other afflictions, including normal aging, that sap memory and reduce function. (7/24/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article129829184.html Simple activities, such as playing games, making crafts, socializing and reading books held off mental decline in older adults, according to a Mayo Clinic study (1/31/17)]&lt;br /&gt;
&lt;br /&gt;
Gamification &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://venturebeat.com/2017/03/08/heart-study-says-pokemon-go-makes-you-twice-as-likely-to-hit-10000-steps-a-day/ Heart study says Pokémon Go makes you twice as likely to walk 10,000 daily steps (3/8/17)]&lt;br /&gt;
&lt;br /&gt;
Nutrition &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/07/13/healthy-diet-longevity-study/ Improving Your Diet Just a Little Bit Can Help You Live Longer, Says Study (7/13/17)]&lt;br /&gt;
* [http://mashable.com/2016/09/29/mediterranean-diet-health-benefits.amp Study suggests a Mediterranean diet could prevent over 19,000 deaths a year in the UK. (9/29/16)]&lt;br /&gt;
&lt;br /&gt;
Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/these-preventive-measures-might-help-delay-dementia-or-cognitive-decline/ Scientists endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure. (7/20/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/16/magazine/losing-fat-gaining-brain-power-on-the-playground.html In children, exercise may help to improve cognition and improve waistlines. (6/16/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/24/well/move/a-1-hour-walk-3-times-a-week-has-benefits-for-dementia.html A 1 hour walk 3 times a week has benefits for dementia (5/24/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/12/well/move/an-hour-of-running-may-add-seven-hours-to-your-life.html An hour of running may add up to seven hours on your life (4/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/patients-can-save-2-500-on-medical-costs-just-by-walking.html Patients can save $2,500 on medical costs annually just by walking (9/8/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/increased-physical-activity-associated-lower-risk-13-types-cancer Increased physical activity associated with lower risk of 13 types of cancer (6/16/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/06/23/483245084/a-protein-that-moves-from-muscle-to-brain-may-tie-exercise-to-memory When muscles work, they release a protein that appears to generate new cells and connections in a part of the brain that is critical to memory (6/23/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/blog/after-hip-fracture-exercise-at-home-boosts-day-to-day-function-201402197041 After hip fracture, exercise at home boosts day-to-day function (2/19/14)]&lt;br /&gt;
* [http://www.fastcompany.com/3045862/fast-feed/sitting-all-day-will-kill-you-but-a-2-minute-walk-could-change-that New research: Breaking up your sedentary day with some light activity can prolong your life. (5/1/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/replace-sitting-with-walking/ Replace sitting with walking – it’s key to decreasing early death rate. (10/27/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Lifestyle Patient Lifestyle] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/why-retiring-after-age-65-could-help-you-live-longer.html Most people retire around age 65. But when people retire at age 66 instead, their mortality rates drop by 11 percent. (9/13/16)]&lt;br /&gt;
Healthy Lifestyle &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/02/476209760/whats-good-for-the-heart-is-good-for-the-brain What's Good For The Heart Is Good For The Brain. 7 factors known to benefit the heart and blood vessels: maintaining a normal body weight, good nutrition, not smoking, getting exercise regularly and keeping blood pressure, cholesterol and blood sugar levels under control. (5/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-a-healthy-lifestyle-could-prevent-half-of-all-deaths-attributed-to-cancer.html A healthy lifestyle could prevent half of all deaths attributed to cancer. 41% of cancer cases and 59% of cancer deaths were potentially preventable in women. 63% of cancer cases and 67% of cancer deaths were preventable, among men. (5/20/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Personal_Achievement Personal Achievement] - ''What Works?''===&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/15/470124189/to-quit-smoking-its-best-to-go-cold-turkey To Quit Smoking, It's Best To Go Cold Turkey (3/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models Health Insurance Payment Models] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Accountable_Care_Organizations Accountable Care Organizations] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/healthcare/medicare-shared-savings-program-acos-show-promise-cost-reduction-quality-improvement-oig Medicare Shared Savings Program ACOs show promise in cost reduction, quality improvement, OIG finds (8/30/17)]&lt;br /&gt;
* [https://www.beckershospitalreview.com/lists/110-acos-to-know-2017.html 110 ACOs to know | 2017 (6/12/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-finds-acos-reduce-hospitalizations-spending Study found an association between participation in an accountable care organization (ACO) and reduced rates of hospitalizations, as well as Medicare spending. (5/9/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2601418 Medicare Shared Savings Program was associated with a 9% differential reduction in postacute spending by 2014, driven by reductions in discharges to facilities, length of facility stays, and acute inpatient care. (2/15/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/1/74.abstract Two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. (1/2017)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/anthem-blue-cross-acos-realize-70m-savings Anthem Blue Cross through its 17 ACO partners accrued savings of $70.4 million over a 12-month period. (11/1/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2017/jan/aco-hospitals-reduced-rehospitalization-faster ACO-Affiliated Hospitals Reduced Rehospitalizations from Skilled Nursing Facilities Faster Than Other Hospitals (1/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/medicare-aco-hospitals-faster-at-reducing-readmissions-study-finds.html Medicare ACO hospitals faster at reducing readmissions, study finds. (1/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/cms-unveils-2015-medicare-aco-quality-financial-performance-12-things-to-know.html ACOs saved Medicare $466M in 2015. (8/26/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Episode-Based_Payments Episode-Based Payments] - ''What Works?''===&lt;br /&gt;
Commercial Health Plans &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthpayerintelligence.com/news/unitedhealthcare-adopts-bundled-payment-model-for-surgeries UnitedHealthcare’s bundled payment model for hip, knee and back surgery pilot program has shown an average savings of $10,000 or more among employers for each episode of care when compared against overall median costs for the same procedures in the same region. (1/19/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2594805 Study of 3942 patients who received joint replacement surgery, there was a decrease of $5577 (20.8%) in total spending per episode. Most of the hospital savings came from implants and supplies and most of the postacute care savings came from decreased use of institutional care. (1/3/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Care_Services Care Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient-Centered_Medical_Homes Patient-Centered Medical Homes] - ''What Works?''===&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071295/ CareFirst Patient-Centered Medical Home Program lowered annual adjusted total claims payments by $109 per participating member (95 % CI: −$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. 42% of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. (7/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-centered-medical-homes-lower-costs-reduce-healthcare-overuse Patient-centered medical homes lower costs, reduce healthcare overuse (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient_Incentives Patient Incentives] - ''What works?''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1455 Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage (8/2017)]&lt;br /&gt;
* [https://healthpayerintelligence.com/news/patient-incentives-from-payers-encourage-preventive-care-visits Patient Incentives from Payers Encourage Preventive Care Visits. MinuteMember Wellness Rewards program offer $50 incentive for members to visit their In-Plan PCP during the calendar year. “In its first year, approximately 9300 members (or 40 percent) received an incentive check. (5/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/financial-incentives-may-be-effective-for-smoking-cessation-study-finds.html Financial incentives may be effective for smoking cessation, study finds. After six months, 36% of participants who received cash and about 6% of the control group had quit smoking. (9/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aetna-pays-employees-up-to-500-per-year-for-sleeping.html Aetna pays employees up to $500 per year for sleeping. Wellness and wellness program responsible for 69 minutes more a month of worker productivity. (4/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/small-study-risk-losing-reward-works-better-reaching-activity-tracking-goals Small study shows risk of losing reward works better for reaching activity tracking goals (2/16/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1414293#t=articleBackground Financial incentives were proven effective in smoking cessation (5/28/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Performance_Based_Pricing Performance-Based Pricing] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Provider-Based_Health_Plans Provider-Based Health Plans] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Care_Programs Value-Based Care Programs] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/regulatory/study-value-based-care-programs-reduce-readmissions Study finds participation in voluntary federal programs that push for quality improvements has a greater impact on reducing readmissions than financial penalties levied against hospitals for high rates alone (4/11/17)]&lt;br /&gt;
* [https://news.umich.edu/voluntary-value-based-health-programs-dramatically-reduce-hospital-readmissions/ University of Michigan Study Links Value-Based Care Programs to Lower Readmission Rates and $32 Million in Medicare Savings in 2015 (4/10/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/sustained-participation-payforvalue-high-need-patients Blue Cross Blue Shield of Michigan members with two or more chronic diseases, including mental health problems, assigned to PCP's participating in the pay-for-performance program for at least four years to outcomes for members assigned to PCPs had almost 20% fewer 30-day hospital readmissions and 27.5% fewer 90-day readmissions. However, total spending did not decline. (3/15/17)]&lt;br /&gt;
* [http://healthpayerintelligence.com/news/anthem-cut-er-costs-by-3-with-value-based-care-reimbursement Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement (2/1/17)]&lt;br /&gt;
* [https://www.uhc.com/content/dam/uhcdotcom/en/ValueBasedCare/PDFs/VBC-Nov2016-Online-Report.pdf UnitedHealthcare expanded value-based care programs such as accountable care organizations, which led to 16.8% fewer acute inpatient admissions among mature Medicaid ACOs in Tennessee, 12.2% fewer ER visits among the longest-running Medicare ACOs and 10% fewer hospital admissions and ER visits among top performing commercial ACOs (11/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/4-strategies-bcbs-used-to-save-1b-through-patient-centered-programs.html 4 strategies BCBS used to save $1B through patient-centered programs. These programs include BCBS' accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs — emphasize prevention, wellness and coordinated care, in conjunction with reducing waste in the healthcare delivery system. (6/2/15)]&lt;br /&gt;
&lt;br /&gt;
Hospital-Acquired Condition Reduction Program &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20161212/NEWS/161219985 HHS report shows hospitals are paying off, preventing 3.1 million harmful hospital-acquired conditions and the deaths of some 125,000 people. Those improvements saved close to $28 billion in healthcare costs from 2010 through 2015. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Readmission Penalties &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/fiscal-penalties-for-low-performing-hospitals-linked-to-improved-readmission-rates.html Fiscal penalties for low-performing hospitals linked to improved readmission rates for heart failure, pneumonia and acute myocardial infarction (heart attack). For every 10,000 patients discharged annually, the lowest performing hospitals avoided 95 readmissions they would have seen before readmissions were penalized under the ACA. (12/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/every-state-but-1-lowered-hospital-readmissions-since-2010-cms-data-shows.html Every state but 1 lowered hospital readmissions since 2010, CMS data shows (9/13/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1294.abstract Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Attributed to Medicare's penalties for re-admissions. (7/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Insurance_Design Value-Based Insurance Design] - ''What Works?''===&lt;br /&gt;
Health plan benefit design to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices&lt;br /&gt;
* [http://khn.org/news/health-insurers-try-paying-more-upfront-to-pay-less-later/amp/ Enhanced insurance benefit that pays for all patients Type 1 diabetes maintenance is paying off. The state has saved about $1 million on medical services since its inception almost 10 years ago. (7/17/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/516.abstract Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan (3/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/horizon-calls-its-6-premium-increase-proof-tiers-work.html Horizon Blue Cross Blue Shield of New Jersey declared its Omnia health plans, which uses Tier 1 — or preferred — hospitals and providers for services, have some of the lowest premium rate increases nationally next year. (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-finds-eliminating-drug-co-payments-leads-to-cost-savings-among-chronically-ill.html Study finds eliminating drug co-payments leads to cost savings among chronically ill (2/17/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/637.abstract Connecticut’s Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence (4/2016)]&lt;br /&gt;
&lt;br /&gt;
Tiered Provider Network &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/870.short Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5% (5/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Wellness_Payment_Models Wellness Payment Models] - ''What Works?''===&lt;br /&gt;
* Wellness Screenings - [http://khn.org/news/medicare-payment-changes-lead-more-men-to-get-screening-colonoscopies/ Medicare Payment Changes Lead More Men To Get Screening Colonoscopies (12/24/15)]&lt;br /&gt;
&lt;br /&gt;
==[[Organization Interventions]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities] - ''What Works?''===&lt;br /&gt;
* [https://www.statnews.com/2017/02/28/health-disparities-community-action/ Decisive action by communities can reduce health disparities and improve lives (2/28/17)]&lt;br /&gt;
* [https://www.bostonglobe.com/metro/2016/12/10/the-san-antonio-way-how-one-texas-city-took-mental-health-community-and-became-national-model/08HLKSq1JdXSTZppaECk2K/story.html San Antonio has built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/10/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/role-food-systems-community.html West Oakland, one of the city’s poorest areas, improved healthy food access and economic opportunity. 640,000 lbs of produced distributed in food insecure area, 55% sourced locally and 76% of shoppers increased consumption of fruits and vegetables (11/28/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Community_.26_Social_Services_Organizations Community &amp;amp; Social Services Organizations] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Employers Employers] - ''What Works?''===&lt;br /&gt;
Employee Wellness Programs &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/human-capital-and-risk/study-suggests-wellness-programs-boost-worker-productivity-by-more-than-5.html Study shows wellness program boosted average worker productivity by more than 5% (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/nearly-60-of-employees-say-wellness-programs-have-improved-their-health-study-shows.html Nearly 60% of employees say wellness programs have improved their health, survey shows (6/1/17)]&lt;br /&gt;
* [http://m.content.healthaffairs.org/content/29/2/304.full Study of Workplace Wellness Programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent (2/21/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/229.abstract Comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees’ health risks, disease prevalence, and medical expenditures. (2/2017)]&lt;br /&gt;
* [http://www.rand.org/content/dam/rand/pubs/research_briefs/RB9700/RB9744/RAND_RB9744.pdf Disease management drives return on investment from workplace wellness programs. Two component programs reduced employer’s average health care costs by about $30 per member per month(PMPM). Disease management was responsible for 87% of those savings. Employees participating in the disease management program generated savings of $136 PMPM, with a nearly 30% reduction in hospital admissions. Only 13% of employees participated in the disease management component, compared with 87% for the lifestyle management component. (1/1/14)]&lt;br /&gt;
On-Site Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/premise-health-a-threat-or-opportunity-for-hospitals.html Coushatta Casino Resort partnered with Premise in 2011 to manage its onsite health center and improve the overall health status of Coushatta's employees and their families. The resort has seen better outcomes and has saved nearly $4 million in healthcare costs. (6/8/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Governments Governments] - ''What Works?''===&lt;br /&gt;
* [https://journals.lww.com/epidem/Citation/2017/11000/Longitudinal_Associations_of_Local_Cigarette.15.aspx A $1 increase in price was associated with a 3% reduction in risk of current smoking (11/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1016.abstract HUD Housing Assistance Associated With Lower Uninsurance Rates And Unmet Medical Need (6/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamacardiology/article-abstract/2618359 Study using data from the New York State Department of Public Health (2002-2013) found 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in counties with vs without trans-fatty acid restrictions. (4/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2017/03/13/520008877/un-sweetened-how-a-maryland-county-cut-soda-sales-without-a-soda-tax A Maryland County Cut Soda Sales Without A Soda Tax. The Unsweetened campaign led to a 20% decrease in sales of soda and a 15% decline in fruit drink sales between January 2013 and December 2015. (3/13/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2017/02/16/hlthaff.2016.1231 Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. (2/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2017/01/31/marylands-all-payer-model-achievements-challenges-and-next-steps/ The state of Maryland launched a bold approach to improve care with an All-Payer Model to slow the growth of healthcare costs.  Maryland has achieved an estimated $429 million in total Medicare hospital savings to date, exceeding the model’s five-year hospital savings requirement of $330 million (1/31/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/collections/signs-of-progress-in-reducing-childhood-obesity.html Some cities, counties, and states have started to see their childhood obesity rates go down by taking a comprehensive approach. (10/2016)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2553293 A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants (9/19/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/08/23/491104093/berkeleys-soda-tax-appears-to-cut-consumption-of-sugary-drinks Soda Tax Appears To Cut Consumption Of Sugary Drinks (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1045.abstract State prescription drug monitoring programs are sssociated with 30% reductions in opioid prescribing by physicians (6/2016)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/hec.3336/full Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers (4/4/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1932.abstract Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement - (1) sugar-sweetened beverage excise tax, (2) elimination of tax subsidy for advertising unhealthy food to children, (3) nutritional standards for food and beverages in schools outside of meals (11/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Health_Insurers Health Insurers]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Advocacy_Organizations Healthcare Advocacy Organizations]===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Provider_Organizations Healthcare Provider Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Support_Services_Organizations Support Services Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Vendor_Partners Vendor Partners]  - ''What Works?''===&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T22:09:00Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Regulating Therapies */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated Devices - continuous glucose monitoring (CGM)&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Digital_Therapeutics_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/What_Works%3F</id>
		<title>What Works?</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/What_Works%3F"/>
				<updated>2019-07-16T22:08:35Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics - What Works? */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday we get a new understanding of which [[Non-Medical Interventions]] work to impact patient health.  With most healthcare research, sites and journals primarily dedicated to which [[Medical Interventions]] work, this page will now duplicate it.  This page will begin to catalog the [[Non-Medical Interventions]] that work. While these are typically not peer reviewed articles, links are provided for people or organizations interested in further evaluating their efficacy and context to managing health.&lt;br /&gt;
&lt;br /&gt;
==[[Care Management Programs]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Behavioral_Health_.26_Primary_Care_Integration Behavioral Health &amp;amp; Primary Care Integration] - ''What Works?''=== &lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/intermountain-cuts-costs-improves-care-by-integrating-mental-health-into-primary-care Intermountain cuts costs, improves care by integrating mental health into primary care (8/25/17)]&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/alaskan-health-center-model-to-integrate-mental-health-into-primary-care Alaskan health center integration of mental health into primary careh as lowered hospital admissions and visits to the emergency room by more than a third between 2000 and 2015 (8/10/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/montefiore-health-system-sees-improvement-anxiety-depression-patients-using-valera-healths Montefiore Health System integrated mental health treatment with primary care and used the Valera Health smartphone app and platform to improve treatment of anxiety and depression. (5/24/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/integrating-behavioral-and-primary-care-can-improve-care-quality-study-finds.html Patients who received integrated primary care and behavioral health treatments had fewer emergency department visits, hospital admissions, ambulatory care sensitive visits and primary care physician encounters. (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/8/1487.abstract UCLA Health combines primary care with behavioral health to reduce emergency room use by 13% for patients in program. (8/16/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/transforming-care/2016/june/profile Care Oregon has a Health Resilience Specialist program that increased behavioral health visits by 16 percent, while E.D. visits and hospitalizations dropped by roughly 20 percent. (6/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/ny-health-system-s-collaborative-care-program-helps-patients-battle-depression NY health system's collaborative care program helps patients battle depression through screening and outreach (5/25/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/04/intermountain-behavioral-health-primary-care/ It costs Intermountain Health’s SelectHealth insurance subsidiary $22 per member per year to embed mental health workers in primary care clinics and processes, and SelectHealth gets an annual return on investment of $115 per member. (4/12/16)]&lt;br /&gt;
&lt;br /&gt;
Binge Eating Disorder (BED) &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/health/archive/2017/08/how-therapy-can-cure-overeating/537537/ Nearly 80 percent of patients abstain from bingeing after 20 sessions of cognitive behavioral therapy (8/23/17)]&lt;br /&gt;
Dementia Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/613.abstract?rss=1 A memory care clinic for older adults suffering from dementia and depression generates an annual net cost savings of up to $2,856 per patient (4/2014)]&lt;br /&gt;
Suicide Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1672 Zero Suicide, a model for better identification and treatment of patients at risk for suicide. (6/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Chronic_Care_Management Chronic Care Management] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/value-based-care-alone-wont-reduce-health-spending-and-improve-patient-outcomes Nemours Children’s Health System pilot program to improve asthma outcomes saw a 60% reduction of asthma-related ER visits, a 44% reduction in asthma-related hospital admissions, and more than a $2,100 reduction in annual medical costs per child after three years. (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/47153/smart-inhaler-boosts-medication-adherence-144-percent-in-small-study/ Smart inhaler boosts medication adherence 144 percent in small study (9/30/15)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2630810 Study of Memorial Sloan Kettering Cancer Center cancer patients demonstrated a Patient Reported Outcome (PRO) group had a better quality of life and lived an average of 5.2 months longer than an randomly assigned usual care group. The PRO group self-report 12 common symptoms at and between visits via a web-based PRO questionnaire platform. (6/4/17)]&lt;br /&gt;
&lt;br /&gt;
Elderly &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rand.org/news/press/2014/03/17/index1.html Improving Continuity of Care for Elderly Patients with Chronic Diseases Cuts Costs and Complications (3/17/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.full Medicare Coordinated Care Demonstration reduced hospitalizations by 8–33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches were: telephone calls to patients; meeting with providers; acting as a communications hub for providers; delivering education to patients; providing medication management; and comprehensive transitional care after hospitalizations. (6/2012)]&lt;br /&gt;
&lt;br /&gt;
End-Stage Renal Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/preventive-care-specialists-key-to-controlling-kidney-failure-treatment-costs/amp/ Preventive Care, Specialists Key To Controlling Kidney Failure Treatment Costs (8/22/16)]&lt;br /&gt;
&lt;br /&gt;
Hypertension &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/6-ways-to-improve-hypertension-control.html 6 best practices for managing hypertension under population health models (5/27/14)]&lt;br /&gt;
&lt;br /&gt;
Pediatrics&lt;br /&gt;
* [https://healthitanalytics.com/news/chronic-care-management-improves-pediatric-outcomes-by-20 Chronic care management program at Cincinnati Children's Hospital helped care teams improve pediatric outcomes for certain conditions by up to 20 percent. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Episode_Management Episode Management] - ''What Works?''===&lt;br /&gt;
* [https://healthpayerintelligence.com/news/population-health-approach-to-prenatal-care-cuts-payer-costs Taking a population health approach to prenatal care and high-risk pregnancies can cut costs for payers and improve outcomes, AHIP says. (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/how-10-more-hospitals-upgraded-their-total-joint-replacement-programs-and-saved-300k.html How 10 more hospitals upgraded their total joint replacement programs and saved $300k+ (11/4/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/bpci-hospitals-drove-down-medicare-payments-for-lower-extremity-joint-replacement-by-1-166.html BPCI hospitals drove down Medicare payments for lower extremity joint replacement by $1,166 (9/20/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/aug/baptist-health-bundled-payment Baptist Health System generate $6.1 million in savings on joint replacement with a bundled payment program that creates incentives for physicians, hospitals, and post-acute care providers to collaborate to drive down costs and improve quality. (8/3/16)]&lt;br /&gt;
* [http://www.ihatoday.org/uploadDocs/1/raisingthebar2014.pdf Illinois hospitals participating in the Hospital Engagement Network (HEN) from January 2012 through March 2014 prevented 15,887 patient harms, with an associated cost savings of $161.8 million. (10/2014)]&lt;br /&gt;
&lt;br /&gt;
Navigators &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/patient-navigators-track-social-determinants-through-ehrs-positive-results 'Patient navigators' track social determinants through EHRs with positive results. 98/7/17)] Kaiser uses a [http://res.cloudinary.com/bdy4ger4/image/upload/v1499804346/Patient_Questionnaire_for_OPB_ckqqld.pdf Current Life Situation Form]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-patient-centered-care-helped-arkansas-hospital-cut-readmissions-by-90 CHI St. Vincent's readmission rate fell by 90%, due largely to the heightened scrutiny of individual patients' processes of care and needs such as transportation gaps, lack of social support or financial obstacles. (11/25/15)]&lt;br /&gt;
* [http://www3.ccc.uab.edu/index.php/newsroom/preliminary-uab-study-shows-dramatic-trend-of-cost-savings-in-lay-navigation-program-for-cancer-patients/ Preliminary UAB study shows dramatic trend of cost savings in lay navigation program for cancer patients. (7/7/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-navigators-reduced-readmissions-overuse-er-pilot-program 'Patient navigators' reduced readmissions, overuse of ER in pilot program (1/27/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Education about Procedures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/educate-patients-and-they-have-better-surgical-outcomes-study-finds Informed patients have better surgical outcomes. Only 36% of patients met the criteria for an informed patient-centered decision. Informed patients were significantly more likely to report being extremely satisfied with their treatment. (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#ER_Case_Management ER Case Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/presbyterian-healthcare-services-finds-success-patient-navigation Presbyterian Healthcare Services patient navigation program screens all emergency department patients, they transfer non-emergency patients to a more appropriate setting, like an urgent care center or primary care facility. Program helped drop ER overuse, improved patient engagement and decreased in treatment or diagnosis delays. (3/21/17)]&lt;br /&gt;
* [http://m.startribune.com/state-deploys-powerful-tool-to-rein-in-medicaid-waste-costly-er-use/404506396/ Minnesota system flags patients who visited hospital ERs as much as 150 times in a single year and people who routinely hop from one physician to the next searching for prescription painkillers. By limiting these “high use” patients to a single primary care provider, along with a hospital and one pharmacy, the program is saving taxpayers at least $7 million a year in unnecessary medical costs (12/3/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/kaiser-permanente-s-takes-new-approach-to-redirect-er-superusers Patient Navigators in the ER helps reduce returns by 55% among the 254 patients that navigators are managing. Navigators help with non-medical problems sucah as housing, food insecurity and lack of transportation. (6/17/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/frequent-flyer-er-visits-drop-coordinated-care 'Frequent flyer' ER visits drop with coordinated care (7/11/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Exercise_.26_Nutrition Exercise &amp;amp; Nutrition] - ''What Works?'' ===&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-prevention-how-one-ymca-program-is-changing-the-game.html A small diabetes prevention program based out of a YMCA in Indianapolis (3/31/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-health-diabetes-prevention-idUSKCN0PN2K720150713 Organized programs help prevent or delay diabetes (7/13/15)]&lt;br /&gt;
* [http://circ.ahajournals.org/content/125/9/1157.short Participants in a lifestyle intervention of reduced calorie, low-fat diet of conventional foods and 150 min/wk of physical activity (typically brisk walking), with the goal of losing 7% of initial weight. After an average of 2.8 years, participants in the lifestyle intervention lost 5.6 kg in comparison to 0.1 kg in the placebo group. The risk of the lifestyle group developing type 2 diabetes was reduced by 58% in comparison with placebo group. (3/5/12)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Health_Coaching Health Coaching] - ''What Works?''===&lt;br /&gt;
Care Goal Setting and Motivational Interviewing &lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-virtas-monitoring-app-plus-low-carb-diet-reverses-diabetes-progression Monitoring app, health coaching plus low-carb diet reverses diabetes progression by lowering average HbA1c from 7.6% to 6.3% and weight reduction of 12% (2/8/18)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/johns-hopkins-study-coaching-app-sweetch-can-increase-weight-loss-activity-prediabetes Johns Hopkins study: coaching app can increase weight loss, activity in prediabetes patients (3/8/18)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481661/ Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction. Participants lost an average of 3.23% total body weight (TBW) at 4 months of coaching. (6/8/17)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/oby.21723/full Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. (1/26/17)]&lt;br /&gt;
* [http://www.annfammed.org/content/14/3/200.full Health coaching is effective for chronic disease self-management in the primary care safety-net setting. Most clinical outcomes improvements persisted 1 year after the completion of the health coaching intervention. (5/2016)]&lt;br /&gt;
* [http://medcitynews.com/2014/03/patient-navigators-helped-diabetics-improve-blood-glucose-control-32-cleveland-clinic-pilot/ Diabetics + patient navigators improved blood glucose control by 32% in Cleveland Clinic pilot (3/18/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/05/your-patient-should-get-a-health-coach-heres-why.html Health coaching improves the management of chronic diseases. It is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care. (5/15/16)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=The+effects+of+health+coaching+on+adult+patients+with+chronic+diseases:+a+systematic+review Health coaching improves the management of chronic diseases (11/2014)]&lt;br /&gt;
Diabetes Prevention&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/417.abstract YMCA Of The USA Diabetes Prevention Program saved $278 per member per quarter during the first three years of the intervention period. Nine fewer ED visits per 1,000 participants per quarter. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Virtual Programs&lt;br /&gt;
* [http://mhealth.jmir.org/2017/6/e80/ App-based health coaching program demonstrated an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% of the participants achieved a clinically significant weight loss of 5% (7/2017)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-shows-seniors-risk-diabetes-and-heart-disease-lose-weight-reduce-healthcare-costs Digital behavioral health coaching program from Omada Health has been shown to reduce overweight and obese seniors' risk of developing type 2 diabetes and heart disease by helping them lose weight and adopt healthier behaviors. (10/13/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-health-coaching-app-nooms-weight-loss-outcomes-comparable-traditional-diabetes 64% of the 43 overweight or obese adult participants, with a diagnosis of prediabetes, people using health coaching app during 24 week program lost more than 5 percent of their weight, which is comparable to the Centers for Disease Control’s findings from traditional diabetes prevention programs. (9/8/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-canary-health%E2%80%99s-digital-diabetes-management-program-helpful-across-five-key Digital health diabetes program that help people with diabetes self-manage their health through online workshops, coaching, and medication adherence and emotional support showed improvement across five key indicators – blood sugar levels, medication adherence and exercise all improved, hypoglycemic symptoms decreased in frequency, and depression symptoms improved. (8/31/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mhn-2016-how-ochsner-used-connected-devices-text-messages-bring-two-thirds-hypertension  Ochsner used connected devices, text messages, health coaching and medication management assistance to bring two-thirds of hypertension patients within range (6/22/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#High_Need_High_Cost High Need High Cost] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/441.abstract Initiative to reduce avoidable hospitalizations among nursing facility residents reduced per resident average of $60–$2,248 for all-cause hospitalizations and by $98–$577 for potentially avoidable hospitalizations. (3/2017)]&lt;br /&gt;
* [http://khn.org/news/tackling-patients-social-problems-can-cut-health-costs/amp/ Houston’s Patient Care Intervention Center program has reduce patient costs in program by 83% and hospital visits by 70%. The program developed by the Camden Coalition led by Dr. Jeffrey Brenner uses social workers who seek out high-need-high-cost patients to address social needs such as securing stable housing. (1/23/17)]&lt;br /&gt;
* [http://m.startribune.com/apartment-job-it-s-just-what-the-doctor-ordered/408873365/ Hennepin Health's outreach efforts helps clients find a job or an apartment — the project has shown it can improve patients’ health while saving money and greatly reducing the number of times they turn up at the ER in crisis. (12/30/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/coordinated-care-clinic-cuts-super-user-hospitalizations-by-a-quarter A strategy focused on team-based care and listening to “super-users” helped a Florida health system cut hospitalizations of such patients by a quarter while also driving down uninsured admissions (8/24/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/care-coordinators-work-high-needs-patients-medical-practices  Intensive Outpatient Care Program (IOCP), which embeds care coordinators in medical practices. Care coordinators work with high-needs patients in medical practice where patients, emergency room visits declined 59 percent and admissions declined 29 percent. (8/22/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/project-echo Complex Care Initiative: Building Capacity to Help “Superutilizers” in Underserved Communities. Number of hospitalizations among participants fell by 27% and emergency department visits dropped by 32%. (8/9/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients  Study compares the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. (8/7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/intensive-care-coordination-saves-14m-super-user-costs 'Intensive care coordination' saves $14M in superuser costs (6/27/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/02/02/using-the-intensive-outpatient-care-program-to-lower-costs-and-improve-care-for-high-cost-patients/ Intensive Outpatient Care Program (IOCP) in commercial populations show a reduction in costs among the medically complex by up to 20 percent. (2/2/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/nation/2014/09/16/focus-on-super-utilizers-cuts-costs/14648069/ Programs focus on high-risk patients to reduce spending (9/16/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.abstract Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients (6/2012)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Home_Care Home Care] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/member-engagement/paramedic-house-calls-help-blue-cross-and-blue-shield-new-mexico-reduce-er-usage How paramedics helped Blue Cross Blue Shield of New Mexico reduce ER usage, readmissions (8/9/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/hospital-at-home Hospital at Home Model: Bringing hospital-level care to the patient results in lower readmissions, better outcomes and lower costs. 92% of patients offered the service took it. It has high patient satisfaction, as patients remained close to their support networks and had less disruption to their lives. (8/22/16)]&lt;br /&gt;
* [http://www.healthleadersmedia.com/quality/front-loaded-home-care-and-office-visits-may-reduce-heart-failure-readmissions A new study finds that front-loaded home care combined with physician office visits shows promise in reducing HF readmissions. (8/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-at-home-model-gains-steam-as-mt-sinai-program-cuts-costs-readmissions Mt. Sinai Hospital's Mobile Acute Care Team (MACT) program delivers hospital-quality home care for patients who are at high risk for readmission. The pilot program cut costs by nearly 20 percent (6/6/16)]&lt;br /&gt;
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Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/sep/sweden-senior-alert-case-study Senior Alert program resulting in 30% reduction in falls, decline in pressure ulcers from 14.3% to 9.4%, and a decline in the incidence of weight losses greater than 5 percent of total body weight from 14.3% of patients to 12.5%. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/study-finds-benefits-when-seniors-call-shots-to-help-them/amp/ Aging in place program asks low-income seniors with disabilities how their lives at home could be better. At the end of the program, 75% of participants were able to perform more daily activities than they could before and symptoms of depression also improved. (9/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/minnesota-health-systems-telehealth-program-seniors-leads-better-outcomes-engagement Telehealth program for seniors leads to better outcomes (86.7% reduction in realized versus expected hospitalization rates) and better engagement (94% of patients interact with the technology and report in their vital signs every day, compared to less than 25% percent in a 2014 national survey of patients in telehealth programs). (8/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/9/1558.abstract?=right Home-Based Care Program Reduces Disability And Promotes Aging In Place. 75% of participants improved their performance of activities of daily living (ADLs)after completing the five-month program. (9/2016)]&lt;br /&gt;
* [http://www.pbs.org/newshour/updates/coordinated-care-gives-patients-freedom-stay-home/ How coordinated care gives patients the freedom to stay at home (7/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/spain-offers-telemedicine-connect-elderly-population-medical-care/ The Basque region of Spain saved $55 million and eliminated 55,000 visits with a telemedicine program aimed at the elderly. (11/15/13)]&lt;br /&gt;
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Falls Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/6/971.abstract In the three years after The LIFT (Living Independently and Falls-free Together) Wellness Program, that included a comprehensive in-home assessment by a registered nurse, participants had a 33% lower incidence of claims for long-term care services and supports (6/2015)]&lt;br /&gt;
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Home-Based Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/overview-home-based-primary-care Medicare’s Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program (6/7/17)]&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/425.short Study finds 5 innovative Home Visit models associated with reductions in costs, hospitalizations, and emergency department use (3/2017)]&lt;br /&gt;
* Home Visits - [http://www.fiercehealthcare.com/healthcare/hospital-workers-visit-patient-homes-to-reduce-er-visits?utm_source=feedly Children's Hospital of Philadelphia (CHOP) sends home visitors to high-risk asthma patients in inner-city Philadelphia (7/29/13)]&lt;br /&gt;
*  [http://content.healthaffairs.org/content/35/1/28.abstract House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care (1/2016)]&lt;br /&gt;
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Medical House Calls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/jul/medstar-washington-hospital-center Medical House Call Program reduced Medicare spending by 20 percent relative to expected spending for that population ($4,060 vs. $5,076) (7/27/16)]&lt;br /&gt;
* [http://khn.org/news/doctors-house-calls-saving-money-for-medicare/ Doctors’ house calls saving Medicare an average of almost $13,600 for each patient in a pilot project. (5/23/16)]&lt;br /&gt;
* [http://www.npr.org/2015/11/08/448406540/doctor-treats-homebound-patients-often-unseen-even-by-neighbors Doctor Treats Homebound Patients, Often Unseen Even By Neighbors (11/8/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2138.abstract Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits (12/2015)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2014/08/07/338393136/house-calls-keep-people-out-of-nursing-homes-and-save-money House Calls Keep People Out Of Nursing Homes And Save Money (8/7/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medical_Home Medical Home] - ''What Works?''===&lt;br /&gt;
Ensuring followup on referrals and recommended preventive screening completed based on [https://www.uspreventiveservicestaskforce.org/BrowseRec/Index USPSTF] recommendations.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-home-model-improves-care-but-not-costs-among-safety-net-providers.html Medical home model improves care, but not costs among safety-net providers (6/27/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/mar/review-of-medical-homes Review of Medical Homes Shows Reduction in Spending for High-Risk Patients, But Design and Implementation Matter (3/28/17)]&lt;br /&gt;
* [http://www.startribune.com/health-care-homes-save-minnesota-1-billion/368187001/ Health care 'homes' save Minnesota $1 billion (2/9/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/11/1985.abstract A “medical village” of providers and community-based resources for patients with diabetes, asthma, and congestive heart failure reduced ED visits by 29.7% percent and hospitalizations by 28.5% (11/2014)]&lt;br /&gt;
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Care Gaps &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.healthcareitnews.com/news/population-health-done-three-ways?single-page=true 3 Healthcare systems explain the technology, process and grit they used to close care gaps needed to improve patient care. (11/3/15)]&lt;br /&gt;
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Care Plan Development &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1627.abstract?rss=1 Moving paradigm from determining “what is the matter?” to discovering “what matters to you?” improves health outcomes (9/2014)]&lt;br /&gt;
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Oncology &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/433.abstract?=right Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending (3/2017)]&lt;br /&gt;
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Preventive Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/prevention/index.html If everyone in the country received recommended clinical care, we could save over 100,000 lives a year. (5/31/17)]&lt;br /&gt;
* [http://m.startribune.com/don-t-smoke-get-your-shots-minnesota-researchers-say-in-influential-study/410159785/ Comparing 28 recommended preventive services, HealthPartners researchers found that tobacco counseling and pediatric immunizations outranked the others in cost-effectiveness and the potential to save lives. (1/9/17)]&lt;br /&gt;
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Patient Centered Medical Homes (PCMH) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/report-pcmh-programs-cut-costs-improve-quality-but-collaboration-key-to-success PCMH programs cut costs and improve quality. Collaboration is the key to their success (7/11/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/patient-centered-medical-homes-systematic-differences A study of 11 PCMH initiatives showed little improvement in costs, utilization, or quality. (3/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/bcbs-michigan-marks-further-expansion-pcmh-model Blue Cross Blue Shield of Michigan's Patient Centered Medical Home (PCMH) program for primary care practices reduced medical costs by $427 million, in part due to lower healthcare utilization. 2016 data show BCBSM-designated PCMH practices had a 15.2% lower rate of adult emergency department visits and 21.4% lower rate of hospital admissions for certain conditions. (9/13/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/study-patient-centered-medical-homes-reduce-er-visits-among-chronically-ill/ Study: Patient-centered medical homes reduce ER visits among chronically ill (9/3/14)]&lt;br /&gt;
* [https://ehrintelligence.com/news/pcmhs-produce-21-lower-healthcare-costs-for-chronically-ill/ Patient-centered medical homes (PCMH) can cut more than 20% off the treatment cost for a chronically ill patient (7/24/13)]&lt;br /&gt;
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Primary Care Practices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/study-primary-care-continuity-could-help-reduce-hospital-admissions.html Patients with high continuity of care were admitted to the hospital 12.49% fewer times than those with low continuity of care (2/2/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/greater-primary-care-involvement-leads-to-lower-end-of-life-care-costs-study-finds.html Patients who resided in regions with the most primary care involvement accrued roughly $4,000 less in Medicare spending in their last two years of life, spent nearly 1.4 fewer days in the intensive care unit in their last six months of life and were less likely to be enrolled in hospice. (1/9/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/study-continuity-care-reduces-risk-ed-visits Seniors that consistently see the same physician in an outpatient setting are 20% less likely to go to the emergency department (8/25/16)]&lt;br /&gt;
* [https://www.bostonglobe.com/business/2015/05/03/iora-health-pioneers-new-primary-care-model/kc7V4W5V8OJ0gxFqY4zBrK/story.html Primary Care Physicians deliver 12% lower healthcare costs, 37% lower hospitalization at one site (5/4/2015)]&lt;br /&gt;
* [http://www.annfammed.org/content/13/3/206 Increasing family physician comprehensiveness of care is associated with decreasing Medicare costs and hospitalizations. (5/2015)]&lt;br /&gt;
* [http://www.prnewswire.com/news-releases/new-primary-care-model-delivers-20-percent-lower-overall-healthcare-costs-increases-patient-satisfaction-and-delivers-better-care-300021116.html Primary Care Physicians deliver 20% lower overall healthcare costs, increase patient satisfaction (1/15/2015)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/how-an-aco-led-by-doctors-helped-cut-the-cost-of-care-in-texas-town/ How an ACO led by doctors helped cut the cost of care in Texas town (9/24/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf Evidence shows that primary care helps prevent illness and death (2005).]&lt;br /&gt;
Virtual Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/population-health-lessons-from-banner-health-s-telemedicine-program When Banner Health launched its iCare telemedicine program, patients didn't use it because it required them to replace their primary care physician. Once they changed that rule, very few patients have left the program voluntarily, and Banner Health saw costs per beneficiary drop by 27% while hospitalizations were reduced by 45%. (12/5/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medication_Management Medication Management] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/3-ways-to-improve-patients-medication-adherence 3 ways to improve patients’ medication adherence (8/25/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/childrens-health-uses-ingestible-sensor-improve-adherence-adolescent-transplant-patients Children's Health uses ingestible sensor to improve adherence in adolescent transplant patients (2/22/17)]&lt;br /&gt;
* [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170905 Pharmacogenetic testing of polypharmacy home health patients aged 50 and older considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare. (2/2/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/walgreens-pill-reminder-activity-tracking-both-improved-medication-adherence-study Walgreens pill reminder, activity tracking both improved medication adherence in study (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/study-quantifies-healthcare-costs-for-medication-adherence-and-non-adherence Patients with multiple medical conditions who adhered to their prescription schedules who had diabetes saved $5,341 annually in medical costs; those who had hypertension saved $4,423, while those who had high cholesterol saved $2,081  (8/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/interventions-to-keep-chronic-illness-patients-on-their-meds-could-save-billions.html  Interventions to keep chronic illness patients on their meds could save billions (8/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/08/medacheck-double-medication-adherence/ The study of 35 patients aged 12-20 with a baseline medication adherence of 42-43%. After 6 months, those with mobile app only increased to 60% and those with the app and reminder calls 85.4% (8/22/16)]&lt;br /&gt;
* [http://khn.org/news/syncing-up-drug-refills-a-way-to-get-patients-to-take-their-medicine/amp/ Syncing Up Drug Refills: A Way To Get Patients To Take Their Medicine (8/8/16)]&lt;br /&gt;
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* [https://ehrintelligence.com/news/how-pharmacy-patient-engagement-boosted-medication-adherence Study shows that the use of a high-touch pharmacy patient engagement system made patients 2.57 times more likely to stay adherent to their medications. (10/27/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1444.abstract Pennsylvania Pharmacist Project significantly improved adherence for all medication classes, from 4.8% for oral diabetes medications to 3.1% for beta-blockers. It also helped reduce per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). (8/2014)]&lt;br /&gt;
During Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/study-medication-reconciliation-programs-halve-hospital-readmissions-6.html Hospital readmission decreased 50 percent when pharmacists reviewed patients' medication regimens and provided counseling during transitions from hospital to home (7/15/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1222.abstract Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs. The program saved $2 for every $1 spent. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/prescription-assistance-programs-lead-to-drop-er-visits Prescription assistance programs lead to drop in ER visits (4/7/16)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Palliative_Care Palliative Care] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/pre-hospice-saves-money-by-keeping-people-at-home-near-the-end-of-life/amp/ ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life (3/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/community-based-palliative-care-may-decrease-ed-visits-study-finds.html Dying patients who received community-based palliative care visited the emergency department half as much in their last year of life, according to a study. (2/22/17)]&lt;br /&gt;
* [http://www.managedcaremag.com/archives/2016/7/palliative-care-improves-quality-care-lowers-costs Aetna’s Compassionate Care Program resulted in improved member satisfaction, an 81% decrease in inpatient days, and net savings of $12,000 per participating member (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/early-palliative-care-can-save-money-reduce-patient-stay-hospital Early palliative care can save money, reduce patient stay in hospital (7/1/15)]&lt;br /&gt;
* [http://healthleadersmedia.com/page-3/LED-283076/Hospitals-Opting-for-Palliative-Care University of Rochester Medical Centers in 2007 found the palliative care intervention saved about 1,400 ICU patient days, at an average of about $450 a day. (8/6/12)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Transitional_Care_Management Transitional Care Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/christiana-care-uses-analytics-for-better-care-coordination-post-discharge Christiana uses its CareLink CareNow infrastructure to help coordinating care for close to 75,000 Medicare beneficiaries beyond discharge. The system has seen a 30% reduction in 90-day readmission rates. (6/19/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/involving-patient-s-family-in-discharge-process-linked-to-25-reduction-in-hospital-readmissions.html Involving patient's family in discharge process linked to 25% reduction in hospital readmissions (4/4/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/a-focused-primary-care-visit-after-hospital-stay-lowers-risk-readmission Patients who had one or more primary care visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician. (11/22/16)]&lt;br /&gt;
* [http://khn.org/news/gaps-in-care-persist-during-transition-from-hospital-to-home/amp/ San Diego County program saved Medicare an estimated $13.8 million (reduced hospital readmissions) over a two-year period with a care transition program that sends nurses and social workers into homes to ensure transitions go smoothly, checking medications one by one, making sure they know how to take them, walking through the house looking things that could cause a fall, asking about caregivers to help with bathing and dressing. (9/6/16)]&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20151205/MAGAZINE/312059995 Hospitals with the lowest readmission rates. Roper St. Francis Healthcare's Care Transitions Program helps elderly patients recognize symptoms of health decline and assists them in managing their medications.  University of Colorado Health's Memorial Hospital assigns a case manager to follow up with patients at risk of heart failure, stroke, pneumonia or heart attack. Hospital for Special Surgery in New York City is developing a mobile application that will allow staff to interact with patients remotely post-discharge. (12/5/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-intervention-cuts-readmissions-for-patients-at-risk-for-delirium-suicide Hospital intervention cuts readmissions for patients at risk for delirium, suicide (7/1/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1531.abstract?rss=1 Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses (9/2014)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/10-recent-stories-studies-on-reducing-readmissions.html 10 stories, studies on reducing readmissions (8/18/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-ritz-carlton-helped-one-hospital-reduce-readmissions-to-74-percent How Ritz-Carlton helped one hospital reduce readmissions to .74 percent for knee and hip replacements (7/15/14)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=1868538 JAMA Studies 18 Activities That Are Preventing 30-Day Hospital Readmissions (7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/beth-israel-deaconess-lowers-readmissions-post-discharge-program Beth Israel Deaconess lowers readmissions with post-discharge program (4/4/14)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/study-social-work-interventions-reduce-readmission-rates-half/2013-07-05?utm_source=rss&amp;amp;utm_medium=rss study] demonstrated high risk patients being discharged from the hospital that receive social work interventions reduce readmission rates to 7% as compared to the 15 percent readmission rate for the control group--patients discharged (7/5/13)&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/reduce-readmissions-by-giving-transitional-care-a-personal-touch Three nonprofit hospitals in the Bronx, N.Y. significantly dropped readmission rates thanks to personal contact with patients before and after discharge (6/28/13)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/hospital-community-collaboration-reduced-readmissions-4570/2013-05-30?utm_source=rss&amp;amp;utm_medium=rss collaborative initiative involving 83 hospitals and 93 community partners in Minnesota] saw 4,570 fewer avoidable hospital readmissions over 24 months, saving more than $40 million by using comprehensive discharge planning, medication management, patient engagement, transition care support, and transition communications. (5/30/13)&lt;br /&gt;
* [http://circoutcomes.ahajournals.org/content/6/4/444.full Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure (5/15/13)]&lt;br /&gt;
Post Surgical Follow-up &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-app-based-visits-seem-viable-post-surgical-follow-ups App-based visits seem viable for post-surgical follow-ups (3/23/17)]&lt;br /&gt;
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==[[Health Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Health_Services#Consumer_Diagnostic_Services Consumer Diagnostic Services] - ''What Works?''===&lt;br /&gt;
DNA Testing &amp;lt;br&amp;gt;&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Health_Services#Convenient_Access Convenient Access] - ''What Works?''===&lt;br /&gt;
24x7 Managing Health Services &amp;lt;br&amp;gt;&lt;br /&gt;
Hot Spotters&lt;br /&gt;
* [http://www.newyorker.com/magazine/2011/01/24/the-hot-spotters Dr. Jeffrey Brenner analyzed data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million. Dr. Brenner secured funding and approvals to begin a Wellness Program at Northgate II tower that housed the high cost high need patients. (1/24/11)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://apps.bostonglobe.com/spotlight/the-desperate-and-the-dead/series/solutions/ San Antonio built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless that resembles a community college. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/11/16)]&lt;br /&gt;
* [http://www.khi.org/news/article/leader-of-kck-mental-health-center-touts-savings-from-care Mental health crisis center saved $6 million last year by stabilizing people in crisis who otherwise would have ended up in state hospitals, local emergency rooms or jails and prisons. (11/15/16)]&lt;br /&gt;
Same Day Appointments &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/01/toby-cosgrove-cleveland-clinic-felt-urgency-day-appointments/ In 2016, Cleveland Clinic had 1.3 million same-day appointments. CEO Toby Cosgrove stated that every patient who calls the Clinic is asked whether he or she would like to see a doctor that same day. 98% of the people who asked to be seen the same day was successful in doing so. (1/10/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Education Education] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/west-virginia-hospital-system-sees-readmission-reductions-patient-education-initiative Charleston Area Medical Center was able to reduce readmission rates for Congestive Heart Failure by over 22% and COPD by almost 30% with educational videos to help patients self-manage their health. (2/9/17)]&lt;br /&gt;
* [http://www.choosingwisely.org/doctor-patient-lists/ '''Choosing Wisely'''] provides decision making education for physicians and patients on over 135 tests and treatments that they say are overused or inappropriate.&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/holistic-education-led-to-dramatic-improvements-for-diabetes-patients Holistic education led to dramatic improvements for diabetes patients (8/11/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/south-carolina-initiative-cuts-readmissions-through-cooperation-education South Carolina initiative cuts readmissions through cooperation, education (7/8/15)]&lt;br /&gt;
&lt;br /&gt;
Behavioral&lt;br /&gt;
* [http://oregonstate.edu/ua/ncs/archives/2015/nov/changing-habits-improve-health-new-study-indicates-behavior-changes-work More than 80 percent of the randomized clinical trials that included a behavioral intervention reported a significant improvement for the targeted behavior and a significant physiological impact such a reduction in weight or blood pressure. (11/10/15)]&lt;br /&gt;
&lt;br /&gt;
Self-Administer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care Parkland Health &amp;amp; Hospital System trained over 1,000 patients to self-administer IV antibiotics in their homes. In the first four years of this effort, these patients experienced a 47% lower 30-day hospital-readmission rate than those receiving treatments in an outpatient facility while the mortality rates of both groups were similar. (6/2/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Decision_Making Decision Making] - ''What Works?''===&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/shared-decision-making-improves-outcomes-satisfaction-for-orthopedic-patients Study: Shared decision-making boosts patient outcomes, leads to higher satisfaction rates (3/15/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Digital_Therapeutics Digital Therapeutics] - ''What Works?''===&lt;br /&gt;
Behavioral Health&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/05/valera-health-app-shows-boost-in-engagement-from-patients-with-depression-anxiety/ Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)]&lt;br /&gt;
* [http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs/ 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/06/telepsychiatry-reduces-wait-times-psyciatric-exams-4-days-10-hours-sc-hospital/ In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)]&lt;br /&gt;
* [http://khn.org/news/telephone-therapy-helps-older-people-in-underserved-rural-areas-study-finds/ Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)]&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/study-real-time-symptom-reporting-helps-cancer-patients-live-longer Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)]&lt;br /&gt;
Cardiac Rehab &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/veterans-respond-well-home-based-cardiac-rehab-app-va-study-shows Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)] &lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2016-03/acoc-dht032216.php Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)]&lt;br /&gt;
* [http://newsnetwork.mayoclinic.org/discussion/cardiac-rehab-patients-who-use-smartphone-app-recover-better-mayo-clinic-research-shows Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092 To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/04/11/well/live/tackling-weight-loss-and-diabetes-with-video-chats.html Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)] &lt;br /&gt;
* [http://www.mobihealthnews.com/content/one-drop-shares-data-showing-app-reduces-a1c-1-percent One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)]&lt;br /&gt;
* [https://www.imedicalapps.com/2017/04/omada-humana-diabetes-study/ Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2017/03/diabetes-online-intervention-study/ Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)]&lt;br /&gt;
* [http://medcitynews.com/2016/09/mississippi-telehealth-remote-monitoring/ Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article116582423.html Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mobile-diabetes-intervention-reduced-hba1c-2-percentage-points-more-standard-care Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)]&lt;br /&gt;
Parkinson &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/nhs-study-finds-mobile-app-improves-management-quality-doctor-visits-people-parkinsons NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)]&lt;br /&gt;
Physical Therapy &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://medcitynews.com/2017/03/virtual-rehab-gain-ground-orthopedics-bundled-payments-take-hold/ Virtual rehab to gain ground in orthopedics as bundled payments take hold (3/14/17)]&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170823.061630/full/ Over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population (8/23/17)]&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0454-y Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/webmds-app-enabled-weight-loss-pilot-helped-800-verizon-employees-lose-weight App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/11/medicare-patients-lose-weight/ A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)]&lt;br /&gt;
* [http://medcitynews.com/2015/06/pwc-infograph-virtual-care-cuts-down-diabetes-costs/ Virtual care reduces diabetes costs by 9% (6/26/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Home Home] - ''What Works?''===&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/home-visits-help-new-parents-overcome-tough-histories-raise-healthy-children/amp/ Home Visits Help New Parents Overcome Tough Histories, Raise Healthy Children (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Housing and Healthcare Integration &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/new-integrated-model-care-for-seniors-lowers-hospitalizations-readmissions-emergency Clinical outcomes of an integrated model of care for frail seniors that bridges housing and healthcare. 50% lower inpatient hospitalization rates, 80% lower readmission rates, 15% lower rate of emergency department use (3/23/17)]&lt;br /&gt;
Medication Reconciliation &amp;lt;br&amp;gt;&lt;br /&gt;
Paramedic Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1111/jgs.14484/full Only 22% of Paramedic responses required transport; 78% were evaluated and treated in the home. Paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals’ homes. (8-30-16)]&lt;br /&gt;
Passive Data Analysis &amp;lt;br&amp;gt;&lt;br /&gt;
Passive Data Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
*  [http://www.cnn.com/2014/08/25/tech/innovation/alzheimers-smart-home/ Sensors let Alzheimer's patients stay at home, safely (10/12/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Therapeutic_Services Therapeutic Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
Behavioral Health&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/05/valera-health-app-shows-boost-in-engagement-from-patients-with-depression-anxiety/ Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)]&lt;br /&gt;
* [http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs/ 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/06/telepsychiatry-reduces-wait-times-psyciatric-exams-4-days-10-hours-sc-hospital/ In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)]&lt;br /&gt;
* [http://khn.org/news/telephone-therapy-helps-older-people-in-underserved-rural-areas-study-finds/ Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)]&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/study-real-time-symptom-reporting-helps-cancer-patients-live-longer Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)]&lt;br /&gt;
Cardiac Rehab &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/veterans-respond-well-home-based-cardiac-rehab-app-va-study-shows Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)] &lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2016-03/acoc-dht032216.php Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)]&lt;br /&gt;
* [http://newsnetwork.mayoclinic.org/discussion/cardiac-rehab-patients-who-use-smartphone-app-recover-better-mayo-clinic-research-shows Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092 To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/04/11/well/live/tackling-weight-loss-and-diabetes-with-video-chats.html Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)] &lt;br /&gt;
* [http://www.mobihealthnews.com/content/one-drop-shares-data-showing-app-reduces-a1c-1-percent One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)]&lt;br /&gt;
* [https://www.imedicalapps.com/2017/04/omada-humana-diabetes-study/ Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2017/03/diabetes-online-intervention-study/ Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)]&lt;br /&gt;
* [http://medcitynews.com/2016/09/mississippi-telehealth-remote-monitoring/ Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article116582423.html Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mobile-diabetes-intervention-reduced-hba1c-2-percentage-points-more-standard-care Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)]&lt;br /&gt;
Parkinson &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/nhs-study-finds-mobile-app-improves-management-quality-doctor-visits-people-parkinsons NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)]&lt;br /&gt;
Physical Therapy &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://medcitynews.com/2017/03/virtual-rehab-gain-ground-orthopedics-bundled-payments-take-hold/ Virtual rehab to gain ground in orthopedics as bundled payments take hold (3/14/17)]&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170823.061630/full/ Over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population (8/23/17)]&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0454-y Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/webmds-app-enabled-weight-loss-pilot-helped-800-verizon-employees-lose-weight App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/11/medicare-patients-lose-weight/ A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)]&lt;br /&gt;
* [http://medcitynews.com/2015/06/pwc-infograph-virtual-care-cuts-down-diabetes-costs/ Virtual care reduces diabetes costs by 9% (6/26/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Virtual_Medical_Services Virtual Medical Services] - ''What Works?''===&lt;br /&gt;
Tele-Health Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/04/how-to-measure-roi-of-telemedicine/ INTEGRIS reduced cost of treating low acuity, non-emergent medical conditions such as upper respiratory infections (URI). In 2016, the cost for onsite visits to treat URIs was $383,702. During the first three months of 2017, costs to treat URI patients virtually was only $9,744. It is expected to save hundreds of thousands of dollars annually (4/20/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-shows-telemedicine-can-improve-screening-access-efficiency-diabetes-caused JAMA study shows telemedicine can improve screening access, efficiency for diabetes-caused blindness in LA County safety net populations (4/11/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/26/519543337/telehealth-doctor-visits-may-be-handy-but-arent-cheaper-overall Telehealth Doctor Visits May Be Handy, But Aren't Cheaper Overall (3/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/how-mercy-created-a-54m-virtual-hospital-in-st-louis.html Virtual Care Center has led to a more than 33 percent decrease in Mercy's emergency room visits and hospitalizations. (9/15/16)]&lt;br /&gt;
Virtual Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/whatsapp-second-medical-opinion-diagnosing/ 20 oral pathologists gathered virtually using the WhatsApp Broadcast functionality to get a second opinions. The accuracy of the 4,940 second opinion diagnoses (SOD) was 98% correctly diagnosed. (11/22/16)]&lt;br /&gt;
&lt;br /&gt;
==[[Digital Health Technology]] - ''What Works?''==&lt;br /&gt;
[[Digital Health Technology]] that enable [[Medical Interventions]] and [[Non-Medical Interventions]] to more efficiently and effectively help improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Devices Devices] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-wearables-may-help-detect-serious-illness Study finds wearables may help detect serious illness (1/12/17)]&lt;br /&gt;
* [http://www.healthcareitnews.com/news/va-study-wearables-ai-shows-promise-heart-failure-patients VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)]&lt;br /&gt;
Activity Trackers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://mobihealthnews.com/content/study-walkadoo-increased-employee-activity-nearly-1000-steps-day Activity platform with adaptable, tailored reminders and activity trackers increased employee activity by an average of 970 steps per day compared to control group with just the trackers. (2/9/16)]&lt;br /&gt;
Continuous Glucose Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.mobihealthnews.com/content/study-dexcom-finds-cgms-can-benefit-type-2-patients-too A study published in Annals of Internal Medicine and sponsored by Dexcom shows that a continuous glucose monitor could lower the HbA1c scores of people with Type 2 diabetes (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Communications Digital Communications] - ''What Works?''===&lt;br /&gt;
* [http://www.mercurynews.com/2016/11/28/elders-who-use-tech-tools-feel-less-lonely-more-physically-fit-stanford-study-finds/ Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)]&lt;br /&gt;
* [http://stateofreform.com/wp-content/uploads/2015/12/AJMC_12_2015_Reed-final.pdf Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)]&lt;br /&gt;
* [http://www.cityam.stfi.re/230372/digital-health-wearables-and-apps-9-in-10-brazilian-doctors-use-whatsapp-to-talk-to-patients?sf=vkrgwp 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/12/mobile-health-company-offers-way-to-improve-interactions-between-medicaid-care-managers-and-patients/ Mobile health company offers way to improve interactions with Medicaid patients, care managers by demonstrating a 12% increase in prescription refills, a 40% increase in attending health appointments and a 22% increase in their knowledge of the recommended lifestyle changes for their care plan. (12/5/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/the-doctor-will-email-you-now.html Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/8/1361.abstract Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Regulating_Therapies Digital Regulating Therapies] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Mobile_Apps Mobile Apps] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Patient_Provided_Data Patient Provided Data] - ''What Works?''===&lt;br /&gt;
* [http://careathand.com/assets/attachments/Avalere-18Nov2015.pdf Three-minute surveys on mobile device by frontline personnel helped detect clinically relevant alerts for intervention. Medicare beneficiaries with 3 or more admissions in the prior year had 29.2% decrease in inpatient admissions and $28,656 reduction in Medicare A inpatient expenditures per beneficiary per year. (11/18/15)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/07/28/century-house-call/tdupWvOQI6b3dKdKcEgdGM/story.html Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Monitoring_and_Management Monitoring &amp;amp; Management] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Text_Messaging Text Messaging] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-texting-improve-medication-adherence-shows-high-engagement Study: Texting to improve medication adherence shows high engagement (5/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/using-patient-engagement-strategies-to-increase-colon-cancer-screenings Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)]&lt;br /&gt;
* [http://www.denverpost.com/2016/10/13/denver-health-text-messages/ Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2495276%20 A text-based smoking cessation intervention improve outcomes among young people. (3/2016)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2484905 Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-patients-who-receive-texts-from-physicians-more-likely-to-exercise.html Study: Patients who receive texts from physicians more likely to exercise (12/14/15)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=Feasibility+of+a+Text+Messaging+Intervention+to+Promote+Self-Management+for+Patients+Prescribed+Oral+Anticancer+Agents. Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2442937 Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)]&lt;br /&gt;
* [http://talkspace.com/online-therapy/wp-content/uploads/2015/06/Talkspace-Preliminary-Research-Study.pdf 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Virtual_Visits_Technology Virtual Visits Technology] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
==[[Support Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Caregiver_Support Caregiver Support] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/boot-camp-helps-alzheimers-dementia-caregivers-take-care-of-themselves-too/ ‘Boot Camp’ Helps Alzheimer’s, Dementia Caregivers Take Care Of Themselves, Too (5/9/17)]&lt;br /&gt;
* [http://khn.org/news/teaching-in-home-caregivers-seems-to-pay-off/amp/ Teaching In-Home Caregivers results in emergency room visits declining by 24% in the first year after caregivers were trained and 41% in the second year (8/11/16)]&lt;br /&gt;
* [http://in.reuters.com/article/us-dementia-caregivers-stress-idINKBN0GJ21920140819 More evidence adult daycare eases stress on dementia caregivers (8/20/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/605.abstract?rss=1 North Dakota Assistance Program For Dementia Caregivers Lowered Utilization, Produced Savings, And Increased Empowerment (4/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/596.abstract?rss=1 Enhanced support services for caregivers of people with dementia have been shown to improve caregivers’ capabilities and well-being and delay patients’ institutionalization (4/2014)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_Health_Worker Community Health Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.uphs.upenn.edu/news/News_Releases/2014/02/kangovi/ Penn's Innovative Community Health Worker Model Improves Outcomes for High-Risk Patients (2/10/14)]&lt;br /&gt;
* [http://medcitynews.com/2014/04/new-idea-extending-reach-care-team-hiring-training-grandparents/ A not-for-profit trains grandparents to work as grand-aides, helps reduce readmissions by over 50% and get medication adherence of 91%. (4/8/14)]&lt;br /&gt;
* [http://www.latimes.com/nation/la-na-healthcare-collaboration-20140319-dto-htmlstory.html#ixzz2wQzyYytp Northern Maine - coordination among businesses and health workers helped to improve health outcomes. (3/19/14)]&lt;br /&gt;
* [http://khn.org/news/volunteers-assist-seniors-by-taking-notes-during-medical-appointments/ Note Takers Help The Elderly At The Doctor (2/28/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_and_Social_Services Community &amp;amp; Social Services] - ''What Works?''===&lt;br /&gt;
* [http://www.dispatch.com/content/stories/local/2016/08/07/medicaid-insurer-provides-life-services-to-connect-clients-with-education-jobs.html Medicaid insurer provides ‘life services’ to connect clients with education, jobs (8/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/faithhealthnc-offers-spiritual-emotional-support-after-discharge Faith Health program has helped to reduce readmissions through a volunteer initiative aimed at helping patients get the emotional support they need after discharge. (6/27/16)] &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/5/760.abstract States with a higher ratio of social to health spending (social spending divided by Medicare and Medicaid spending) had better subsequent health outcome, including for: adult obesity, asthma, mentally unhealthy days, days with activity limitation, mortality rates for lung cancer, acute myocardial infarction and type 2 diabetes. (5/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-one-health-system-addressed-2-000-patients-social-needs-in-2-years.html  Health system addressed 2,000 patients' social needs in 2 years. Undergraduate students from local universities, called advocates, connect patients with resources for food stamps, subsidized child care or housing or payment plans and discounts for their electricity bills. (6/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/3/544.abstract Strong Social Support Services, Such As Transportation And Help For Caregivers, Can Lead To Lower Health Care Use And Costs (3/2013)]&lt;br /&gt;
* [http://www.spokesman.com/stories/2014/may/19/hospitals-say-online-language-services-help-reduce/ Providence turns to online interpreters to improve health outcomes (5/19/14)]&lt;br /&gt;
* [http://www.communityplans.net/LinkClick.aspx?fileticket=wcPKMzqiacQ%3d&amp;amp;tabid=214&amp;amp;mid=718&amp;amp;forcedownload=true Positively Impacting Social Determinants of Health - How Safety Net Health Plans Lead the Way (6/2014)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/02/12/oregon-bridges-the-gap-between-health-care-and-community-based-health/ Oregon is showing success in integrating of health care with social services and public health (2/12/15)]&lt;br /&gt;
* [http://healthyamericans.org/report/110/ 79 evidence-based disease and injury prevention programs that have saved lives and improved health. (11/2013)]&lt;br /&gt;
* [https://uwphi.pophealth.wisc.edu/programs/match/healthiest-state/what-works-rural-report-july-2015.pdf What Works? Strategies to Improve Rural Health (7/2015)]&lt;br /&gt;
* [https://www.icsi.org/_asset/pvr9ot/lessonslearned.pdf Lessons Learned: Leaders Successfully Stepping Out to Transform Health and Health Care (4/2015]&lt;br /&gt;
* [http://www.bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Research provide evidence that addressing social determinants of health can improve health and reduce health care costs. Study describes effective interventions 7 Housing examples, 5 Nutrition Assistance examples, 2 Income Support examples, public safety and education examples. (6/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Employment_Support Employment] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1098.abstract Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives. Yet funding is lacking. (6/2016)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Financial_Counseling Financial Counseling] - ''What Works?''===&lt;br /&gt;
* [http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ Insured patients can save money by pretending to be uninsured (1/3/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Home_Support Home Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Housing_Support Housing Support] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/this-hospital-is-giving-free-housing-to-frequent-er-patients.html Hospital provides free housing to frequent ER patients. $3,000 per day to care for patients who frequently visit the emergency room or approximately $33 per day for an apartment. (6/30/16)]&lt;br /&gt;
* [http://khn.org/news/old-motels-get-new-life-helping-homeless-heal/amp/Old Motels Get New Life Helping Homeless Heal (6/29/16)]&lt;br /&gt;
* [http://www.npr.org/2015/12/10/459100751/utah-reduced-chronic-homelessness-by-91-percent-heres-how Utah Reduced Chronic Homelessness By 91 Percent; HUD estimates that annual cost of homelessness is between $30,000 and $50,000 per person because of services like emergency room visits and jail time. (12/10/15)]&lt;br /&gt;
* [http://www.leadingage.org/Affordable_Senior_Housing_Plus_Services_Program_Slows_Growth_in_Medicare_Costs.aspx Affordable Senior Housing Plus Services Program Slows Growth in Medicare Costs (12/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/homeless-navigators-help-reduce-er-use-readmissions?utm_source=feedly 'Homeless navigators' help reduce ER use, readmissions (10/25/13)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/20.abstract Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing (1/2016)]&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Housing First program for people experiencing chronic homelessness in Seattle and Boston results in $29,388 per person per year in net savings, and $8,949 per person per year in net savings, respectively (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Special Homeless Initiative (HI) Adults with serious mental illness in Boston results in 93% reduction in hospital costs, $18 million reduction in health care costs annually (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf 10th Decile Project for high-need homeless in Los Angeles 72% reduction in total health care costs; positive rate of return as every $1 invested in housing and support was estimated to reduce public and hospital costs by $2 the following year and $6 in subsequent years (6/2015])&lt;br /&gt;
* [http://www.communityplans.net/Portals/0/Fact%20Sheets/ACAP_Plans_and_Social_Determinants_of_Health.pdf UPMC developed a “shelter plus care” program through a multi-party partnership including primary care practice, local government and community services. A 23% reduction in overall per-member-per-month (PMPM) claims costs. Roughly $4,100 before program to roughly $3,200 while in program (6/2014)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Legal_Support Legal Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Medication_Support Medication Support] - ''What Works?''===&lt;br /&gt;
* [http://www.bizjournals.com/washington/news/2017/05/08/the-simple-way-medstar-just-found-to-get-patient.html MedStar and CVS Health may have found a simple solution. The pharmacy pre-packages and labels patients' medications in multi-dose pouches. A group of 10 primary care offices recently improved medication compliance among patients taking six or more drugs a day from 60% to more than 90%. (5/8/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Nutrition_Support Nutrition Support] - ''What Works?''===&lt;br /&gt;
* [https://www.beckershospitalreview.com/finance/study-advocate-hospitals-saved-nearly-4-9m-by-implementing-nutrition-care-program.html Advocate Health Care saved nearly $4.9 million dollars by reducing readmission rates and shortening inpatient stays after implementing a nutrition care program at four Chicago hospitals (8/11/18)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/09/20/how-community-partnerships-can-help-end-food-insecurity-part-1/ How Community Partnerships Can Help End Food Insecurity - Part 1 (9/20/16)] [http://healthaffairs.org/blog/2016/09/21/how-community-partnerships-can-help-end-food-insecurity-part-2/ Part 2 (9/21/16)]&lt;br /&gt;
* [http://www.marketplace.org/2015/06/22/health-care/new-math-healthcare-make-money-saving-money Healthy foods delivered to 5% of the patients spending 50% of money can save money (6/22/2015)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001076/ Study found that if every state were to provide home-delivered meals to an additional 1 percent of its population of adults ages sixty-five and older, would save state Medicaid programs over $109 million for the country. (10/2013)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/06/09/hospitals-reach-into-patients-homes-deliver-healthy-smoked-tofu-but-also-bbq-shrimp-scampi/QSqNQiycZUNxa9qbRWzs8I/story.html Steward Health Care] delivers three low-sodium meals and two snacks to selected heart failure patient's home each day hoping healthy food will reduce trips to the hospital. (6/10/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Prison_to_Community_Transitions Prison to Community Transitions] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1006.abstract People returning to communities from prison that were referred by correctional partners to an enhanced primary care Transitions Clinic Network (TCN) had fewer acute care visits than people referred later. (6/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Social_Workers Social Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27119772 Social-work conducted transitional care reduced all cause readmissions among all home-going Medicare FFS beneficiaries by 20%. (5/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-based-clinic-helped-reduce-ed-super-user-visits Hospital-based clinic used social workers to reduce ED super-users risk of ED use by 22% and hospitalizations by 30% (5/9/14)]&lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2013-09-26/obamacare-incentives-push-hospitals-to-keep-medicare-patients-healthy Social workers are the new frontline of the accountable-care model (9/26/13)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/10/23/451154605/a-hospital-reduces-repeat-er-visits-by-providing-social-workers Hospital Reduces Repeat ER Visits By Providing Social Workers. In four months, visits by 39 people to the ER fell by 68 percent, cost fell from $1.5 million to $440,000. (10/23/15).]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Support_Communities Support Communities] - ''What Works?''===&lt;br /&gt;
* [http://www.imedicalapps.com/2016/08/web-based-support-group-tbi-caregivers/ Online-video support group could aid in the care of patients with traumatic brain injuries (TBI). (8/5/16)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/167056/mhealth-comes-patient-support-groups Mobile Health Comes to Patient Support Groups (6/3/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/152556/one-one-cancer-support-empowers-patients One-on-One Cancer Support Empowers Patients (3/10/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/5-advantages-online-patient-communities.html 5 advantages of online patient communities (8/2/13)]&lt;br /&gt;
* [http://davidleescher.com/2013/07/11/why-online-patient-communities-are-better-than-real-life-support-groups/ Online Patient Communities] can provide many potential benefits, such as improving coping skills, reducing anxiety, depression, isolation, ignorance about the condition and finding others that are experience common conditions. (7/11/13)&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Transportation Transportation] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/caremore-lyft-collaboration-reduces-medical-transportation-waits-by-30.html CareMore, Lyft collaboration reduces medical transportation waits by 30% (9/6/16)]&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/495476/ Hospitals Are Partnering With Uber to Get Patients to Checkups (8/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] - ''What Works?''==&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Caregiver_Activity Caregiver Activity] - ''What Works?''===&lt;br /&gt;
* Caregivers - [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers States are focusing on activating them (6/22/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activation Patient Activation] - ''What Works?''===&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/06/22/these-few-things-may-stave-off-dementia-scientists-say/103119512/ There is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (6/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/22/well/live/back-pain-try-yoga.html A study of people with low to moderate lower back pain found they could use yoga to reduce back pain and functional limitations (6/22/17)] &lt;br /&gt;
* [http://www.hhnmag.com/articles/8230-Patients-increasingly-providing-self-care-improving-outcomes-reducing-cost DIY Medicine Helps Improve Outcomes, Reduce Cost. Patients avoid long inpatient stays by learning to self-administer care for chronic conditions (5/16/17)]&lt;br /&gt;
* [http://khn.org/news/with-chronic-illness-you-are-your-own-best-friend/amp/ What patients with chronic illnesses do outside the doctor’s office affect their health conditions (exercise, diet, taking their medication). Diabetic patients who participated in a online self-management program had lower blood sugar levels and took their medication more regularly (9/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-activation-influences-readmission-rates?utm_source=feedly Patient activation influences readmission rates (10/11/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activity Patient Activity] - ''What Works?''===&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-brain-training-dementia-20160724-snap-story.html Specialized brain training can help prevent Alzheimer’s Disease and other afflictions, including normal aging, that sap memory and reduce function. (7/24/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article129829184.html Simple activities, such as playing games, making crafts, socializing and reading books held off mental decline in older adults, according to a Mayo Clinic study (1/31/17)]&lt;br /&gt;
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Gamification &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://venturebeat.com/2017/03/08/heart-study-says-pokemon-go-makes-you-twice-as-likely-to-hit-10000-steps-a-day/ Heart study says Pokémon Go makes you twice as likely to walk 10,000 daily steps (3/8/17)]&lt;br /&gt;
&lt;br /&gt;
Nutrition &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/07/13/healthy-diet-longevity-study/ Improving Your Diet Just a Little Bit Can Help You Live Longer, Says Study (7/13/17)]&lt;br /&gt;
* [http://mashable.com/2016/09/29/mediterranean-diet-health-benefits.amp Study suggests a Mediterranean diet could prevent over 19,000 deaths a year in the UK. (9/29/16)]&lt;br /&gt;
&lt;br /&gt;
Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/these-preventive-measures-might-help-delay-dementia-or-cognitive-decline/ Scientists endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure. (7/20/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/16/magazine/losing-fat-gaining-brain-power-on-the-playground.html In children, exercise may help to improve cognition and improve waistlines. (6/16/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/24/well/move/a-1-hour-walk-3-times-a-week-has-benefits-for-dementia.html A 1 hour walk 3 times a week has benefits for dementia (5/24/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/12/well/move/an-hour-of-running-may-add-seven-hours-to-your-life.html An hour of running may add up to seven hours on your life (4/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/patients-can-save-2-500-on-medical-costs-just-by-walking.html Patients can save $2,500 on medical costs annually just by walking (9/8/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/increased-physical-activity-associated-lower-risk-13-types-cancer Increased physical activity associated with lower risk of 13 types of cancer (6/16/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/06/23/483245084/a-protein-that-moves-from-muscle-to-brain-may-tie-exercise-to-memory When muscles work, they release a protein that appears to generate new cells and connections in a part of the brain that is critical to memory (6/23/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/blog/after-hip-fracture-exercise-at-home-boosts-day-to-day-function-201402197041 After hip fracture, exercise at home boosts day-to-day function (2/19/14)]&lt;br /&gt;
* [http://www.fastcompany.com/3045862/fast-feed/sitting-all-day-will-kill-you-but-a-2-minute-walk-could-change-that New research: Breaking up your sedentary day with some light activity can prolong your life. (5/1/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/replace-sitting-with-walking/ Replace sitting with walking – it’s key to decreasing early death rate. (10/27/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Lifestyle Patient Lifestyle] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/why-retiring-after-age-65-could-help-you-live-longer.html Most people retire around age 65. But when people retire at age 66 instead, their mortality rates drop by 11 percent. (9/13/16)]&lt;br /&gt;
Healthy Lifestyle &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/02/476209760/whats-good-for-the-heart-is-good-for-the-brain What's Good For The Heart Is Good For The Brain. 7 factors known to benefit the heart and blood vessels: maintaining a normal body weight, good nutrition, not smoking, getting exercise regularly and keeping blood pressure, cholesterol and blood sugar levels under control. (5/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-a-healthy-lifestyle-could-prevent-half-of-all-deaths-attributed-to-cancer.html A healthy lifestyle could prevent half of all deaths attributed to cancer. 41% of cancer cases and 59% of cancer deaths were potentially preventable in women. 63% of cancer cases and 67% of cancer deaths were preventable, among men. (5/20/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Personal_Achievement Personal Achievement] - ''What Works?''===&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/15/470124189/to-quit-smoking-its-best-to-go-cold-turkey To Quit Smoking, It's Best To Go Cold Turkey (3/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models Health Insurance Payment Models] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Accountable_Care_Organizations Accountable Care Organizations] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/healthcare/medicare-shared-savings-program-acos-show-promise-cost-reduction-quality-improvement-oig Medicare Shared Savings Program ACOs show promise in cost reduction, quality improvement, OIG finds (8/30/17)]&lt;br /&gt;
* [https://www.beckershospitalreview.com/lists/110-acos-to-know-2017.html 110 ACOs to know | 2017 (6/12/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-finds-acos-reduce-hospitalizations-spending Study found an association between participation in an accountable care organization (ACO) and reduced rates of hospitalizations, as well as Medicare spending. (5/9/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2601418 Medicare Shared Savings Program was associated with a 9% differential reduction in postacute spending by 2014, driven by reductions in discharges to facilities, length of facility stays, and acute inpatient care. (2/15/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/1/74.abstract Two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. (1/2017)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/anthem-blue-cross-acos-realize-70m-savings Anthem Blue Cross through its 17 ACO partners accrued savings of $70.4 million over a 12-month period. (11/1/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2017/jan/aco-hospitals-reduced-rehospitalization-faster ACO-Affiliated Hospitals Reduced Rehospitalizations from Skilled Nursing Facilities Faster Than Other Hospitals (1/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/medicare-aco-hospitals-faster-at-reducing-readmissions-study-finds.html Medicare ACO hospitals faster at reducing readmissions, study finds. (1/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/cms-unveils-2015-medicare-aco-quality-financial-performance-12-things-to-know.html ACOs saved Medicare $466M in 2015. (8/26/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Episode-Based_Payments Episode-Based Payments] - ''What Works?''===&lt;br /&gt;
Commercial Health Plans &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthpayerintelligence.com/news/unitedhealthcare-adopts-bundled-payment-model-for-surgeries UnitedHealthcare’s bundled payment model for hip, knee and back surgery pilot program has shown an average savings of $10,000 or more among employers for each episode of care when compared against overall median costs for the same procedures in the same region. (1/19/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2594805 Study of 3942 patients who received joint replacement surgery, there was a decrease of $5577 (20.8%) in total spending per episode. Most of the hospital savings came from implants and supplies and most of the postacute care savings came from decreased use of institutional care. (1/3/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Care_Services Care Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient-Centered_Medical_Homes Patient-Centered Medical Homes] - ''What Works?''===&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071295/ CareFirst Patient-Centered Medical Home Program lowered annual adjusted total claims payments by $109 per participating member (95 % CI: −$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. 42% of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. (7/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-centered-medical-homes-lower-costs-reduce-healthcare-overuse Patient-centered medical homes lower costs, reduce healthcare overuse (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient_Incentives Patient Incentives] - ''What works?''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1455 Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage (8/2017)]&lt;br /&gt;
* [https://healthpayerintelligence.com/news/patient-incentives-from-payers-encourage-preventive-care-visits Patient Incentives from Payers Encourage Preventive Care Visits. MinuteMember Wellness Rewards program offer $50 incentive for members to visit their In-Plan PCP during the calendar year. “In its first year, approximately 9300 members (or 40 percent) received an incentive check. (5/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/financial-incentives-may-be-effective-for-smoking-cessation-study-finds.html Financial incentives may be effective for smoking cessation, study finds. After six months, 36% of participants who received cash and about 6% of the control group had quit smoking. (9/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aetna-pays-employees-up-to-500-per-year-for-sleeping.html Aetna pays employees up to $500 per year for sleeping. Wellness and wellness program responsible for 69 minutes more a month of worker productivity. (4/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/small-study-risk-losing-reward-works-better-reaching-activity-tracking-goals Small study shows risk of losing reward works better for reaching activity tracking goals (2/16/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1414293#t=articleBackground Financial incentives were proven effective in smoking cessation (5/28/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Performance_Based_Pricing Performance-Based Pricing] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Provider-Based_Health_Plans Provider-Based Health Plans] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Care_Programs Value-Based Care Programs] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/regulatory/study-value-based-care-programs-reduce-readmissions Study finds participation in voluntary federal programs that push for quality improvements has a greater impact on reducing readmissions than financial penalties levied against hospitals for high rates alone (4/11/17)]&lt;br /&gt;
* [https://news.umich.edu/voluntary-value-based-health-programs-dramatically-reduce-hospital-readmissions/ University of Michigan Study Links Value-Based Care Programs to Lower Readmission Rates and $32 Million in Medicare Savings in 2015 (4/10/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/sustained-participation-payforvalue-high-need-patients Blue Cross Blue Shield of Michigan members with two or more chronic diseases, including mental health problems, assigned to PCP's participating in the pay-for-performance program for at least four years to outcomes for members assigned to PCPs had almost 20% fewer 30-day hospital readmissions and 27.5% fewer 90-day readmissions. However, total spending did not decline. (3/15/17)]&lt;br /&gt;
* [http://healthpayerintelligence.com/news/anthem-cut-er-costs-by-3-with-value-based-care-reimbursement Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement (2/1/17)]&lt;br /&gt;
* [https://www.uhc.com/content/dam/uhcdotcom/en/ValueBasedCare/PDFs/VBC-Nov2016-Online-Report.pdf UnitedHealthcare expanded value-based care programs such as accountable care organizations, which led to 16.8% fewer acute inpatient admissions among mature Medicaid ACOs in Tennessee, 12.2% fewer ER visits among the longest-running Medicare ACOs and 10% fewer hospital admissions and ER visits among top performing commercial ACOs (11/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/4-strategies-bcbs-used-to-save-1b-through-patient-centered-programs.html 4 strategies BCBS used to save $1B through patient-centered programs. These programs include BCBS' accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs — emphasize prevention, wellness and coordinated care, in conjunction with reducing waste in the healthcare delivery system. (6/2/15)]&lt;br /&gt;
&lt;br /&gt;
Hospital-Acquired Condition Reduction Program &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20161212/NEWS/161219985 HHS report shows hospitals are paying off, preventing 3.1 million harmful hospital-acquired conditions and the deaths of some 125,000 people. Those improvements saved close to $28 billion in healthcare costs from 2010 through 2015. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Readmission Penalties &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/fiscal-penalties-for-low-performing-hospitals-linked-to-improved-readmission-rates.html Fiscal penalties for low-performing hospitals linked to improved readmission rates for heart failure, pneumonia and acute myocardial infarction (heart attack). For every 10,000 patients discharged annually, the lowest performing hospitals avoided 95 readmissions they would have seen before readmissions were penalized under the ACA. (12/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/every-state-but-1-lowered-hospital-readmissions-since-2010-cms-data-shows.html Every state but 1 lowered hospital readmissions since 2010, CMS data shows (9/13/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1294.abstract Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Attributed to Medicare's penalties for re-admissions. (7/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Insurance_Design Value-Based Insurance Design] - ''What Works?''===&lt;br /&gt;
Health plan benefit design to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices&lt;br /&gt;
* [http://khn.org/news/health-insurers-try-paying-more-upfront-to-pay-less-later/amp/ Enhanced insurance benefit that pays for all patients Type 1 diabetes maintenance is paying off. The state has saved about $1 million on medical services since its inception almost 10 years ago. (7/17/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/516.abstract Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan (3/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/horizon-calls-its-6-premium-increase-proof-tiers-work.html Horizon Blue Cross Blue Shield of New Jersey declared its Omnia health plans, which uses Tier 1 — or preferred — hospitals and providers for services, have some of the lowest premium rate increases nationally next year. (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-finds-eliminating-drug-co-payments-leads-to-cost-savings-among-chronically-ill.html Study finds eliminating drug co-payments leads to cost savings among chronically ill (2/17/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/637.abstract Connecticut’s Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence (4/2016)]&lt;br /&gt;
&lt;br /&gt;
Tiered Provider Network &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/870.short Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5% (5/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Wellness_Payment_Models Wellness Payment Models] - ''What Works?''===&lt;br /&gt;
* Wellness Screenings - [http://khn.org/news/medicare-payment-changes-lead-more-men-to-get-screening-colonoscopies/ Medicare Payment Changes Lead More Men To Get Screening Colonoscopies (12/24/15)]&lt;br /&gt;
&lt;br /&gt;
==[[Organization Interventions]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities] - ''What Works?''===&lt;br /&gt;
* [https://www.statnews.com/2017/02/28/health-disparities-community-action/ Decisive action by communities can reduce health disparities and improve lives (2/28/17)]&lt;br /&gt;
* [https://www.bostonglobe.com/metro/2016/12/10/the-san-antonio-way-how-one-texas-city-took-mental-health-community-and-became-national-model/08HLKSq1JdXSTZppaECk2K/story.html San Antonio has built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/10/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/role-food-systems-community.html West Oakland, one of the city’s poorest areas, improved healthy food access and economic opportunity. 640,000 lbs of produced distributed in food insecure area, 55% sourced locally and 76% of shoppers increased consumption of fruits and vegetables (11/28/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Community_.26_Social_Services_Organizations Community &amp;amp; Social Services Organizations] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Employers Employers] - ''What Works?''===&lt;br /&gt;
Employee Wellness Programs &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/human-capital-and-risk/study-suggests-wellness-programs-boost-worker-productivity-by-more-than-5.html Study shows wellness program boosted average worker productivity by more than 5% (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/nearly-60-of-employees-say-wellness-programs-have-improved-their-health-study-shows.html Nearly 60% of employees say wellness programs have improved their health, survey shows (6/1/17)]&lt;br /&gt;
* [http://m.content.healthaffairs.org/content/29/2/304.full Study of Workplace Wellness Programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent (2/21/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/229.abstract Comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees’ health risks, disease prevalence, and medical expenditures. (2/2017)]&lt;br /&gt;
* [http://www.rand.org/content/dam/rand/pubs/research_briefs/RB9700/RB9744/RAND_RB9744.pdf Disease management drives return on investment from workplace wellness programs. Two component programs reduced employer’s average health care costs by about $30 per member per month(PMPM). Disease management was responsible for 87% of those savings. Employees participating in the disease management program generated savings of $136 PMPM, with a nearly 30% reduction in hospital admissions. Only 13% of employees participated in the disease management component, compared with 87% for the lifestyle management component. (1/1/14)]&lt;br /&gt;
On-Site Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/premise-health-a-threat-or-opportunity-for-hospitals.html Coushatta Casino Resort partnered with Premise in 2011 to manage its onsite health center and improve the overall health status of Coushatta's employees and their families. The resort has seen better outcomes and has saved nearly $4 million in healthcare costs. (6/8/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Governments Governments] - ''What Works?''===&lt;br /&gt;
* [https://journals.lww.com/epidem/Citation/2017/11000/Longitudinal_Associations_of_Local_Cigarette.15.aspx A $1 increase in price was associated with a 3% reduction in risk of current smoking (11/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1016.abstract HUD Housing Assistance Associated With Lower Uninsurance Rates And Unmet Medical Need (6/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamacardiology/article-abstract/2618359 Study using data from the New York State Department of Public Health (2002-2013) found 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in counties with vs without trans-fatty acid restrictions. (4/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2017/03/13/520008877/un-sweetened-how-a-maryland-county-cut-soda-sales-without-a-soda-tax A Maryland County Cut Soda Sales Without A Soda Tax. The Unsweetened campaign led to a 20% decrease in sales of soda and a 15% decline in fruit drink sales between January 2013 and December 2015. (3/13/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2017/02/16/hlthaff.2016.1231 Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. (2/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2017/01/31/marylands-all-payer-model-achievements-challenges-and-next-steps/ The state of Maryland launched a bold approach to improve care with an All-Payer Model to slow the growth of healthcare costs.  Maryland has achieved an estimated $429 million in total Medicare hospital savings to date, exceeding the model’s five-year hospital savings requirement of $330 million (1/31/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/collections/signs-of-progress-in-reducing-childhood-obesity.html Some cities, counties, and states have started to see their childhood obesity rates go down by taking a comprehensive approach. (10/2016)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2553293 A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants (9/19/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/08/23/491104093/berkeleys-soda-tax-appears-to-cut-consumption-of-sugary-drinks Soda Tax Appears To Cut Consumption Of Sugary Drinks (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1045.abstract State prescription drug monitoring programs are sssociated with 30% reductions in opioid prescribing by physicians (6/2016)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/hec.3336/full Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers (4/4/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1932.abstract Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement - (1) sugar-sweetened beverage excise tax, (2) elimination of tax subsidy for advertising unhealthy food to children, (3) nutritional standards for food and beverages in schools outside of meals (11/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Health_Insurers Health Insurers]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Advocacy_Organizations Healthcare Advocacy Organizations]===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Provider_Organizations Healthcare Provider Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Support_Services_Organizations Support Services Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Vendor_Partners Vendor Partners]  - ''What Works?''===&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Mobile_Health_Apps</id>
		<title>Mobile Health Apps</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Mobile_Health_Apps"/>
				<updated>2019-07-16T22:06:40Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Diabetes &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.mobihealthnews.com/content/novo-nordisk-glooko-team-diabetes-app Cornerstones4Care - App to help people manage diabetes. Powered by Glooko. It has tools and resources to help managing healthy eating, being active, diabetes medicine, and tracking outcomes. User can sync their blood glucose and activity data from most available diabetes and exercise devices. (7/17/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/mayo-clinic-chips-glookos-35m-growth-round Glooko works with a wide array of provider, payer, pharma customers, as well as technology companies in the diabetes management space like Dexcom. (6/27/17)]&lt;br /&gt;
&lt;br /&gt;
Symptom Checkers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/buoy-health-gets-67m-plans-work-payers-providers Buoy Health is the makers of a machine learning-powered next generation symptom checker, replacing simple decision trees algoritms. (8/9/17)]&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Mobile_Apps Mobile Apps]&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T22:05:59Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated Devices - continuous glucose monitoring (CGM)&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Digital_Therapeutics_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T22:05:12Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated Devices - continuous glucose monitoring (CGM)&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/What_Works%3F</id>
		<title>What Works?</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/What_Works%3F"/>
				<updated>2019-07-16T22:03:11Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics - What Works? */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday we get a new understanding of which [[Non-Medical Interventions]] work to impact patient health.  With most healthcare research, sites and journals primarily dedicated to which [[Medical Interventions]] work, this page will now duplicate it.  This page will begin to catalog the [[Non-Medical Interventions]] that work. While these are typically not peer reviewed articles, links are provided for people or organizations interested in further evaluating their efficacy and context to managing health.&lt;br /&gt;
&lt;br /&gt;
==[[Care Management Programs]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Behavioral_Health_.26_Primary_Care_Integration Behavioral Health &amp;amp; Primary Care Integration] - ''What Works?''=== &lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/intermountain-cuts-costs-improves-care-by-integrating-mental-health-into-primary-care Intermountain cuts costs, improves care by integrating mental health into primary care (8/25/17)]&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/alaskan-health-center-model-to-integrate-mental-health-into-primary-care Alaskan health center integration of mental health into primary careh as lowered hospital admissions and visits to the emergency room by more than a third between 2000 and 2015 (8/10/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/montefiore-health-system-sees-improvement-anxiety-depression-patients-using-valera-healths Montefiore Health System integrated mental health treatment with primary care and used the Valera Health smartphone app and platform to improve treatment of anxiety and depression. (5/24/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/integrating-behavioral-and-primary-care-can-improve-care-quality-study-finds.html Patients who received integrated primary care and behavioral health treatments had fewer emergency department visits, hospital admissions, ambulatory care sensitive visits and primary care physician encounters. (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/8/1487.abstract UCLA Health combines primary care with behavioral health to reduce emergency room use by 13% for patients in program. (8/16/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/transforming-care/2016/june/profile Care Oregon has a Health Resilience Specialist program that increased behavioral health visits by 16 percent, while E.D. visits and hospitalizations dropped by roughly 20 percent. (6/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/ny-health-system-s-collaborative-care-program-helps-patients-battle-depression NY health system's collaborative care program helps patients battle depression through screening and outreach (5/25/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/04/intermountain-behavioral-health-primary-care/ It costs Intermountain Health’s SelectHealth insurance subsidiary $22 per member per year to embed mental health workers in primary care clinics and processes, and SelectHealth gets an annual return on investment of $115 per member. (4/12/16)]&lt;br /&gt;
&lt;br /&gt;
Binge Eating Disorder (BED) &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/health/archive/2017/08/how-therapy-can-cure-overeating/537537/ Nearly 80 percent of patients abstain from bingeing after 20 sessions of cognitive behavioral therapy (8/23/17)]&lt;br /&gt;
Dementia Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/613.abstract?rss=1 A memory care clinic for older adults suffering from dementia and depression generates an annual net cost savings of up to $2,856 per patient (4/2014)]&lt;br /&gt;
Suicide Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1672 Zero Suicide, a model for better identification and treatment of patients at risk for suicide. (6/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Chronic_Care_Management Chronic Care Management] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/value-based-care-alone-wont-reduce-health-spending-and-improve-patient-outcomes Nemours Children’s Health System pilot program to improve asthma outcomes saw a 60% reduction of asthma-related ER visits, a 44% reduction in asthma-related hospital admissions, and more than a $2,100 reduction in annual medical costs per child after three years. (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/47153/smart-inhaler-boosts-medication-adherence-144-percent-in-small-study/ Smart inhaler boosts medication adherence 144 percent in small study (9/30/15)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2630810 Study of Memorial Sloan Kettering Cancer Center cancer patients demonstrated a Patient Reported Outcome (PRO) group had a better quality of life and lived an average of 5.2 months longer than an randomly assigned usual care group. The PRO group self-report 12 common symptoms at and between visits via a web-based PRO questionnaire platform. (6/4/17)]&lt;br /&gt;
&lt;br /&gt;
Elderly &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rand.org/news/press/2014/03/17/index1.html Improving Continuity of Care for Elderly Patients with Chronic Diseases Cuts Costs and Complications (3/17/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.full Medicare Coordinated Care Demonstration reduced hospitalizations by 8–33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches were: telephone calls to patients; meeting with providers; acting as a communications hub for providers; delivering education to patients; providing medication management; and comprehensive transitional care after hospitalizations. (6/2012)]&lt;br /&gt;
&lt;br /&gt;
End-Stage Renal Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/preventive-care-specialists-key-to-controlling-kidney-failure-treatment-costs/amp/ Preventive Care, Specialists Key To Controlling Kidney Failure Treatment Costs (8/22/16)]&lt;br /&gt;
&lt;br /&gt;
Hypertension &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/6-ways-to-improve-hypertension-control.html 6 best practices for managing hypertension under population health models (5/27/14)]&lt;br /&gt;
&lt;br /&gt;
Pediatrics&lt;br /&gt;
* [https://healthitanalytics.com/news/chronic-care-management-improves-pediatric-outcomes-by-20 Chronic care management program at Cincinnati Children's Hospital helped care teams improve pediatric outcomes for certain conditions by up to 20 percent. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Episode_Management Episode Management] - ''What Works?''===&lt;br /&gt;
* [https://healthpayerintelligence.com/news/population-health-approach-to-prenatal-care-cuts-payer-costs Taking a population health approach to prenatal care and high-risk pregnancies can cut costs for payers and improve outcomes, AHIP says. (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/how-10-more-hospitals-upgraded-their-total-joint-replacement-programs-and-saved-300k.html How 10 more hospitals upgraded their total joint replacement programs and saved $300k+ (11/4/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/bpci-hospitals-drove-down-medicare-payments-for-lower-extremity-joint-replacement-by-1-166.html BPCI hospitals drove down Medicare payments for lower extremity joint replacement by $1,166 (9/20/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/aug/baptist-health-bundled-payment Baptist Health System generate $6.1 million in savings on joint replacement with a bundled payment program that creates incentives for physicians, hospitals, and post-acute care providers to collaborate to drive down costs and improve quality. (8/3/16)]&lt;br /&gt;
* [http://www.ihatoday.org/uploadDocs/1/raisingthebar2014.pdf Illinois hospitals participating in the Hospital Engagement Network (HEN) from January 2012 through March 2014 prevented 15,887 patient harms, with an associated cost savings of $161.8 million. (10/2014)]&lt;br /&gt;
&lt;br /&gt;
Navigators &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/patient-navigators-track-social-determinants-through-ehrs-positive-results 'Patient navigators' track social determinants through EHRs with positive results. 98/7/17)] Kaiser uses a [http://res.cloudinary.com/bdy4ger4/image/upload/v1499804346/Patient_Questionnaire_for_OPB_ckqqld.pdf Current Life Situation Form]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-patient-centered-care-helped-arkansas-hospital-cut-readmissions-by-90 CHI St. Vincent's readmission rate fell by 90%, due largely to the heightened scrutiny of individual patients' processes of care and needs such as transportation gaps, lack of social support or financial obstacles. (11/25/15)]&lt;br /&gt;
* [http://www3.ccc.uab.edu/index.php/newsroom/preliminary-uab-study-shows-dramatic-trend-of-cost-savings-in-lay-navigation-program-for-cancer-patients/ Preliminary UAB study shows dramatic trend of cost savings in lay navigation program for cancer patients. (7/7/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-navigators-reduced-readmissions-overuse-er-pilot-program 'Patient navigators' reduced readmissions, overuse of ER in pilot program (1/27/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Education about Procedures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/educate-patients-and-they-have-better-surgical-outcomes-study-finds Informed patients have better surgical outcomes. Only 36% of patients met the criteria for an informed patient-centered decision. Informed patients were significantly more likely to report being extremely satisfied with their treatment. (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#ER_Case_Management ER Case Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/presbyterian-healthcare-services-finds-success-patient-navigation Presbyterian Healthcare Services patient navigation program screens all emergency department patients, they transfer non-emergency patients to a more appropriate setting, like an urgent care center or primary care facility. Program helped drop ER overuse, improved patient engagement and decreased in treatment or diagnosis delays. (3/21/17)]&lt;br /&gt;
* [http://m.startribune.com/state-deploys-powerful-tool-to-rein-in-medicaid-waste-costly-er-use/404506396/ Minnesota system flags patients who visited hospital ERs as much as 150 times in a single year and people who routinely hop from one physician to the next searching for prescription painkillers. By limiting these “high use” patients to a single primary care provider, along with a hospital and one pharmacy, the program is saving taxpayers at least $7 million a year in unnecessary medical costs (12/3/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/kaiser-permanente-s-takes-new-approach-to-redirect-er-superusers Patient Navigators in the ER helps reduce returns by 55% among the 254 patients that navigators are managing. Navigators help with non-medical problems sucah as housing, food insecurity and lack of transportation. (6/17/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/frequent-flyer-er-visits-drop-coordinated-care 'Frequent flyer' ER visits drop with coordinated care (7/11/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Exercise_.26_Nutrition Exercise &amp;amp; Nutrition] - ''What Works?'' ===&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-prevention-how-one-ymca-program-is-changing-the-game.html A small diabetes prevention program based out of a YMCA in Indianapolis (3/31/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-health-diabetes-prevention-idUSKCN0PN2K720150713 Organized programs help prevent or delay diabetes (7/13/15)]&lt;br /&gt;
* [http://circ.ahajournals.org/content/125/9/1157.short Participants in a lifestyle intervention of reduced calorie, low-fat diet of conventional foods and 150 min/wk of physical activity (typically brisk walking), with the goal of losing 7% of initial weight. After an average of 2.8 years, participants in the lifestyle intervention lost 5.6 kg in comparison to 0.1 kg in the placebo group. The risk of the lifestyle group developing type 2 diabetes was reduced by 58% in comparison with placebo group. (3/5/12)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Health_Coaching Health Coaching] - ''What Works?''===&lt;br /&gt;
Care Goal Setting and Motivational Interviewing &lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-virtas-monitoring-app-plus-low-carb-diet-reverses-diabetes-progression Monitoring app, health coaching plus low-carb diet reverses diabetes progression by lowering average HbA1c from 7.6% to 6.3% and weight reduction of 12% (2/8/18)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/johns-hopkins-study-coaching-app-sweetch-can-increase-weight-loss-activity-prediabetes Johns Hopkins study: coaching app can increase weight loss, activity in prediabetes patients (3/8/18)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481661/ Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction. Participants lost an average of 3.23% total body weight (TBW) at 4 months of coaching. (6/8/17)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/oby.21723/full Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. (1/26/17)]&lt;br /&gt;
* [http://www.annfammed.org/content/14/3/200.full Health coaching is effective for chronic disease self-management in the primary care safety-net setting. Most clinical outcomes improvements persisted 1 year after the completion of the health coaching intervention. (5/2016)]&lt;br /&gt;
* [http://medcitynews.com/2014/03/patient-navigators-helped-diabetics-improve-blood-glucose-control-32-cleveland-clinic-pilot/ Diabetics + patient navigators improved blood glucose control by 32% in Cleveland Clinic pilot (3/18/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/05/your-patient-should-get-a-health-coach-heres-why.html Health coaching improves the management of chronic diseases. It is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care. (5/15/16)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=The+effects+of+health+coaching+on+adult+patients+with+chronic+diseases:+a+systematic+review Health coaching improves the management of chronic diseases (11/2014)]&lt;br /&gt;
Diabetes Prevention&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/417.abstract YMCA Of The USA Diabetes Prevention Program saved $278 per member per quarter during the first three years of the intervention period. Nine fewer ED visits per 1,000 participants per quarter. (3/2017)]&lt;br /&gt;
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Virtual Programs&lt;br /&gt;
* [http://mhealth.jmir.org/2017/6/e80/ App-based health coaching program demonstrated an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% of the participants achieved a clinically significant weight loss of 5% (7/2017)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-shows-seniors-risk-diabetes-and-heart-disease-lose-weight-reduce-healthcare-costs Digital behavioral health coaching program from Omada Health has been shown to reduce overweight and obese seniors' risk of developing type 2 diabetes and heart disease by helping them lose weight and adopt healthier behaviors. (10/13/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-health-coaching-app-nooms-weight-loss-outcomes-comparable-traditional-diabetes 64% of the 43 overweight or obese adult participants, with a diagnosis of prediabetes, people using health coaching app during 24 week program lost more than 5 percent of their weight, which is comparable to the Centers for Disease Control’s findings from traditional diabetes prevention programs. (9/8/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-canary-health%E2%80%99s-digital-diabetes-management-program-helpful-across-five-key Digital health diabetes program that help people with diabetes self-manage their health through online workshops, coaching, and medication adherence and emotional support showed improvement across five key indicators – blood sugar levels, medication adherence and exercise all improved, hypoglycemic symptoms decreased in frequency, and depression symptoms improved. (8/31/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mhn-2016-how-ochsner-used-connected-devices-text-messages-bring-two-thirds-hypertension  Ochsner used connected devices, text messages, health coaching and medication management assistance to bring two-thirds of hypertension patients within range (6/22/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#High_Need_High_Cost High Need High Cost] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/441.abstract Initiative to reduce avoidable hospitalizations among nursing facility residents reduced per resident average of $60–$2,248 for all-cause hospitalizations and by $98–$577 for potentially avoidable hospitalizations. (3/2017)]&lt;br /&gt;
* [http://khn.org/news/tackling-patients-social-problems-can-cut-health-costs/amp/ Houston’s Patient Care Intervention Center program has reduce patient costs in program by 83% and hospital visits by 70%. The program developed by the Camden Coalition led by Dr. Jeffrey Brenner uses social workers who seek out high-need-high-cost patients to address social needs such as securing stable housing. (1/23/17)]&lt;br /&gt;
* [http://m.startribune.com/apartment-job-it-s-just-what-the-doctor-ordered/408873365/ Hennepin Health's outreach efforts helps clients find a job or an apartment — the project has shown it can improve patients’ health while saving money and greatly reducing the number of times they turn up at the ER in crisis. (12/30/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/coordinated-care-clinic-cuts-super-user-hospitalizations-by-a-quarter A strategy focused on team-based care and listening to “super-users” helped a Florida health system cut hospitalizations of such patients by a quarter while also driving down uninsured admissions (8/24/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/care-coordinators-work-high-needs-patients-medical-practices  Intensive Outpatient Care Program (IOCP), which embeds care coordinators in medical practices. Care coordinators work with high-needs patients in medical practice where patients, emergency room visits declined 59 percent and admissions declined 29 percent. (8/22/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/project-echo Complex Care Initiative: Building Capacity to Help “Superutilizers” in Underserved Communities. Number of hospitalizations among participants fell by 27% and emergency department visits dropped by 32%. (8/9/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients  Study compares the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. (8/7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/intensive-care-coordination-saves-14m-super-user-costs 'Intensive care coordination' saves $14M in superuser costs (6/27/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/02/02/using-the-intensive-outpatient-care-program-to-lower-costs-and-improve-care-for-high-cost-patients/ Intensive Outpatient Care Program (IOCP) in commercial populations show a reduction in costs among the medically complex by up to 20 percent. (2/2/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/nation/2014/09/16/focus-on-super-utilizers-cuts-costs/14648069/ Programs focus on high-risk patients to reduce spending (9/16/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.abstract Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients (6/2012)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Home_Care Home Care] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/member-engagement/paramedic-house-calls-help-blue-cross-and-blue-shield-new-mexico-reduce-er-usage How paramedics helped Blue Cross Blue Shield of New Mexico reduce ER usage, readmissions (8/9/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/hospital-at-home Hospital at Home Model: Bringing hospital-level care to the patient results in lower readmissions, better outcomes and lower costs. 92% of patients offered the service took it. It has high patient satisfaction, as patients remained close to their support networks and had less disruption to their lives. (8/22/16)]&lt;br /&gt;
* [http://www.healthleadersmedia.com/quality/front-loaded-home-care-and-office-visits-may-reduce-heart-failure-readmissions A new study finds that front-loaded home care combined with physician office visits shows promise in reducing HF readmissions. (8/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-at-home-model-gains-steam-as-mt-sinai-program-cuts-costs-readmissions Mt. Sinai Hospital's Mobile Acute Care Team (MACT) program delivers hospital-quality home care for patients who are at high risk for readmission. The pilot program cut costs by nearly 20 percent (6/6/16)]&lt;br /&gt;
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Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/sep/sweden-senior-alert-case-study Senior Alert program resulting in 30% reduction in falls, decline in pressure ulcers from 14.3% to 9.4%, and a decline in the incidence of weight losses greater than 5 percent of total body weight from 14.3% of patients to 12.5%. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/study-finds-benefits-when-seniors-call-shots-to-help-them/amp/ Aging in place program asks low-income seniors with disabilities how their lives at home could be better. At the end of the program, 75% of participants were able to perform more daily activities than they could before and symptoms of depression also improved. (9/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/minnesota-health-systems-telehealth-program-seniors-leads-better-outcomes-engagement Telehealth program for seniors leads to better outcomes (86.7% reduction in realized versus expected hospitalization rates) and better engagement (94% of patients interact with the technology and report in their vital signs every day, compared to less than 25% percent in a 2014 national survey of patients in telehealth programs). (8/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/9/1558.abstract?=right Home-Based Care Program Reduces Disability And Promotes Aging In Place. 75% of participants improved their performance of activities of daily living (ADLs)after completing the five-month program. (9/2016)]&lt;br /&gt;
* [http://www.pbs.org/newshour/updates/coordinated-care-gives-patients-freedom-stay-home/ How coordinated care gives patients the freedom to stay at home (7/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/spain-offers-telemedicine-connect-elderly-population-medical-care/ The Basque region of Spain saved $55 million and eliminated 55,000 visits with a telemedicine program aimed at the elderly. (11/15/13)]&lt;br /&gt;
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Falls Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/6/971.abstract In the three years after The LIFT (Living Independently and Falls-free Together) Wellness Program, that included a comprehensive in-home assessment by a registered nurse, participants had a 33% lower incidence of claims for long-term care services and supports (6/2015)]&lt;br /&gt;
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Home-Based Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/overview-home-based-primary-care Medicare’s Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program (6/7/17)]&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/425.short Study finds 5 innovative Home Visit models associated with reductions in costs, hospitalizations, and emergency department use (3/2017)]&lt;br /&gt;
* Home Visits - [http://www.fiercehealthcare.com/healthcare/hospital-workers-visit-patient-homes-to-reduce-er-visits?utm_source=feedly Children's Hospital of Philadelphia (CHOP) sends home visitors to high-risk asthma patients in inner-city Philadelphia (7/29/13)]&lt;br /&gt;
*  [http://content.healthaffairs.org/content/35/1/28.abstract House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care (1/2016)]&lt;br /&gt;
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Medical House Calls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/jul/medstar-washington-hospital-center Medical House Call Program reduced Medicare spending by 20 percent relative to expected spending for that population ($4,060 vs. $5,076) (7/27/16)]&lt;br /&gt;
* [http://khn.org/news/doctors-house-calls-saving-money-for-medicare/ Doctors’ house calls saving Medicare an average of almost $13,600 for each patient in a pilot project. (5/23/16)]&lt;br /&gt;
* [http://www.npr.org/2015/11/08/448406540/doctor-treats-homebound-patients-often-unseen-even-by-neighbors Doctor Treats Homebound Patients, Often Unseen Even By Neighbors (11/8/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2138.abstract Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits (12/2015)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2014/08/07/338393136/house-calls-keep-people-out-of-nursing-homes-and-save-money House Calls Keep People Out Of Nursing Homes And Save Money (8/7/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medical_Home Medical Home] - ''What Works?''===&lt;br /&gt;
Ensuring followup on referrals and recommended preventive screening completed based on [https://www.uspreventiveservicestaskforce.org/BrowseRec/Index USPSTF] recommendations.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-home-model-improves-care-but-not-costs-among-safety-net-providers.html Medical home model improves care, but not costs among safety-net providers (6/27/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/mar/review-of-medical-homes Review of Medical Homes Shows Reduction in Spending for High-Risk Patients, But Design and Implementation Matter (3/28/17)]&lt;br /&gt;
* [http://www.startribune.com/health-care-homes-save-minnesota-1-billion/368187001/ Health care 'homes' save Minnesota $1 billion (2/9/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/11/1985.abstract A “medical village” of providers and community-based resources for patients with diabetes, asthma, and congestive heart failure reduced ED visits by 29.7% percent and hospitalizations by 28.5% (11/2014)]&lt;br /&gt;
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Care Gaps &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.healthcareitnews.com/news/population-health-done-three-ways?single-page=true 3 Healthcare systems explain the technology, process and grit they used to close care gaps needed to improve patient care. (11/3/15)]&lt;br /&gt;
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Care Plan Development &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1627.abstract?rss=1 Moving paradigm from determining “what is the matter?” to discovering “what matters to you?” improves health outcomes (9/2014)]&lt;br /&gt;
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Oncology &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/433.abstract?=right Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending (3/2017)]&lt;br /&gt;
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Preventive Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/prevention/index.html If everyone in the country received recommended clinical care, we could save over 100,000 lives a year. (5/31/17)]&lt;br /&gt;
* [http://m.startribune.com/don-t-smoke-get-your-shots-minnesota-researchers-say-in-influential-study/410159785/ Comparing 28 recommended preventive services, HealthPartners researchers found that tobacco counseling and pediatric immunizations outranked the others in cost-effectiveness and the potential to save lives. (1/9/17)]&lt;br /&gt;
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Patient Centered Medical Homes (PCMH) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/report-pcmh-programs-cut-costs-improve-quality-but-collaboration-key-to-success PCMH programs cut costs and improve quality. Collaboration is the key to their success (7/11/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/patient-centered-medical-homes-systematic-differences A study of 11 PCMH initiatives showed little improvement in costs, utilization, or quality. (3/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/bcbs-michigan-marks-further-expansion-pcmh-model Blue Cross Blue Shield of Michigan's Patient Centered Medical Home (PCMH) program for primary care practices reduced medical costs by $427 million, in part due to lower healthcare utilization. 2016 data show BCBSM-designated PCMH practices had a 15.2% lower rate of adult emergency department visits and 21.4% lower rate of hospital admissions for certain conditions. (9/13/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/study-patient-centered-medical-homes-reduce-er-visits-among-chronically-ill/ Study: Patient-centered medical homes reduce ER visits among chronically ill (9/3/14)]&lt;br /&gt;
* [https://ehrintelligence.com/news/pcmhs-produce-21-lower-healthcare-costs-for-chronically-ill/ Patient-centered medical homes (PCMH) can cut more than 20% off the treatment cost for a chronically ill patient (7/24/13)]&lt;br /&gt;
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Primary Care Practices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/study-primary-care-continuity-could-help-reduce-hospital-admissions.html Patients with high continuity of care were admitted to the hospital 12.49% fewer times than those with low continuity of care (2/2/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/greater-primary-care-involvement-leads-to-lower-end-of-life-care-costs-study-finds.html Patients who resided in regions with the most primary care involvement accrued roughly $4,000 less in Medicare spending in their last two years of life, spent nearly 1.4 fewer days in the intensive care unit in their last six months of life and were less likely to be enrolled in hospice. (1/9/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/study-continuity-care-reduces-risk-ed-visits Seniors that consistently see the same physician in an outpatient setting are 20% less likely to go to the emergency department (8/25/16)]&lt;br /&gt;
* [https://www.bostonglobe.com/business/2015/05/03/iora-health-pioneers-new-primary-care-model/kc7V4W5V8OJ0gxFqY4zBrK/story.html Primary Care Physicians deliver 12% lower healthcare costs, 37% lower hospitalization at one site (5/4/2015)]&lt;br /&gt;
* [http://www.annfammed.org/content/13/3/206 Increasing family physician comprehensiveness of care is associated with decreasing Medicare costs and hospitalizations. (5/2015)]&lt;br /&gt;
* [http://www.prnewswire.com/news-releases/new-primary-care-model-delivers-20-percent-lower-overall-healthcare-costs-increases-patient-satisfaction-and-delivers-better-care-300021116.html Primary Care Physicians deliver 20% lower overall healthcare costs, increase patient satisfaction (1/15/2015)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/how-an-aco-led-by-doctors-helped-cut-the-cost-of-care-in-texas-town/ How an ACO led by doctors helped cut the cost of care in Texas town (9/24/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf Evidence shows that primary care helps prevent illness and death (2005).]&lt;br /&gt;
Virtual Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/population-health-lessons-from-banner-health-s-telemedicine-program When Banner Health launched its iCare telemedicine program, patients didn't use it because it required them to replace their primary care physician. Once they changed that rule, very few patients have left the program voluntarily, and Banner Health saw costs per beneficiary drop by 27% while hospitalizations were reduced by 45%. (12/5/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medication_Management Medication Management] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/3-ways-to-improve-patients-medication-adherence 3 ways to improve patients’ medication adherence (8/25/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/childrens-health-uses-ingestible-sensor-improve-adherence-adolescent-transplant-patients Children's Health uses ingestible sensor to improve adherence in adolescent transplant patients (2/22/17)]&lt;br /&gt;
* [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170905 Pharmacogenetic testing of polypharmacy home health patients aged 50 and older considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare. (2/2/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/walgreens-pill-reminder-activity-tracking-both-improved-medication-adherence-study Walgreens pill reminder, activity tracking both improved medication adherence in study (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/study-quantifies-healthcare-costs-for-medication-adherence-and-non-adherence Patients with multiple medical conditions who adhered to their prescription schedules who had diabetes saved $5,341 annually in medical costs; those who had hypertension saved $4,423, while those who had high cholesterol saved $2,081  (8/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/interventions-to-keep-chronic-illness-patients-on-their-meds-could-save-billions.html  Interventions to keep chronic illness patients on their meds could save billions (8/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/08/medacheck-double-medication-adherence/ The study of 35 patients aged 12-20 with a baseline medication adherence of 42-43%. After 6 months, those with mobile app only increased to 60% and those with the app and reminder calls 85.4% (8/22/16)]&lt;br /&gt;
* [http://khn.org/news/syncing-up-drug-refills-a-way-to-get-patients-to-take-their-medicine/amp/ Syncing Up Drug Refills: A Way To Get Patients To Take Their Medicine (8/8/16)]&lt;br /&gt;
&lt;br /&gt;
* [https://ehrintelligence.com/news/how-pharmacy-patient-engagement-boosted-medication-adherence Study shows that the use of a high-touch pharmacy patient engagement system made patients 2.57 times more likely to stay adherent to their medications. (10/27/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1444.abstract Pennsylvania Pharmacist Project significantly improved adherence for all medication classes, from 4.8% for oral diabetes medications to 3.1% for beta-blockers. It also helped reduce per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). (8/2014)]&lt;br /&gt;
During Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/study-medication-reconciliation-programs-halve-hospital-readmissions-6.html Hospital readmission decreased 50 percent when pharmacists reviewed patients' medication regimens and provided counseling during transitions from hospital to home (7/15/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1222.abstract Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs. The program saved $2 for every $1 spent. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/prescription-assistance-programs-lead-to-drop-er-visits Prescription assistance programs lead to drop in ER visits (4/7/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Palliative_Care Palliative Care] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/pre-hospice-saves-money-by-keeping-people-at-home-near-the-end-of-life/amp/ ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life (3/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/community-based-palliative-care-may-decrease-ed-visits-study-finds.html Dying patients who received community-based palliative care visited the emergency department half as much in their last year of life, according to a study. (2/22/17)]&lt;br /&gt;
* [http://www.managedcaremag.com/archives/2016/7/palliative-care-improves-quality-care-lowers-costs Aetna’s Compassionate Care Program resulted in improved member satisfaction, an 81% decrease in inpatient days, and net savings of $12,000 per participating member (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/early-palliative-care-can-save-money-reduce-patient-stay-hospital Early palliative care can save money, reduce patient stay in hospital (7/1/15)]&lt;br /&gt;
* [http://healthleadersmedia.com/page-3/LED-283076/Hospitals-Opting-for-Palliative-Care University of Rochester Medical Centers in 2007 found the palliative care intervention saved about 1,400 ICU patient days, at an average of about $450 a day. (8/6/12)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Transitional_Care_Management Transitional Care Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/christiana-care-uses-analytics-for-better-care-coordination-post-discharge Christiana uses its CareLink CareNow infrastructure to help coordinating care for close to 75,000 Medicare beneficiaries beyond discharge. The system has seen a 30% reduction in 90-day readmission rates. (6/19/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/involving-patient-s-family-in-discharge-process-linked-to-25-reduction-in-hospital-readmissions.html Involving patient's family in discharge process linked to 25% reduction in hospital readmissions (4/4/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/a-focused-primary-care-visit-after-hospital-stay-lowers-risk-readmission Patients who had one or more primary care visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician. (11/22/16)]&lt;br /&gt;
* [http://khn.org/news/gaps-in-care-persist-during-transition-from-hospital-to-home/amp/ San Diego County program saved Medicare an estimated $13.8 million (reduced hospital readmissions) over a two-year period with a care transition program that sends nurses and social workers into homes to ensure transitions go smoothly, checking medications one by one, making sure they know how to take them, walking through the house looking things that could cause a fall, asking about caregivers to help with bathing and dressing. (9/6/16)]&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20151205/MAGAZINE/312059995 Hospitals with the lowest readmission rates. Roper St. Francis Healthcare's Care Transitions Program helps elderly patients recognize symptoms of health decline and assists them in managing their medications.  University of Colorado Health's Memorial Hospital assigns a case manager to follow up with patients at risk of heart failure, stroke, pneumonia or heart attack. Hospital for Special Surgery in New York City is developing a mobile application that will allow staff to interact with patients remotely post-discharge. (12/5/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-intervention-cuts-readmissions-for-patients-at-risk-for-delirium-suicide Hospital intervention cuts readmissions for patients at risk for delirium, suicide (7/1/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1531.abstract?rss=1 Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses (9/2014)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/10-recent-stories-studies-on-reducing-readmissions.html 10 stories, studies on reducing readmissions (8/18/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-ritz-carlton-helped-one-hospital-reduce-readmissions-to-74-percent How Ritz-Carlton helped one hospital reduce readmissions to .74 percent for knee and hip replacements (7/15/14)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=1868538 JAMA Studies 18 Activities That Are Preventing 30-Day Hospital Readmissions (7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/beth-israel-deaconess-lowers-readmissions-post-discharge-program Beth Israel Deaconess lowers readmissions with post-discharge program (4/4/14)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/study-social-work-interventions-reduce-readmission-rates-half/2013-07-05?utm_source=rss&amp;amp;utm_medium=rss study] demonstrated high risk patients being discharged from the hospital that receive social work interventions reduce readmission rates to 7% as compared to the 15 percent readmission rate for the control group--patients discharged (7/5/13)&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/reduce-readmissions-by-giving-transitional-care-a-personal-touch Three nonprofit hospitals in the Bronx, N.Y. significantly dropped readmission rates thanks to personal contact with patients before and after discharge (6/28/13)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/hospital-community-collaboration-reduced-readmissions-4570/2013-05-30?utm_source=rss&amp;amp;utm_medium=rss collaborative initiative involving 83 hospitals and 93 community partners in Minnesota] saw 4,570 fewer avoidable hospital readmissions over 24 months, saving more than $40 million by using comprehensive discharge planning, medication management, patient engagement, transition care support, and transition communications. (5/30/13)&lt;br /&gt;
* [http://circoutcomes.ahajournals.org/content/6/4/444.full Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure (5/15/13)]&lt;br /&gt;
Post Surgical Follow-up &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-app-based-visits-seem-viable-post-surgical-follow-ups App-based visits seem viable for post-surgical follow-ups (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
==[[Health Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Consumer_Diagnostic_Services Consumer Diagnostic Services] - ''What Works?''===&lt;br /&gt;
DNA Testing &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Convenient_Access Convenient Access] - ''What Works?''===&lt;br /&gt;
24x7 Managing Health Services &amp;lt;br&amp;gt;&lt;br /&gt;
Hot Spotters&lt;br /&gt;
* [http://www.newyorker.com/magazine/2011/01/24/the-hot-spotters Dr. Jeffrey Brenner analyzed data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million. Dr. Brenner secured funding and approvals to begin a Wellness Program at Northgate II tower that housed the high cost high need patients. (1/24/11)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://apps.bostonglobe.com/spotlight/the-desperate-and-the-dead/series/solutions/ San Antonio built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless that resembles a community college. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/11/16)]&lt;br /&gt;
* [http://www.khi.org/news/article/leader-of-kck-mental-health-center-touts-savings-from-care Mental health crisis center saved $6 million last year by stabilizing people in crisis who otherwise would have ended up in state hospitals, local emergency rooms or jails and prisons. (11/15/16)]&lt;br /&gt;
Same Day Appointments &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/01/toby-cosgrove-cleveland-clinic-felt-urgency-day-appointments/ In 2016, Cleveland Clinic had 1.3 million same-day appointments. CEO Toby Cosgrove stated that every patient who calls the Clinic is asked whether he or she would like to see a doctor that same day. 98% of the people who asked to be seen the same day was successful in doing so. (1/10/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Education Education] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/west-virginia-hospital-system-sees-readmission-reductions-patient-education-initiative Charleston Area Medical Center was able to reduce readmission rates for Congestive Heart Failure by over 22% and COPD by almost 30% with educational videos to help patients self-manage their health. (2/9/17)]&lt;br /&gt;
* [http://www.choosingwisely.org/doctor-patient-lists/ '''Choosing Wisely'''] provides decision making education for physicians and patients on over 135 tests and treatments that they say are overused or inappropriate.&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/holistic-education-led-to-dramatic-improvements-for-diabetes-patients Holistic education led to dramatic improvements for diabetes patients (8/11/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/south-carolina-initiative-cuts-readmissions-through-cooperation-education South Carolina initiative cuts readmissions through cooperation, education (7/8/15)]&lt;br /&gt;
&lt;br /&gt;
Behavioral&lt;br /&gt;
* [http://oregonstate.edu/ua/ncs/archives/2015/nov/changing-habits-improve-health-new-study-indicates-behavior-changes-work More than 80 percent of the randomized clinical trials that included a behavioral intervention reported a significant improvement for the targeted behavior and a significant physiological impact such a reduction in weight or blood pressure. (11/10/15)]&lt;br /&gt;
&lt;br /&gt;
Self-Administer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care Parkland Health &amp;amp; Hospital System trained over 1,000 patients to self-administer IV antibiotics in their homes. In the first four years of this effort, these patients experienced a 47% lower 30-day hospital-readmission rate than those receiving treatments in an outpatient facility while the mortality rates of both groups were similar. (6/2/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Decision_Making Decision Making] - ''What Works?''===&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/shared-decision-making-improves-outcomes-satisfaction-for-orthopedic-patients Study: Shared decision-making boosts patient outcomes, leads to higher satisfaction rates (3/15/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Decision_Making Digital Therapeutics] - ''What Works?''===&lt;br /&gt;
Behavioral Health&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/05/valera-health-app-shows-boost-in-engagement-from-patients-with-depression-anxiety/ Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)]&lt;br /&gt;
* [http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs/ 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/06/telepsychiatry-reduces-wait-times-psyciatric-exams-4-days-10-hours-sc-hospital/ In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)]&lt;br /&gt;
* [http://khn.org/news/telephone-therapy-helps-older-people-in-underserved-rural-areas-study-finds/ Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)]&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/study-real-time-symptom-reporting-helps-cancer-patients-live-longer Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)]&lt;br /&gt;
Cardiac Rehab &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/veterans-respond-well-home-based-cardiac-rehab-app-va-study-shows Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)] &lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2016-03/acoc-dht032216.php Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)]&lt;br /&gt;
* [http://newsnetwork.mayoclinic.org/discussion/cardiac-rehab-patients-who-use-smartphone-app-recover-better-mayo-clinic-research-shows Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092 To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/04/11/well/live/tackling-weight-loss-and-diabetes-with-video-chats.html Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)] &lt;br /&gt;
* [http://www.mobihealthnews.com/content/one-drop-shares-data-showing-app-reduces-a1c-1-percent One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)]&lt;br /&gt;
* [https://www.imedicalapps.com/2017/04/omada-humana-diabetes-study/ Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2017/03/diabetes-online-intervention-study/ Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)]&lt;br /&gt;
* [http://medcitynews.com/2016/09/mississippi-telehealth-remote-monitoring/ Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article116582423.html Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mobile-diabetes-intervention-reduced-hba1c-2-percentage-points-more-standard-care Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)]&lt;br /&gt;
Parkinson &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/nhs-study-finds-mobile-app-improves-management-quality-doctor-visits-people-parkinsons NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)]&lt;br /&gt;
Physical Therapy &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://medcitynews.com/2017/03/virtual-rehab-gain-ground-orthopedics-bundled-payments-take-hold/ Virtual rehab to gain ground in orthopedics as bundled payments take hold (3/14/17)]&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170823.061630/full/ Over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population (8/23/17)]&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0454-y Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/webmds-app-enabled-weight-loss-pilot-helped-800-verizon-employees-lose-weight App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/11/medicare-patients-lose-weight/ A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)]&lt;br /&gt;
* [http://medcitynews.com/2015/06/pwc-infograph-virtual-care-cuts-down-diabetes-costs/ Virtual care reduces diabetes costs by 9% (6/26/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Home Home] - ''What Works?''===&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/home-visits-help-new-parents-overcome-tough-histories-raise-healthy-children/amp/ Home Visits Help New Parents Overcome Tough Histories, Raise Healthy Children (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Housing and Healthcare Integration &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/new-integrated-model-care-for-seniors-lowers-hospitalizations-readmissions-emergency Clinical outcomes of an integrated model of care for frail seniors that bridges housing and healthcare. 50% lower inpatient hospitalization rates, 80% lower readmission rates, 15% lower rate of emergency department use (3/23/17)]&lt;br /&gt;
Medication Reconciliation &amp;lt;br&amp;gt;&lt;br /&gt;
Paramedic Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1111/jgs.14484/full Only 22% of Paramedic responses required transport; 78% were evaluated and treated in the home. Paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals’ homes. (8-30-16)]&lt;br /&gt;
Passive Data Analysis &amp;lt;br&amp;gt;&lt;br /&gt;
Passive Data Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
*  [http://www.cnn.com/2014/08/25/tech/innovation/alzheimers-smart-home/ Sensors let Alzheimer's patients stay at home, safely (10/12/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Therapeutic_Services Therapeutic Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
Behavioral Health&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/05/valera-health-app-shows-boost-in-engagement-from-patients-with-depression-anxiety/ Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)]&lt;br /&gt;
* [http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs/ 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/06/telepsychiatry-reduces-wait-times-psyciatric-exams-4-days-10-hours-sc-hospital/ In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)]&lt;br /&gt;
* [http://khn.org/news/telephone-therapy-helps-older-people-in-underserved-rural-areas-study-finds/ Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)]&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/study-real-time-symptom-reporting-helps-cancer-patients-live-longer Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)]&lt;br /&gt;
Cardiac Rehab &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/veterans-respond-well-home-based-cardiac-rehab-app-va-study-shows Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)] &lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2016-03/acoc-dht032216.php Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)]&lt;br /&gt;
* [http://newsnetwork.mayoclinic.org/discussion/cardiac-rehab-patients-who-use-smartphone-app-recover-better-mayo-clinic-research-shows Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092 To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/04/11/well/live/tackling-weight-loss-and-diabetes-with-video-chats.html Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)] &lt;br /&gt;
* [http://www.mobihealthnews.com/content/one-drop-shares-data-showing-app-reduces-a1c-1-percent One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)]&lt;br /&gt;
* [https://www.imedicalapps.com/2017/04/omada-humana-diabetes-study/ Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2017/03/diabetes-online-intervention-study/ Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)]&lt;br /&gt;
* [http://medcitynews.com/2016/09/mississippi-telehealth-remote-monitoring/ Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article116582423.html Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mobile-diabetes-intervention-reduced-hba1c-2-percentage-points-more-standard-care Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)]&lt;br /&gt;
Parkinson &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/nhs-study-finds-mobile-app-improves-management-quality-doctor-visits-people-parkinsons NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)]&lt;br /&gt;
Physical Therapy &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://medcitynews.com/2017/03/virtual-rehab-gain-ground-orthopedics-bundled-payments-take-hold/ Virtual rehab to gain ground in orthopedics as bundled payments take hold (3/14/17)]&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170823.061630/full/ Over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population (8/23/17)]&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0454-y Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/webmds-app-enabled-weight-loss-pilot-helped-800-verizon-employees-lose-weight App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/11/medicare-patients-lose-weight/ A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)]&lt;br /&gt;
* [http://medcitynews.com/2015/06/pwc-infograph-virtual-care-cuts-down-diabetes-costs/ Virtual care reduces diabetes costs by 9% (6/26/15)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Health_Services#Virtual_Medical_Services Virtual Medical Services] - ''What Works?''===&lt;br /&gt;
Tele-Health Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/04/how-to-measure-roi-of-telemedicine/ INTEGRIS reduced cost of treating low acuity, non-emergent medical conditions such as upper respiratory infections (URI). In 2016, the cost for onsite visits to treat URIs was $383,702. During the first three months of 2017, costs to treat URI patients virtually was only $9,744. It is expected to save hundreds of thousands of dollars annually (4/20/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-shows-telemedicine-can-improve-screening-access-efficiency-diabetes-caused JAMA study shows telemedicine can improve screening access, efficiency for diabetes-caused blindness in LA County safety net populations (4/11/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/26/519543337/telehealth-doctor-visits-may-be-handy-but-arent-cheaper-overall Telehealth Doctor Visits May Be Handy, But Aren't Cheaper Overall (3/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/how-mercy-created-a-54m-virtual-hospital-in-st-louis.html Virtual Care Center has led to a more than 33 percent decrease in Mercy's emergency room visits and hospitalizations. (9/15/16)]&lt;br /&gt;
Virtual Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/whatsapp-second-medical-opinion-diagnosing/ 20 oral pathologists gathered virtually using the WhatsApp Broadcast functionality to get a second opinions. The accuracy of the 4,940 second opinion diagnoses (SOD) was 98% correctly diagnosed. (11/22/16)]&lt;br /&gt;
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==[[Digital Health Technology]] - ''What Works?''==&lt;br /&gt;
[[Digital Health Technology]] that enable [[Medical Interventions]] and [[Non-Medical Interventions]] to more efficiently and effectively help improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Devices Devices] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-wearables-may-help-detect-serious-illness Study finds wearables may help detect serious illness (1/12/17)]&lt;br /&gt;
* [http://www.healthcareitnews.com/news/va-study-wearables-ai-shows-promise-heart-failure-patients VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)]&lt;br /&gt;
Activity Trackers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://mobihealthnews.com/content/study-walkadoo-increased-employee-activity-nearly-1000-steps-day Activity platform with adaptable, tailored reminders and activity trackers increased employee activity by an average of 970 steps per day compared to control group with just the trackers. (2/9/16)]&lt;br /&gt;
Continuous Glucose Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.mobihealthnews.com/content/study-dexcom-finds-cgms-can-benefit-type-2-patients-too A study published in Annals of Internal Medicine and sponsored by Dexcom shows that a continuous glucose monitor could lower the HbA1c scores of people with Type 2 diabetes (8/21/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Communications Digital Communications] - ''What Works?''===&lt;br /&gt;
* [http://www.mercurynews.com/2016/11/28/elders-who-use-tech-tools-feel-less-lonely-more-physically-fit-stanford-study-finds/ Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)]&lt;br /&gt;
* [http://stateofreform.com/wp-content/uploads/2015/12/AJMC_12_2015_Reed-final.pdf Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)]&lt;br /&gt;
* [http://www.cityam.stfi.re/230372/digital-health-wearables-and-apps-9-in-10-brazilian-doctors-use-whatsapp-to-talk-to-patients?sf=vkrgwp 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/12/mobile-health-company-offers-way-to-improve-interactions-between-medicaid-care-managers-and-patients/ Mobile health company offers way to improve interactions with Medicaid patients, care managers by demonstrating a 12% increase in prescription refills, a 40% increase in attending health appointments and a 22% increase in their knowledge of the recommended lifestyle changes for their care plan. (12/5/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/the-doctor-will-email-you-now.html Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/8/1361.abstract Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Regulating_Therapies Digital Regulating Therapies] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Mobile_Apps Mobile Apps] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Patient_Provided_Data Patient Provided Data] - ''What Works?''===&lt;br /&gt;
* [http://careathand.com/assets/attachments/Avalere-18Nov2015.pdf Three-minute surveys on mobile device by frontline personnel helped detect clinically relevant alerts for intervention. Medicare beneficiaries with 3 or more admissions in the prior year had 29.2% decrease in inpatient admissions and $28,656 reduction in Medicare A inpatient expenditures per beneficiary per year. (11/18/15)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/07/28/century-house-call/tdupWvOQI6b3dKdKcEgdGM/story.html Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Monitoring_and_Management Monitoring &amp;amp; Management] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Text_Messaging Text Messaging] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-texting-improve-medication-adherence-shows-high-engagement Study: Texting to improve medication adherence shows high engagement (5/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/using-patient-engagement-strategies-to-increase-colon-cancer-screenings Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)]&lt;br /&gt;
* [http://www.denverpost.com/2016/10/13/denver-health-text-messages/ Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2495276%20 A text-based smoking cessation intervention improve outcomes among young people. (3/2016)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2484905 Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-patients-who-receive-texts-from-physicians-more-likely-to-exercise.html Study: Patients who receive texts from physicians more likely to exercise (12/14/15)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=Feasibility+of+a+Text+Messaging+Intervention+to+Promote+Self-Management+for+Patients+Prescribed+Oral+Anticancer+Agents. Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2442937 Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)]&lt;br /&gt;
* [http://talkspace.com/online-therapy/wp-content/uploads/2015/06/Talkspace-Preliminary-Research-Study.pdf 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Virtual_Visits_Technology Virtual Visits Technology] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
==[[Support Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Caregiver_Support Caregiver Support] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/boot-camp-helps-alzheimers-dementia-caregivers-take-care-of-themselves-too/ ‘Boot Camp’ Helps Alzheimer’s, Dementia Caregivers Take Care Of Themselves, Too (5/9/17)]&lt;br /&gt;
* [http://khn.org/news/teaching-in-home-caregivers-seems-to-pay-off/amp/ Teaching In-Home Caregivers results in emergency room visits declining by 24% in the first year after caregivers were trained and 41% in the second year (8/11/16)]&lt;br /&gt;
* [http://in.reuters.com/article/us-dementia-caregivers-stress-idINKBN0GJ21920140819 More evidence adult daycare eases stress on dementia caregivers (8/20/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/605.abstract?rss=1 North Dakota Assistance Program For Dementia Caregivers Lowered Utilization, Produced Savings, And Increased Empowerment (4/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/596.abstract?rss=1 Enhanced support services for caregivers of people with dementia have been shown to improve caregivers’ capabilities and well-being and delay patients’ institutionalization (4/2014)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_Health_Worker Community Health Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.uphs.upenn.edu/news/News_Releases/2014/02/kangovi/ Penn's Innovative Community Health Worker Model Improves Outcomes for High-Risk Patients (2/10/14)]&lt;br /&gt;
* [http://medcitynews.com/2014/04/new-idea-extending-reach-care-team-hiring-training-grandparents/ A not-for-profit trains grandparents to work as grand-aides, helps reduce readmissions by over 50% and get medication adherence of 91%. (4/8/14)]&lt;br /&gt;
* [http://www.latimes.com/nation/la-na-healthcare-collaboration-20140319-dto-htmlstory.html#ixzz2wQzyYytp Northern Maine - coordination among businesses and health workers helped to improve health outcomes. (3/19/14)]&lt;br /&gt;
* [http://khn.org/news/volunteers-assist-seniors-by-taking-notes-during-medical-appointments/ Note Takers Help The Elderly At The Doctor (2/28/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_and_Social_Services Community &amp;amp; Social Services] - ''What Works?''===&lt;br /&gt;
* [http://www.dispatch.com/content/stories/local/2016/08/07/medicaid-insurer-provides-life-services-to-connect-clients-with-education-jobs.html Medicaid insurer provides ‘life services’ to connect clients with education, jobs (8/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/faithhealthnc-offers-spiritual-emotional-support-after-discharge Faith Health program has helped to reduce readmissions through a volunteer initiative aimed at helping patients get the emotional support they need after discharge. (6/27/16)] &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/5/760.abstract States with a higher ratio of social to health spending (social spending divided by Medicare and Medicaid spending) had better subsequent health outcome, including for: adult obesity, asthma, mentally unhealthy days, days with activity limitation, mortality rates for lung cancer, acute myocardial infarction and type 2 diabetes. (5/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-one-health-system-addressed-2-000-patients-social-needs-in-2-years.html  Health system addressed 2,000 patients' social needs in 2 years. Undergraduate students from local universities, called advocates, connect patients with resources for food stamps, subsidized child care or housing or payment plans and discounts for their electricity bills. (6/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/3/544.abstract Strong Social Support Services, Such As Transportation And Help For Caregivers, Can Lead To Lower Health Care Use And Costs (3/2013)]&lt;br /&gt;
* [http://www.spokesman.com/stories/2014/may/19/hospitals-say-online-language-services-help-reduce/ Providence turns to online interpreters to improve health outcomes (5/19/14)]&lt;br /&gt;
* [http://www.communityplans.net/LinkClick.aspx?fileticket=wcPKMzqiacQ%3d&amp;amp;tabid=214&amp;amp;mid=718&amp;amp;forcedownload=true Positively Impacting Social Determinants of Health - How Safety Net Health Plans Lead the Way (6/2014)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/02/12/oregon-bridges-the-gap-between-health-care-and-community-based-health/ Oregon is showing success in integrating of health care with social services and public health (2/12/15)]&lt;br /&gt;
* [http://healthyamericans.org/report/110/ 79 evidence-based disease and injury prevention programs that have saved lives and improved health. (11/2013)]&lt;br /&gt;
* [https://uwphi.pophealth.wisc.edu/programs/match/healthiest-state/what-works-rural-report-july-2015.pdf What Works? Strategies to Improve Rural Health (7/2015)]&lt;br /&gt;
* [https://www.icsi.org/_asset/pvr9ot/lessonslearned.pdf Lessons Learned: Leaders Successfully Stepping Out to Transform Health and Health Care (4/2015]&lt;br /&gt;
* [http://www.bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Research provide evidence that addressing social determinants of health can improve health and reduce health care costs. Study describes effective interventions 7 Housing examples, 5 Nutrition Assistance examples, 2 Income Support examples, public safety and education examples. (6/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Employment_Support Employment] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1098.abstract Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives. Yet funding is lacking. (6/2016)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Financial_Counseling Financial Counseling] - ''What Works?''===&lt;br /&gt;
* [http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ Insured patients can save money by pretending to be uninsured (1/3/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Home_Support Home Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Housing_Support Housing Support] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/this-hospital-is-giving-free-housing-to-frequent-er-patients.html Hospital provides free housing to frequent ER patients. $3,000 per day to care for patients who frequently visit the emergency room or approximately $33 per day for an apartment. (6/30/16)]&lt;br /&gt;
* [http://khn.org/news/old-motels-get-new-life-helping-homeless-heal/amp/Old Motels Get New Life Helping Homeless Heal (6/29/16)]&lt;br /&gt;
* [http://www.npr.org/2015/12/10/459100751/utah-reduced-chronic-homelessness-by-91-percent-heres-how Utah Reduced Chronic Homelessness By 91 Percent; HUD estimates that annual cost of homelessness is between $30,000 and $50,000 per person because of services like emergency room visits and jail time. (12/10/15)]&lt;br /&gt;
* [http://www.leadingage.org/Affordable_Senior_Housing_Plus_Services_Program_Slows_Growth_in_Medicare_Costs.aspx Affordable Senior Housing Plus Services Program Slows Growth in Medicare Costs (12/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/homeless-navigators-help-reduce-er-use-readmissions?utm_source=feedly 'Homeless navigators' help reduce ER use, readmissions (10/25/13)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/20.abstract Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing (1/2016)]&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Housing First program for people experiencing chronic homelessness in Seattle and Boston results in $29,388 per person per year in net savings, and $8,949 per person per year in net savings, respectively (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Special Homeless Initiative (HI) Adults with serious mental illness in Boston results in 93% reduction in hospital costs, $18 million reduction in health care costs annually (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf 10th Decile Project for high-need homeless in Los Angeles 72% reduction in total health care costs; positive rate of return as every $1 invested in housing and support was estimated to reduce public and hospital costs by $2 the following year and $6 in subsequent years (6/2015])&lt;br /&gt;
* [http://www.communityplans.net/Portals/0/Fact%20Sheets/ACAP_Plans_and_Social_Determinants_of_Health.pdf UPMC developed a “shelter plus care” program through a multi-party partnership including primary care practice, local government and community services. A 23% reduction in overall per-member-per-month (PMPM) claims costs. Roughly $4,100 before program to roughly $3,200 while in program (6/2014)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Legal_Support Legal Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Medication_Support Medication Support] - ''What Works?''===&lt;br /&gt;
* [http://www.bizjournals.com/washington/news/2017/05/08/the-simple-way-medstar-just-found-to-get-patient.html MedStar and CVS Health may have found a simple solution. The pharmacy pre-packages and labels patients' medications in multi-dose pouches. A group of 10 primary care offices recently improved medication compliance among patients taking six or more drugs a day from 60% to more than 90%. (5/8/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Nutrition_Support Nutrition Support] - ''What Works?''===&lt;br /&gt;
* [https://www.beckershospitalreview.com/finance/study-advocate-hospitals-saved-nearly-4-9m-by-implementing-nutrition-care-program.html Advocate Health Care saved nearly $4.9 million dollars by reducing readmission rates and shortening inpatient stays after implementing a nutrition care program at four Chicago hospitals (8/11/18)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/09/20/how-community-partnerships-can-help-end-food-insecurity-part-1/ How Community Partnerships Can Help End Food Insecurity - Part 1 (9/20/16)] [http://healthaffairs.org/blog/2016/09/21/how-community-partnerships-can-help-end-food-insecurity-part-2/ Part 2 (9/21/16)]&lt;br /&gt;
* [http://www.marketplace.org/2015/06/22/health-care/new-math-healthcare-make-money-saving-money Healthy foods delivered to 5% of the patients spending 50% of money can save money (6/22/2015)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001076/ Study found that if every state were to provide home-delivered meals to an additional 1 percent of its population of adults ages sixty-five and older, would save state Medicaid programs over $109 million for the country. (10/2013)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/06/09/hospitals-reach-into-patients-homes-deliver-healthy-smoked-tofu-but-also-bbq-shrimp-scampi/QSqNQiycZUNxa9qbRWzs8I/story.html Steward Health Care] delivers three low-sodium meals and two snacks to selected heart failure patient's home each day hoping healthy food will reduce trips to the hospital. (6/10/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Prison_to_Community_Transitions Prison to Community Transitions] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1006.abstract People returning to communities from prison that were referred by correctional partners to an enhanced primary care Transitions Clinic Network (TCN) had fewer acute care visits than people referred later. (6/2017)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Social_Workers Social Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27119772 Social-work conducted transitional care reduced all cause readmissions among all home-going Medicare FFS beneficiaries by 20%. (5/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-based-clinic-helped-reduce-ed-super-user-visits Hospital-based clinic used social workers to reduce ED super-users risk of ED use by 22% and hospitalizations by 30% (5/9/14)]&lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2013-09-26/obamacare-incentives-push-hospitals-to-keep-medicare-patients-healthy Social workers are the new frontline of the accountable-care model (9/26/13)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/10/23/451154605/a-hospital-reduces-repeat-er-visits-by-providing-social-workers Hospital Reduces Repeat ER Visits By Providing Social Workers. In four months, visits by 39 people to the ER fell by 68 percent, cost fell from $1.5 million to $440,000. (10/23/15).]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Support_Communities Support Communities] - ''What Works?''===&lt;br /&gt;
* [http://www.imedicalapps.com/2016/08/web-based-support-group-tbi-caregivers/ Online-video support group could aid in the care of patients with traumatic brain injuries (TBI). (8/5/16)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/167056/mhealth-comes-patient-support-groups Mobile Health Comes to Patient Support Groups (6/3/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/152556/one-one-cancer-support-empowers-patients One-on-One Cancer Support Empowers Patients (3/10/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/5-advantages-online-patient-communities.html 5 advantages of online patient communities (8/2/13)]&lt;br /&gt;
* [http://davidleescher.com/2013/07/11/why-online-patient-communities-are-better-than-real-life-support-groups/ Online Patient Communities] can provide many potential benefits, such as improving coping skills, reducing anxiety, depression, isolation, ignorance about the condition and finding others that are experience common conditions. (7/11/13)&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Transportation Transportation] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/caremore-lyft-collaboration-reduces-medical-transportation-waits-by-30.html CareMore, Lyft collaboration reduces medical transportation waits by 30% (9/6/16)]&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/495476/ Hospitals Are Partnering With Uber to Get Patients to Checkups (8/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] - ''What Works?''==&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Caregiver_Activity Caregiver Activity] - ''What Works?''===&lt;br /&gt;
* Caregivers - [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers States are focusing on activating them (6/22/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activation Patient Activation] - ''What Works?''===&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/06/22/these-few-things-may-stave-off-dementia-scientists-say/103119512/ There is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (6/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/22/well/live/back-pain-try-yoga.html A study of people with low to moderate lower back pain found they could use yoga to reduce back pain and functional limitations (6/22/17)] &lt;br /&gt;
* [http://www.hhnmag.com/articles/8230-Patients-increasingly-providing-self-care-improving-outcomes-reducing-cost DIY Medicine Helps Improve Outcomes, Reduce Cost. Patients avoid long inpatient stays by learning to self-administer care for chronic conditions (5/16/17)]&lt;br /&gt;
* [http://khn.org/news/with-chronic-illness-you-are-your-own-best-friend/amp/ What patients with chronic illnesses do outside the doctor’s office affect their health conditions (exercise, diet, taking their medication). Diabetic patients who participated in a online self-management program had lower blood sugar levels and took their medication more regularly (9/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-activation-influences-readmission-rates?utm_source=feedly Patient activation influences readmission rates (10/11/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activity Patient Activity] - ''What Works?''===&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-brain-training-dementia-20160724-snap-story.html Specialized brain training can help prevent Alzheimer’s Disease and other afflictions, including normal aging, that sap memory and reduce function. (7/24/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article129829184.html Simple activities, such as playing games, making crafts, socializing and reading books held off mental decline in older adults, according to a Mayo Clinic study (1/31/17)]&lt;br /&gt;
&lt;br /&gt;
Gamification &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://venturebeat.com/2017/03/08/heart-study-says-pokemon-go-makes-you-twice-as-likely-to-hit-10000-steps-a-day/ Heart study says Pokémon Go makes you twice as likely to walk 10,000 daily steps (3/8/17)]&lt;br /&gt;
&lt;br /&gt;
Nutrition &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/07/13/healthy-diet-longevity-study/ Improving Your Diet Just a Little Bit Can Help You Live Longer, Says Study (7/13/17)]&lt;br /&gt;
* [http://mashable.com/2016/09/29/mediterranean-diet-health-benefits.amp Study suggests a Mediterranean diet could prevent over 19,000 deaths a year in the UK. (9/29/16)]&lt;br /&gt;
&lt;br /&gt;
Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/these-preventive-measures-might-help-delay-dementia-or-cognitive-decline/ Scientists endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure. (7/20/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/16/magazine/losing-fat-gaining-brain-power-on-the-playground.html In children, exercise may help to improve cognition and improve waistlines. (6/16/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/24/well/move/a-1-hour-walk-3-times-a-week-has-benefits-for-dementia.html A 1 hour walk 3 times a week has benefits for dementia (5/24/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/12/well/move/an-hour-of-running-may-add-seven-hours-to-your-life.html An hour of running may add up to seven hours on your life (4/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/patients-can-save-2-500-on-medical-costs-just-by-walking.html Patients can save $2,500 on medical costs annually just by walking (9/8/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/increased-physical-activity-associated-lower-risk-13-types-cancer Increased physical activity associated with lower risk of 13 types of cancer (6/16/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/06/23/483245084/a-protein-that-moves-from-muscle-to-brain-may-tie-exercise-to-memory When muscles work, they release a protein that appears to generate new cells and connections in a part of the brain that is critical to memory (6/23/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/blog/after-hip-fracture-exercise-at-home-boosts-day-to-day-function-201402197041 After hip fracture, exercise at home boosts day-to-day function (2/19/14)]&lt;br /&gt;
* [http://www.fastcompany.com/3045862/fast-feed/sitting-all-day-will-kill-you-but-a-2-minute-walk-could-change-that New research: Breaking up your sedentary day with some light activity can prolong your life. (5/1/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/replace-sitting-with-walking/ Replace sitting with walking – it’s key to decreasing early death rate. (10/27/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Lifestyle Patient Lifestyle] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/why-retiring-after-age-65-could-help-you-live-longer.html Most people retire around age 65. But when people retire at age 66 instead, their mortality rates drop by 11 percent. (9/13/16)]&lt;br /&gt;
Healthy Lifestyle &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/02/476209760/whats-good-for-the-heart-is-good-for-the-brain What's Good For The Heart Is Good For The Brain. 7 factors known to benefit the heart and blood vessels: maintaining a normal body weight, good nutrition, not smoking, getting exercise regularly and keeping blood pressure, cholesterol and blood sugar levels under control. (5/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-a-healthy-lifestyle-could-prevent-half-of-all-deaths-attributed-to-cancer.html A healthy lifestyle could prevent half of all deaths attributed to cancer. 41% of cancer cases and 59% of cancer deaths were potentially preventable in women. 63% of cancer cases and 67% of cancer deaths were preventable, among men. (5/20/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Personal_Achievement Personal Achievement] - ''What Works?''===&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/15/470124189/to-quit-smoking-its-best-to-go-cold-turkey To Quit Smoking, It's Best To Go Cold Turkey (3/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models Health Insurance Payment Models] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Accountable_Care_Organizations Accountable Care Organizations] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/healthcare/medicare-shared-savings-program-acos-show-promise-cost-reduction-quality-improvement-oig Medicare Shared Savings Program ACOs show promise in cost reduction, quality improvement, OIG finds (8/30/17)]&lt;br /&gt;
* [https://www.beckershospitalreview.com/lists/110-acos-to-know-2017.html 110 ACOs to know | 2017 (6/12/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-finds-acos-reduce-hospitalizations-spending Study found an association between participation in an accountable care organization (ACO) and reduced rates of hospitalizations, as well as Medicare spending. (5/9/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2601418 Medicare Shared Savings Program was associated with a 9% differential reduction in postacute spending by 2014, driven by reductions in discharges to facilities, length of facility stays, and acute inpatient care. (2/15/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/1/74.abstract Two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. (1/2017)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/anthem-blue-cross-acos-realize-70m-savings Anthem Blue Cross through its 17 ACO partners accrued savings of $70.4 million over a 12-month period. (11/1/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2017/jan/aco-hospitals-reduced-rehospitalization-faster ACO-Affiliated Hospitals Reduced Rehospitalizations from Skilled Nursing Facilities Faster Than Other Hospitals (1/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/medicare-aco-hospitals-faster-at-reducing-readmissions-study-finds.html Medicare ACO hospitals faster at reducing readmissions, study finds. (1/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/cms-unveils-2015-medicare-aco-quality-financial-performance-12-things-to-know.html ACOs saved Medicare $466M in 2015. (8/26/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Episode-Based_Payments Episode-Based Payments] - ''What Works?''===&lt;br /&gt;
Commercial Health Plans &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthpayerintelligence.com/news/unitedhealthcare-adopts-bundled-payment-model-for-surgeries UnitedHealthcare’s bundled payment model for hip, knee and back surgery pilot program has shown an average savings of $10,000 or more among employers for each episode of care when compared against overall median costs for the same procedures in the same region. (1/19/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2594805 Study of 3942 patients who received joint replacement surgery, there was a decrease of $5577 (20.8%) in total spending per episode. Most of the hospital savings came from implants and supplies and most of the postacute care savings came from decreased use of institutional care. (1/3/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Care_Services Care Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient-Centered_Medical_Homes Patient-Centered Medical Homes] - ''What Works?''===&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071295/ CareFirst Patient-Centered Medical Home Program lowered annual adjusted total claims payments by $109 per participating member (95 % CI: −$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. 42% of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. (7/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-centered-medical-homes-lower-costs-reduce-healthcare-overuse Patient-centered medical homes lower costs, reduce healthcare overuse (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient_Incentives Patient Incentives] - ''What works?''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1455 Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage (8/2017)]&lt;br /&gt;
* [https://healthpayerintelligence.com/news/patient-incentives-from-payers-encourage-preventive-care-visits Patient Incentives from Payers Encourage Preventive Care Visits. MinuteMember Wellness Rewards program offer $50 incentive for members to visit their In-Plan PCP during the calendar year. “In its first year, approximately 9300 members (or 40 percent) received an incentive check. (5/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/financial-incentives-may-be-effective-for-smoking-cessation-study-finds.html Financial incentives may be effective for smoking cessation, study finds. After six months, 36% of participants who received cash and about 6% of the control group had quit smoking. (9/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aetna-pays-employees-up-to-500-per-year-for-sleeping.html Aetna pays employees up to $500 per year for sleeping. Wellness and wellness program responsible for 69 minutes more a month of worker productivity. (4/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/small-study-risk-losing-reward-works-better-reaching-activity-tracking-goals Small study shows risk of losing reward works better for reaching activity tracking goals (2/16/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1414293#t=articleBackground Financial incentives were proven effective in smoking cessation (5/28/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Performance_Based_Pricing Performance-Based Pricing] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Provider-Based_Health_Plans Provider-Based Health Plans] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Care_Programs Value-Based Care Programs] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/regulatory/study-value-based-care-programs-reduce-readmissions Study finds participation in voluntary federal programs that push for quality improvements has a greater impact on reducing readmissions than financial penalties levied against hospitals for high rates alone (4/11/17)]&lt;br /&gt;
* [https://news.umich.edu/voluntary-value-based-health-programs-dramatically-reduce-hospital-readmissions/ University of Michigan Study Links Value-Based Care Programs to Lower Readmission Rates and $32 Million in Medicare Savings in 2015 (4/10/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/sustained-participation-payforvalue-high-need-patients Blue Cross Blue Shield of Michigan members with two or more chronic diseases, including mental health problems, assigned to PCP's participating in the pay-for-performance program for at least four years to outcomes for members assigned to PCPs had almost 20% fewer 30-day hospital readmissions and 27.5% fewer 90-day readmissions. However, total spending did not decline. (3/15/17)]&lt;br /&gt;
* [http://healthpayerintelligence.com/news/anthem-cut-er-costs-by-3-with-value-based-care-reimbursement Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement (2/1/17)]&lt;br /&gt;
* [https://www.uhc.com/content/dam/uhcdotcom/en/ValueBasedCare/PDFs/VBC-Nov2016-Online-Report.pdf UnitedHealthcare expanded value-based care programs such as accountable care organizations, which led to 16.8% fewer acute inpatient admissions among mature Medicaid ACOs in Tennessee, 12.2% fewer ER visits among the longest-running Medicare ACOs and 10% fewer hospital admissions and ER visits among top performing commercial ACOs (11/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/4-strategies-bcbs-used-to-save-1b-through-patient-centered-programs.html 4 strategies BCBS used to save $1B through patient-centered programs. These programs include BCBS' accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs — emphasize prevention, wellness and coordinated care, in conjunction with reducing waste in the healthcare delivery system. (6/2/15)]&lt;br /&gt;
&lt;br /&gt;
Hospital-Acquired Condition Reduction Program &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20161212/NEWS/161219985 HHS report shows hospitals are paying off, preventing 3.1 million harmful hospital-acquired conditions and the deaths of some 125,000 people. Those improvements saved close to $28 billion in healthcare costs from 2010 through 2015. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Readmission Penalties &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/fiscal-penalties-for-low-performing-hospitals-linked-to-improved-readmission-rates.html Fiscal penalties for low-performing hospitals linked to improved readmission rates for heart failure, pneumonia and acute myocardial infarction (heart attack). For every 10,000 patients discharged annually, the lowest performing hospitals avoided 95 readmissions they would have seen before readmissions were penalized under the ACA. (12/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/every-state-but-1-lowered-hospital-readmissions-since-2010-cms-data-shows.html Every state but 1 lowered hospital readmissions since 2010, CMS data shows (9/13/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1294.abstract Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Attributed to Medicare's penalties for re-admissions. (7/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Insurance_Design Value-Based Insurance Design] - ''What Works?''===&lt;br /&gt;
Health plan benefit design to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices&lt;br /&gt;
* [http://khn.org/news/health-insurers-try-paying-more-upfront-to-pay-less-later/amp/ Enhanced insurance benefit that pays for all patients Type 1 diabetes maintenance is paying off. The state has saved about $1 million on medical services since its inception almost 10 years ago. (7/17/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/516.abstract Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan (3/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/horizon-calls-its-6-premium-increase-proof-tiers-work.html Horizon Blue Cross Blue Shield of New Jersey declared its Omnia health plans, which uses Tier 1 — or preferred — hospitals and providers for services, have some of the lowest premium rate increases nationally next year. (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-finds-eliminating-drug-co-payments-leads-to-cost-savings-among-chronically-ill.html Study finds eliminating drug co-payments leads to cost savings among chronically ill (2/17/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/637.abstract Connecticut’s Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence (4/2016)]&lt;br /&gt;
&lt;br /&gt;
Tiered Provider Network &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/870.short Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5% (5/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Wellness_Payment_Models Wellness Payment Models] - ''What Works?''===&lt;br /&gt;
* Wellness Screenings - [http://khn.org/news/medicare-payment-changes-lead-more-men-to-get-screening-colonoscopies/ Medicare Payment Changes Lead More Men To Get Screening Colonoscopies (12/24/15)]&lt;br /&gt;
&lt;br /&gt;
==[[Organization Interventions]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities] - ''What Works?''===&lt;br /&gt;
* [https://www.statnews.com/2017/02/28/health-disparities-community-action/ Decisive action by communities can reduce health disparities and improve lives (2/28/17)]&lt;br /&gt;
* [https://www.bostonglobe.com/metro/2016/12/10/the-san-antonio-way-how-one-texas-city-took-mental-health-community-and-became-national-model/08HLKSq1JdXSTZppaECk2K/story.html San Antonio has built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/10/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/role-food-systems-community.html West Oakland, one of the city’s poorest areas, improved healthy food access and economic opportunity. 640,000 lbs of produced distributed in food insecure area, 55% sourced locally and 76% of shoppers increased consumption of fruits and vegetables (11/28/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Community_.26_Social_Services_Organizations Community &amp;amp; Social Services Organizations] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Employers Employers] - ''What Works?''===&lt;br /&gt;
Employee Wellness Programs &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/human-capital-and-risk/study-suggests-wellness-programs-boost-worker-productivity-by-more-than-5.html Study shows wellness program boosted average worker productivity by more than 5% (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/nearly-60-of-employees-say-wellness-programs-have-improved-their-health-study-shows.html Nearly 60% of employees say wellness programs have improved their health, survey shows (6/1/17)]&lt;br /&gt;
* [http://m.content.healthaffairs.org/content/29/2/304.full Study of Workplace Wellness Programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent (2/21/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/229.abstract Comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees’ health risks, disease prevalence, and medical expenditures. (2/2017)]&lt;br /&gt;
* [http://www.rand.org/content/dam/rand/pubs/research_briefs/RB9700/RB9744/RAND_RB9744.pdf Disease management drives return on investment from workplace wellness programs. Two component programs reduced employer’s average health care costs by about $30 per member per month(PMPM). Disease management was responsible for 87% of those savings. Employees participating in the disease management program generated savings of $136 PMPM, with a nearly 30% reduction in hospital admissions. Only 13% of employees participated in the disease management component, compared with 87% for the lifestyle management component. (1/1/14)]&lt;br /&gt;
On-Site Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/premise-health-a-threat-or-opportunity-for-hospitals.html Coushatta Casino Resort partnered with Premise in 2011 to manage its onsite health center and improve the overall health status of Coushatta's employees and their families. The resort has seen better outcomes and has saved nearly $4 million in healthcare costs. (6/8/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Governments Governments] - ''What Works?''===&lt;br /&gt;
* [https://journals.lww.com/epidem/Citation/2017/11000/Longitudinal_Associations_of_Local_Cigarette.15.aspx A $1 increase in price was associated with a 3% reduction in risk of current smoking (11/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1016.abstract HUD Housing Assistance Associated With Lower Uninsurance Rates And Unmet Medical Need (6/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamacardiology/article-abstract/2618359 Study using data from the New York State Department of Public Health (2002-2013) found 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in counties with vs without trans-fatty acid restrictions. (4/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2017/03/13/520008877/un-sweetened-how-a-maryland-county-cut-soda-sales-without-a-soda-tax A Maryland County Cut Soda Sales Without A Soda Tax. The Unsweetened campaign led to a 20% decrease in sales of soda and a 15% decline in fruit drink sales between January 2013 and December 2015. (3/13/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2017/02/16/hlthaff.2016.1231 Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. (2/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2017/01/31/marylands-all-payer-model-achievements-challenges-and-next-steps/ The state of Maryland launched a bold approach to improve care with an All-Payer Model to slow the growth of healthcare costs.  Maryland has achieved an estimated $429 million in total Medicare hospital savings to date, exceeding the model’s five-year hospital savings requirement of $330 million (1/31/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/collections/signs-of-progress-in-reducing-childhood-obesity.html Some cities, counties, and states have started to see their childhood obesity rates go down by taking a comprehensive approach. (10/2016)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2553293 A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants (9/19/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/08/23/491104093/berkeleys-soda-tax-appears-to-cut-consumption-of-sugary-drinks Soda Tax Appears To Cut Consumption Of Sugary Drinks (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1045.abstract State prescription drug monitoring programs are sssociated with 30% reductions in opioid prescribing by physicians (6/2016)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/hec.3336/full Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers (4/4/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1932.abstract Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement - (1) sugar-sweetened beverage excise tax, (2) elimination of tax subsidy for advertising unhealthy food to children, (3) nutritional standards for food and beverages in schools outside of meals (11/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Health_Insurers Health Insurers]  - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Advocacy_Organizations Healthcare Advocacy Organizations]===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Provider_Organizations Healthcare Provider Organizations]  - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Support_Services_Organizations Support Services Organizations]  - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Vendor_Partners Vendor Partners]  - ''What Works?''===&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/What_Works%3F</id>
		<title>What Works?</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/What_Works%3F"/>
				<updated>2019-07-16T22:02:15Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Decision Making - What Works? */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday we get a new understanding of which [[Non-Medical Interventions]] work to impact patient health.  With most healthcare research, sites and journals primarily dedicated to which [[Medical Interventions]] work, this page will now duplicate it.  This page will begin to catalog the [[Non-Medical Interventions]] that work. While these are typically not peer reviewed articles, links are provided for people or organizations interested in further evaluating their efficacy and context to managing health.&lt;br /&gt;
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==[[Care Management Programs]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Behavioral_Health_.26_Primary_Care_Integration Behavioral Health &amp;amp; Primary Care Integration] - ''What Works?''=== &lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/intermountain-cuts-costs-improves-care-by-integrating-mental-health-into-primary-care Intermountain cuts costs, improves care by integrating mental health into primary care (8/25/17)]&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/alaskan-health-center-model-to-integrate-mental-health-into-primary-care Alaskan health center integration of mental health into primary careh as lowered hospital admissions and visits to the emergency room by more than a third between 2000 and 2015 (8/10/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/montefiore-health-system-sees-improvement-anxiety-depression-patients-using-valera-healths Montefiore Health System integrated mental health treatment with primary care and used the Valera Health smartphone app and platform to improve treatment of anxiety and depression. (5/24/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/integrating-behavioral-and-primary-care-can-improve-care-quality-study-finds.html Patients who received integrated primary care and behavioral health treatments had fewer emergency department visits, hospital admissions, ambulatory care sensitive visits and primary care physician encounters. (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/8/1487.abstract UCLA Health combines primary care with behavioral health to reduce emergency room use by 13% for patients in program. (8/16/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/transforming-care/2016/june/profile Care Oregon has a Health Resilience Specialist program that increased behavioral health visits by 16 percent, while E.D. visits and hospitalizations dropped by roughly 20 percent. (6/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/ny-health-system-s-collaborative-care-program-helps-patients-battle-depression NY health system's collaborative care program helps patients battle depression through screening and outreach (5/25/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/04/intermountain-behavioral-health-primary-care/ It costs Intermountain Health’s SelectHealth insurance subsidiary $22 per member per year to embed mental health workers in primary care clinics and processes, and SelectHealth gets an annual return on investment of $115 per member. (4/12/16)]&lt;br /&gt;
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Binge Eating Disorder (BED) &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/health/archive/2017/08/how-therapy-can-cure-overeating/537537/ Nearly 80 percent of patients abstain from bingeing after 20 sessions of cognitive behavioral therapy (8/23/17)]&lt;br /&gt;
Dementia Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/613.abstract?rss=1 A memory care clinic for older adults suffering from dementia and depression generates an annual net cost savings of up to $2,856 per patient (4/2014)]&lt;br /&gt;
Suicide Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1672 Zero Suicide, a model for better identification and treatment of patients at risk for suicide. (6/2016)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Chronic_Care_Management Chronic Care Management] - ''What Works?''===&lt;br /&gt;
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Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/value-based-care-alone-wont-reduce-health-spending-and-improve-patient-outcomes Nemours Children’s Health System pilot program to improve asthma outcomes saw a 60% reduction of asthma-related ER visits, a 44% reduction in asthma-related hospital admissions, and more than a $2,100 reduction in annual medical costs per child after three years. (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/47153/smart-inhaler-boosts-medication-adherence-144-percent-in-small-study/ Smart inhaler boosts medication adherence 144 percent in small study (9/30/15)]&lt;br /&gt;
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Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2630810 Study of Memorial Sloan Kettering Cancer Center cancer patients demonstrated a Patient Reported Outcome (PRO) group had a better quality of life and lived an average of 5.2 months longer than an randomly assigned usual care group. The PRO group self-report 12 common symptoms at and between visits via a web-based PRO questionnaire platform. (6/4/17)]&lt;br /&gt;
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Elderly &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rand.org/news/press/2014/03/17/index1.html Improving Continuity of Care for Elderly Patients with Chronic Diseases Cuts Costs and Complications (3/17/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.full Medicare Coordinated Care Demonstration reduced hospitalizations by 8–33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches were: telephone calls to patients; meeting with providers; acting as a communications hub for providers; delivering education to patients; providing medication management; and comprehensive transitional care after hospitalizations. (6/2012)]&lt;br /&gt;
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End-Stage Renal Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/preventive-care-specialists-key-to-controlling-kidney-failure-treatment-costs/amp/ Preventive Care, Specialists Key To Controlling Kidney Failure Treatment Costs (8/22/16)]&lt;br /&gt;
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Hypertension &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/6-ways-to-improve-hypertension-control.html 6 best practices for managing hypertension under population health models (5/27/14)]&lt;br /&gt;
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Pediatrics&lt;br /&gt;
* [https://healthitanalytics.com/news/chronic-care-management-improves-pediatric-outcomes-by-20 Chronic care management program at Cincinnati Children's Hospital helped care teams improve pediatric outcomes for certain conditions by up to 20 percent. (2/28/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Episode_Management Episode Management] - ''What Works?''===&lt;br /&gt;
* [https://healthpayerintelligence.com/news/population-health-approach-to-prenatal-care-cuts-payer-costs Taking a population health approach to prenatal care and high-risk pregnancies can cut costs for payers and improve outcomes, AHIP says. (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/how-10-more-hospitals-upgraded-their-total-joint-replacement-programs-and-saved-300k.html How 10 more hospitals upgraded their total joint replacement programs and saved $300k+ (11/4/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/bpci-hospitals-drove-down-medicare-payments-for-lower-extremity-joint-replacement-by-1-166.html BPCI hospitals drove down Medicare payments for lower extremity joint replacement by $1,166 (9/20/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/aug/baptist-health-bundled-payment Baptist Health System generate $6.1 million in savings on joint replacement with a bundled payment program that creates incentives for physicians, hospitals, and post-acute care providers to collaborate to drive down costs and improve quality. (8/3/16)]&lt;br /&gt;
* [http://www.ihatoday.org/uploadDocs/1/raisingthebar2014.pdf Illinois hospitals participating in the Hospital Engagement Network (HEN) from January 2012 through March 2014 prevented 15,887 patient harms, with an associated cost savings of $161.8 million. (10/2014)]&lt;br /&gt;
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Navigators &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/patient-navigators-track-social-determinants-through-ehrs-positive-results 'Patient navigators' track social determinants through EHRs with positive results. 98/7/17)] Kaiser uses a [http://res.cloudinary.com/bdy4ger4/image/upload/v1499804346/Patient_Questionnaire_for_OPB_ckqqld.pdf Current Life Situation Form]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-patient-centered-care-helped-arkansas-hospital-cut-readmissions-by-90 CHI St. Vincent's readmission rate fell by 90%, due largely to the heightened scrutiny of individual patients' processes of care and needs such as transportation gaps, lack of social support or financial obstacles. (11/25/15)]&lt;br /&gt;
* [http://www3.ccc.uab.edu/index.php/newsroom/preliminary-uab-study-shows-dramatic-trend-of-cost-savings-in-lay-navigation-program-for-cancer-patients/ Preliminary UAB study shows dramatic trend of cost savings in lay navigation program for cancer patients. (7/7/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-navigators-reduced-readmissions-overuse-er-pilot-program 'Patient navigators' reduced readmissions, overuse of ER in pilot program (1/27/15)]&lt;br /&gt;
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Patient Education about Procedures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/educate-patients-and-they-have-better-surgical-outcomes-study-finds Informed patients have better surgical outcomes. Only 36% of patients met the criteria for an informed patient-centered decision. Informed patients were significantly more likely to report being extremely satisfied with their treatment. (3/23/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#ER_Case_Management ER Case Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/presbyterian-healthcare-services-finds-success-patient-navigation Presbyterian Healthcare Services patient navigation program screens all emergency department patients, they transfer non-emergency patients to a more appropriate setting, like an urgent care center or primary care facility. Program helped drop ER overuse, improved patient engagement and decreased in treatment or diagnosis delays. (3/21/17)]&lt;br /&gt;
* [http://m.startribune.com/state-deploys-powerful-tool-to-rein-in-medicaid-waste-costly-er-use/404506396/ Minnesota system flags patients who visited hospital ERs as much as 150 times in a single year and people who routinely hop from one physician to the next searching for prescription painkillers. By limiting these “high use” patients to a single primary care provider, along with a hospital and one pharmacy, the program is saving taxpayers at least $7 million a year in unnecessary medical costs (12/3/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/kaiser-permanente-s-takes-new-approach-to-redirect-er-superusers Patient Navigators in the ER helps reduce returns by 55% among the 254 patients that navigators are managing. Navigators help with non-medical problems sucah as housing, food insecurity and lack of transportation. (6/17/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/frequent-flyer-er-visits-drop-coordinated-care 'Frequent flyer' ER visits drop with coordinated care (7/11/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Exercise_.26_Nutrition Exercise &amp;amp; Nutrition] - ''What Works?'' ===&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-prevention-how-one-ymca-program-is-changing-the-game.html A small diabetes prevention program based out of a YMCA in Indianapolis (3/31/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-health-diabetes-prevention-idUSKCN0PN2K720150713 Organized programs help prevent or delay diabetes (7/13/15)]&lt;br /&gt;
* [http://circ.ahajournals.org/content/125/9/1157.short Participants in a lifestyle intervention of reduced calorie, low-fat diet of conventional foods and 150 min/wk of physical activity (typically brisk walking), with the goal of losing 7% of initial weight. After an average of 2.8 years, participants in the lifestyle intervention lost 5.6 kg in comparison to 0.1 kg in the placebo group. The risk of the lifestyle group developing type 2 diabetes was reduced by 58% in comparison with placebo group. (3/5/12)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Health_Coaching Health Coaching] - ''What Works?''===&lt;br /&gt;
Care Goal Setting and Motivational Interviewing &lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-virtas-monitoring-app-plus-low-carb-diet-reverses-diabetes-progression Monitoring app, health coaching plus low-carb diet reverses diabetes progression by lowering average HbA1c from 7.6% to 6.3% and weight reduction of 12% (2/8/18)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/johns-hopkins-study-coaching-app-sweetch-can-increase-weight-loss-activity-prediabetes Johns Hopkins study: coaching app can increase weight loss, activity in prediabetes patients (3/8/18)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481661/ Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction. Participants lost an average of 3.23% total body weight (TBW) at 4 months of coaching. (6/8/17)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/oby.21723/full Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. (1/26/17)]&lt;br /&gt;
* [http://www.annfammed.org/content/14/3/200.full Health coaching is effective for chronic disease self-management in the primary care safety-net setting. Most clinical outcomes improvements persisted 1 year after the completion of the health coaching intervention. (5/2016)]&lt;br /&gt;
* [http://medcitynews.com/2014/03/patient-navigators-helped-diabetics-improve-blood-glucose-control-32-cleveland-clinic-pilot/ Diabetics + patient navigators improved blood glucose control by 32% in Cleveland Clinic pilot (3/18/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/05/your-patient-should-get-a-health-coach-heres-why.html Health coaching improves the management of chronic diseases. It is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care. (5/15/16)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=The+effects+of+health+coaching+on+adult+patients+with+chronic+diseases:+a+systematic+review Health coaching improves the management of chronic diseases (11/2014)]&lt;br /&gt;
Diabetes Prevention&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/417.abstract YMCA Of The USA Diabetes Prevention Program saved $278 per member per quarter during the first three years of the intervention period. Nine fewer ED visits per 1,000 participants per quarter. (3/2017)]&lt;br /&gt;
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Virtual Programs&lt;br /&gt;
* [http://mhealth.jmir.org/2017/6/e80/ App-based health coaching program demonstrated an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% of the participants achieved a clinically significant weight loss of 5% (7/2017)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-shows-seniors-risk-diabetes-and-heart-disease-lose-weight-reduce-healthcare-costs Digital behavioral health coaching program from Omada Health has been shown to reduce overweight and obese seniors' risk of developing type 2 diabetes and heart disease by helping them lose weight and adopt healthier behaviors. (10/13/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-health-coaching-app-nooms-weight-loss-outcomes-comparable-traditional-diabetes 64% of the 43 overweight or obese adult participants, with a diagnosis of prediabetes, people using health coaching app during 24 week program lost more than 5 percent of their weight, which is comparable to the Centers for Disease Control’s findings from traditional diabetes prevention programs. (9/8/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-canary-health%E2%80%99s-digital-diabetes-management-program-helpful-across-five-key Digital health diabetes program that help people with diabetes self-manage their health through online workshops, coaching, and medication adherence and emotional support showed improvement across five key indicators – blood sugar levels, medication adherence and exercise all improved, hypoglycemic symptoms decreased in frequency, and depression symptoms improved. (8/31/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mhn-2016-how-ochsner-used-connected-devices-text-messages-bring-two-thirds-hypertension  Ochsner used connected devices, text messages, health coaching and medication management assistance to bring two-thirds of hypertension patients within range (6/22/16)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#High_Need_High_Cost High Need High Cost] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/441.abstract Initiative to reduce avoidable hospitalizations among nursing facility residents reduced per resident average of $60–$2,248 for all-cause hospitalizations and by $98–$577 for potentially avoidable hospitalizations. (3/2017)]&lt;br /&gt;
* [http://khn.org/news/tackling-patients-social-problems-can-cut-health-costs/amp/ Houston’s Patient Care Intervention Center program has reduce patient costs in program by 83% and hospital visits by 70%. The program developed by the Camden Coalition led by Dr. Jeffrey Brenner uses social workers who seek out high-need-high-cost patients to address social needs such as securing stable housing. (1/23/17)]&lt;br /&gt;
* [http://m.startribune.com/apartment-job-it-s-just-what-the-doctor-ordered/408873365/ Hennepin Health's outreach efforts helps clients find a job or an apartment — the project has shown it can improve patients’ health while saving money and greatly reducing the number of times they turn up at the ER in crisis. (12/30/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/coordinated-care-clinic-cuts-super-user-hospitalizations-by-a-quarter A strategy focused on team-based care and listening to “super-users” helped a Florida health system cut hospitalizations of such patients by a quarter while also driving down uninsured admissions (8/24/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/care-coordinators-work-high-needs-patients-medical-practices  Intensive Outpatient Care Program (IOCP), which embeds care coordinators in medical practices. Care coordinators work with high-needs patients in medical practice where patients, emergency room visits declined 59 percent and admissions declined 29 percent. (8/22/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/project-echo Complex Care Initiative: Building Capacity to Help “Superutilizers” in Underserved Communities. Number of hospitalizations among participants fell by 27% and emergency department visits dropped by 32%. (8/9/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients  Study compares the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. (8/7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/intensive-care-coordination-saves-14m-super-user-costs 'Intensive care coordination' saves $14M in superuser costs (6/27/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/02/02/using-the-intensive-outpatient-care-program-to-lower-costs-and-improve-care-for-high-cost-patients/ Intensive Outpatient Care Program (IOCP) in commercial populations show a reduction in costs among the medically complex by up to 20 percent. (2/2/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/nation/2014/09/16/focus-on-super-utilizers-cuts-costs/14648069/ Programs focus on high-risk patients to reduce spending (9/16/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.abstract Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients (6/2012)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Home_Care Home Care] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/member-engagement/paramedic-house-calls-help-blue-cross-and-blue-shield-new-mexico-reduce-er-usage How paramedics helped Blue Cross Blue Shield of New Mexico reduce ER usage, readmissions (8/9/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/hospital-at-home Hospital at Home Model: Bringing hospital-level care to the patient results in lower readmissions, better outcomes and lower costs. 92% of patients offered the service took it. It has high patient satisfaction, as patients remained close to their support networks and had less disruption to their lives. (8/22/16)]&lt;br /&gt;
* [http://www.healthleadersmedia.com/quality/front-loaded-home-care-and-office-visits-may-reduce-heart-failure-readmissions A new study finds that front-loaded home care combined with physician office visits shows promise in reducing HF readmissions. (8/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-at-home-model-gains-steam-as-mt-sinai-program-cuts-costs-readmissions Mt. Sinai Hospital's Mobile Acute Care Team (MACT) program delivers hospital-quality home care for patients who are at high risk for readmission. The pilot program cut costs by nearly 20 percent (6/6/16)]&lt;br /&gt;
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Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/sep/sweden-senior-alert-case-study Senior Alert program resulting in 30% reduction in falls, decline in pressure ulcers from 14.3% to 9.4%, and a decline in the incidence of weight losses greater than 5 percent of total body weight from 14.3% of patients to 12.5%. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/study-finds-benefits-when-seniors-call-shots-to-help-them/amp/ Aging in place program asks low-income seniors with disabilities how their lives at home could be better. At the end of the program, 75% of participants were able to perform more daily activities than they could before and symptoms of depression also improved. (9/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/minnesota-health-systems-telehealth-program-seniors-leads-better-outcomes-engagement Telehealth program for seniors leads to better outcomes (86.7% reduction in realized versus expected hospitalization rates) and better engagement (94% of patients interact with the technology and report in their vital signs every day, compared to less than 25% percent in a 2014 national survey of patients in telehealth programs). (8/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/9/1558.abstract?=right Home-Based Care Program Reduces Disability And Promotes Aging In Place. 75% of participants improved their performance of activities of daily living (ADLs)after completing the five-month program. (9/2016)]&lt;br /&gt;
* [http://www.pbs.org/newshour/updates/coordinated-care-gives-patients-freedom-stay-home/ How coordinated care gives patients the freedom to stay at home (7/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/spain-offers-telemedicine-connect-elderly-population-medical-care/ The Basque region of Spain saved $55 million and eliminated 55,000 visits with a telemedicine program aimed at the elderly. (11/15/13)]&lt;br /&gt;
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Falls Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/6/971.abstract In the three years after The LIFT (Living Independently and Falls-free Together) Wellness Program, that included a comprehensive in-home assessment by a registered nurse, participants had a 33% lower incidence of claims for long-term care services and supports (6/2015)]&lt;br /&gt;
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Home-Based Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/overview-home-based-primary-care Medicare’s Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program (6/7/17)]&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/425.short Study finds 5 innovative Home Visit models associated with reductions in costs, hospitalizations, and emergency department use (3/2017)]&lt;br /&gt;
* Home Visits - [http://www.fiercehealthcare.com/healthcare/hospital-workers-visit-patient-homes-to-reduce-er-visits?utm_source=feedly Children's Hospital of Philadelphia (CHOP) sends home visitors to high-risk asthma patients in inner-city Philadelphia (7/29/13)]&lt;br /&gt;
*  [http://content.healthaffairs.org/content/35/1/28.abstract House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care (1/2016)]&lt;br /&gt;
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Medical House Calls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/jul/medstar-washington-hospital-center Medical House Call Program reduced Medicare spending by 20 percent relative to expected spending for that population ($4,060 vs. $5,076) (7/27/16)]&lt;br /&gt;
* [http://khn.org/news/doctors-house-calls-saving-money-for-medicare/ Doctors’ house calls saving Medicare an average of almost $13,600 for each patient in a pilot project. (5/23/16)]&lt;br /&gt;
* [http://www.npr.org/2015/11/08/448406540/doctor-treats-homebound-patients-often-unseen-even-by-neighbors Doctor Treats Homebound Patients, Often Unseen Even By Neighbors (11/8/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2138.abstract Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits (12/2015)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2014/08/07/338393136/house-calls-keep-people-out-of-nursing-homes-and-save-money House Calls Keep People Out Of Nursing Homes And Save Money (8/7/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medical_Home Medical Home] - ''What Works?''===&lt;br /&gt;
Ensuring followup on referrals and recommended preventive screening completed based on [https://www.uspreventiveservicestaskforce.org/BrowseRec/Index USPSTF] recommendations.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-home-model-improves-care-but-not-costs-among-safety-net-providers.html Medical home model improves care, but not costs among safety-net providers (6/27/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/mar/review-of-medical-homes Review of Medical Homes Shows Reduction in Spending for High-Risk Patients, But Design and Implementation Matter (3/28/17)]&lt;br /&gt;
* [http://www.startribune.com/health-care-homes-save-minnesota-1-billion/368187001/ Health care 'homes' save Minnesota $1 billion (2/9/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/11/1985.abstract A “medical village” of providers and community-based resources for patients with diabetes, asthma, and congestive heart failure reduced ED visits by 29.7% percent and hospitalizations by 28.5% (11/2014)]&lt;br /&gt;
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Care Gaps &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.healthcareitnews.com/news/population-health-done-three-ways?single-page=true 3 Healthcare systems explain the technology, process and grit they used to close care gaps needed to improve patient care. (11/3/15)]&lt;br /&gt;
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Care Plan Development &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1627.abstract?rss=1 Moving paradigm from determining “what is the matter?” to discovering “what matters to you?” improves health outcomes (9/2014)]&lt;br /&gt;
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Oncology &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/433.abstract?=right Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending (3/2017)]&lt;br /&gt;
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Preventive Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/prevention/index.html If everyone in the country received recommended clinical care, we could save over 100,000 lives a year. (5/31/17)]&lt;br /&gt;
* [http://m.startribune.com/don-t-smoke-get-your-shots-minnesota-researchers-say-in-influential-study/410159785/ Comparing 28 recommended preventive services, HealthPartners researchers found that tobacco counseling and pediatric immunizations outranked the others in cost-effectiveness and the potential to save lives. (1/9/17)]&lt;br /&gt;
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Patient Centered Medical Homes (PCMH) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/report-pcmh-programs-cut-costs-improve-quality-but-collaboration-key-to-success PCMH programs cut costs and improve quality. Collaboration is the key to their success (7/11/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/patient-centered-medical-homes-systematic-differences A study of 11 PCMH initiatives showed little improvement in costs, utilization, or quality. (3/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/bcbs-michigan-marks-further-expansion-pcmh-model Blue Cross Blue Shield of Michigan's Patient Centered Medical Home (PCMH) program for primary care practices reduced medical costs by $427 million, in part due to lower healthcare utilization. 2016 data show BCBSM-designated PCMH practices had a 15.2% lower rate of adult emergency department visits and 21.4% lower rate of hospital admissions for certain conditions. (9/13/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/study-patient-centered-medical-homes-reduce-er-visits-among-chronically-ill/ Study: Patient-centered medical homes reduce ER visits among chronically ill (9/3/14)]&lt;br /&gt;
* [https://ehrintelligence.com/news/pcmhs-produce-21-lower-healthcare-costs-for-chronically-ill/ Patient-centered medical homes (PCMH) can cut more than 20% off the treatment cost for a chronically ill patient (7/24/13)]&lt;br /&gt;
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Primary Care Practices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/study-primary-care-continuity-could-help-reduce-hospital-admissions.html Patients with high continuity of care were admitted to the hospital 12.49% fewer times than those with low continuity of care (2/2/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/greater-primary-care-involvement-leads-to-lower-end-of-life-care-costs-study-finds.html Patients who resided in regions with the most primary care involvement accrued roughly $4,000 less in Medicare spending in their last two years of life, spent nearly 1.4 fewer days in the intensive care unit in their last six months of life and were less likely to be enrolled in hospice. (1/9/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/study-continuity-care-reduces-risk-ed-visits Seniors that consistently see the same physician in an outpatient setting are 20% less likely to go to the emergency department (8/25/16)]&lt;br /&gt;
* [https://www.bostonglobe.com/business/2015/05/03/iora-health-pioneers-new-primary-care-model/kc7V4W5V8OJ0gxFqY4zBrK/story.html Primary Care Physicians deliver 12% lower healthcare costs, 37% lower hospitalization at one site (5/4/2015)]&lt;br /&gt;
* [http://www.annfammed.org/content/13/3/206 Increasing family physician comprehensiveness of care is associated with decreasing Medicare costs and hospitalizations. (5/2015)]&lt;br /&gt;
* [http://www.prnewswire.com/news-releases/new-primary-care-model-delivers-20-percent-lower-overall-healthcare-costs-increases-patient-satisfaction-and-delivers-better-care-300021116.html Primary Care Physicians deliver 20% lower overall healthcare costs, increase patient satisfaction (1/15/2015)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/how-an-aco-led-by-doctors-helped-cut-the-cost-of-care-in-texas-town/ How an ACO led by doctors helped cut the cost of care in Texas town (9/24/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf Evidence shows that primary care helps prevent illness and death (2005).]&lt;br /&gt;
Virtual Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/population-health-lessons-from-banner-health-s-telemedicine-program When Banner Health launched its iCare telemedicine program, patients didn't use it because it required them to replace their primary care physician. Once they changed that rule, very few patients have left the program voluntarily, and Banner Health saw costs per beneficiary drop by 27% while hospitalizations were reduced by 45%. (12/5/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medication_Management Medication Management] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/3-ways-to-improve-patients-medication-adherence 3 ways to improve patients’ medication adherence (8/25/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/childrens-health-uses-ingestible-sensor-improve-adherence-adolescent-transplant-patients Children's Health uses ingestible sensor to improve adherence in adolescent transplant patients (2/22/17)]&lt;br /&gt;
* [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170905 Pharmacogenetic testing of polypharmacy home health patients aged 50 and older considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare. (2/2/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/walgreens-pill-reminder-activity-tracking-both-improved-medication-adherence-study Walgreens pill reminder, activity tracking both improved medication adherence in study (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/study-quantifies-healthcare-costs-for-medication-adherence-and-non-adherence Patients with multiple medical conditions who adhered to their prescription schedules who had diabetes saved $5,341 annually in medical costs; those who had hypertension saved $4,423, while those who had high cholesterol saved $2,081  (8/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/interventions-to-keep-chronic-illness-patients-on-their-meds-could-save-billions.html  Interventions to keep chronic illness patients on their meds could save billions (8/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/08/medacheck-double-medication-adherence/ The study of 35 patients aged 12-20 with a baseline medication adherence of 42-43%. After 6 months, those with mobile app only increased to 60% and those with the app and reminder calls 85.4% (8/22/16)]&lt;br /&gt;
* [http://khn.org/news/syncing-up-drug-refills-a-way-to-get-patients-to-take-their-medicine/amp/ Syncing Up Drug Refills: A Way To Get Patients To Take Their Medicine (8/8/16)]&lt;br /&gt;
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* [https://ehrintelligence.com/news/how-pharmacy-patient-engagement-boosted-medication-adherence Study shows that the use of a high-touch pharmacy patient engagement system made patients 2.57 times more likely to stay adherent to their medications. (10/27/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1444.abstract Pennsylvania Pharmacist Project significantly improved adherence for all medication classes, from 4.8% for oral diabetes medications to 3.1% for beta-blockers. It also helped reduce per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). (8/2014)]&lt;br /&gt;
During Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/study-medication-reconciliation-programs-halve-hospital-readmissions-6.html Hospital readmission decreased 50 percent when pharmacists reviewed patients' medication regimens and provided counseling during transitions from hospital to home (7/15/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1222.abstract Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs. The program saved $2 for every $1 spent. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/prescription-assistance-programs-lead-to-drop-er-visits Prescription assistance programs lead to drop in ER visits (4/7/16)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Palliative_Care Palliative Care] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/pre-hospice-saves-money-by-keeping-people-at-home-near-the-end-of-life/amp/ ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life (3/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/community-based-palliative-care-may-decrease-ed-visits-study-finds.html Dying patients who received community-based palliative care visited the emergency department half as much in their last year of life, according to a study. (2/22/17)]&lt;br /&gt;
* [http://www.managedcaremag.com/archives/2016/7/palliative-care-improves-quality-care-lowers-costs Aetna’s Compassionate Care Program resulted in improved member satisfaction, an 81% decrease in inpatient days, and net savings of $12,000 per participating member (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/early-palliative-care-can-save-money-reduce-patient-stay-hospital Early palliative care can save money, reduce patient stay in hospital (7/1/15)]&lt;br /&gt;
* [http://healthleadersmedia.com/page-3/LED-283076/Hospitals-Opting-for-Palliative-Care University of Rochester Medical Centers in 2007 found the palliative care intervention saved about 1,400 ICU patient days, at an average of about $450 a day. (8/6/12)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Transitional_Care_Management Transitional Care Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/christiana-care-uses-analytics-for-better-care-coordination-post-discharge Christiana uses its CareLink CareNow infrastructure to help coordinating care for close to 75,000 Medicare beneficiaries beyond discharge. The system has seen a 30% reduction in 90-day readmission rates. (6/19/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/involving-patient-s-family-in-discharge-process-linked-to-25-reduction-in-hospital-readmissions.html Involving patient's family in discharge process linked to 25% reduction in hospital readmissions (4/4/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/a-focused-primary-care-visit-after-hospital-stay-lowers-risk-readmission Patients who had one or more primary care visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician. (11/22/16)]&lt;br /&gt;
* [http://khn.org/news/gaps-in-care-persist-during-transition-from-hospital-to-home/amp/ San Diego County program saved Medicare an estimated $13.8 million (reduced hospital readmissions) over a two-year period with a care transition program that sends nurses and social workers into homes to ensure transitions go smoothly, checking medications one by one, making sure they know how to take them, walking through the house looking things that could cause a fall, asking about caregivers to help with bathing and dressing. (9/6/16)]&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20151205/MAGAZINE/312059995 Hospitals with the lowest readmission rates. Roper St. Francis Healthcare's Care Transitions Program helps elderly patients recognize symptoms of health decline and assists them in managing their medications.  University of Colorado Health's Memorial Hospital assigns a case manager to follow up with patients at risk of heart failure, stroke, pneumonia or heart attack. Hospital for Special Surgery in New York City is developing a mobile application that will allow staff to interact with patients remotely post-discharge. (12/5/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-intervention-cuts-readmissions-for-patients-at-risk-for-delirium-suicide Hospital intervention cuts readmissions for patients at risk for delirium, suicide (7/1/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1531.abstract?rss=1 Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses (9/2014)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/10-recent-stories-studies-on-reducing-readmissions.html 10 stories, studies on reducing readmissions (8/18/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-ritz-carlton-helped-one-hospital-reduce-readmissions-to-74-percent How Ritz-Carlton helped one hospital reduce readmissions to .74 percent for knee and hip replacements (7/15/14)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=1868538 JAMA Studies 18 Activities That Are Preventing 30-Day Hospital Readmissions (7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/beth-israel-deaconess-lowers-readmissions-post-discharge-program Beth Israel Deaconess lowers readmissions with post-discharge program (4/4/14)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/study-social-work-interventions-reduce-readmission-rates-half/2013-07-05?utm_source=rss&amp;amp;utm_medium=rss study] demonstrated high risk patients being discharged from the hospital that receive social work interventions reduce readmission rates to 7% as compared to the 15 percent readmission rate for the control group--patients discharged (7/5/13)&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/reduce-readmissions-by-giving-transitional-care-a-personal-touch Three nonprofit hospitals in the Bronx, N.Y. significantly dropped readmission rates thanks to personal contact with patients before and after discharge (6/28/13)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/hospital-community-collaboration-reduced-readmissions-4570/2013-05-30?utm_source=rss&amp;amp;utm_medium=rss collaborative initiative involving 83 hospitals and 93 community partners in Minnesota] saw 4,570 fewer avoidable hospital readmissions over 24 months, saving more than $40 million by using comprehensive discharge planning, medication management, patient engagement, transition care support, and transition communications. (5/30/13)&lt;br /&gt;
* [http://circoutcomes.ahajournals.org/content/6/4/444.full Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure (5/15/13)]&lt;br /&gt;
Post Surgical Follow-up &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-app-based-visits-seem-viable-post-surgical-follow-ups App-based visits seem viable for post-surgical follow-ups (3/23/17)]&lt;br /&gt;
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==[[Health Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Health_Services#Consumer_Diagnostic_Services Consumer Diagnostic Services] - ''What Works?''===&lt;br /&gt;
DNA Testing &amp;lt;br&amp;gt;&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Health_Services#Convenient_Access Convenient Access] - ''What Works?''===&lt;br /&gt;
24x7 Managing Health Services &amp;lt;br&amp;gt;&lt;br /&gt;
Hot Spotters&lt;br /&gt;
* [http://www.newyorker.com/magazine/2011/01/24/the-hot-spotters Dr. Jeffrey Brenner analyzed data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million. Dr. Brenner secured funding and approvals to begin a Wellness Program at Northgate II tower that housed the high cost high need patients. (1/24/11)]&lt;br /&gt;
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Mental Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://apps.bostonglobe.com/spotlight/the-desperate-and-the-dead/series/solutions/ San Antonio built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless that resembles a community college. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/11/16)]&lt;br /&gt;
* [http://www.khi.org/news/article/leader-of-kck-mental-health-center-touts-savings-from-care Mental health crisis center saved $6 million last year by stabilizing people in crisis who otherwise would have ended up in state hospitals, local emergency rooms or jails and prisons. (11/15/16)]&lt;br /&gt;
Same Day Appointments &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/01/toby-cosgrove-cleveland-clinic-felt-urgency-day-appointments/ In 2016, Cleveland Clinic had 1.3 million same-day appointments. CEO Toby Cosgrove stated that every patient who calls the Clinic is asked whether he or she would like to see a doctor that same day. 98% of the people who asked to be seen the same day was successful in doing so. (1/10/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Education Education] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/west-virginia-hospital-system-sees-readmission-reductions-patient-education-initiative Charleston Area Medical Center was able to reduce readmission rates for Congestive Heart Failure by over 22% and COPD by almost 30% with educational videos to help patients self-manage their health. (2/9/17)]&lt;br /&gt;
* [http://www.choosingwisely.org/doctor-patient-lists/ '''Choosing Wisely'''] provides decision making education for physicians and patients on over 135 tests and treatments that they say are overused or inappropriate.&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/holistic-education-led-to-dramatic-improvements-for-diabetes-patients Holistic education led to dramatic improvements for diabetes patients (8/11/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/south-carolina-initiative-cuts-readmissions-through-cooperation-education South Carolina initiative cuts readmissions through cooperation, education (7/8/15)]&lt;br /&gt;
&lt;br /&gt;
Behavioral&lt;br /&gt;
* [http://oregonstate.edu/ua/ncs/archives/2015/nov/changing-habits-improve-health-new-study-indicates-behavior-changes-work More than 80 percent of the randomized clinical trials that included a behavioral intervention reported a significant improvement for the targeted behavior and a significant physiological impact such a reduction in weight or blood pressure. (11/10/15)]&lt;br /&gt;
&lt;br /&gt;
Self-Administer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care Parkland Health &amp;amp; Hospital System trained over 1,000 patients to self-administer IV antibiotics in their homes. In the first four years of this effort, these patients experienced a 47% lower 30-day hospital-readmission rate than those receiving treatments in an outpatient facility while the mortality rates of both groups were similar. (6/2/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Decision_Making Decision Making] - ''What Works?''===&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/shared-decision-making-improves-outcomes-satisfaction-for-orthopedic-patients Study: Shared decision-making boosts patient outcomes, leads to higher satisfaction rates (3/15/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Decision_Making Digital Therapeutics] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Health_Services#Home Home] - ''What Works?''===&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/home-visits-help-new-parents-overcome-tough-histories-raise-healthy-children/amp/ Home Visits Help New Parents Overcome Tough Histories, Raise Healthy Children (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Housing and Healthcare Integration &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/new-integrated-model-care-for-seniors-lowers-hospitalizations-readmissions-emergency Clinical outcomes of an integrated model of care for frail seniors that bridges housing and healthcare. 50% lower inpatient hospitalization rates, 80% lower readmission rates, 15% lower rate of emergency department use (3/23/17)]&lt;br /&gt;
Medication Reconciliation &amp;lt;br&amp;gt;&lt;br /&gt;
Paramedic Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1111/jgs.14484/full Only 22% of Paramedic responses required transport; 78% were evaluated and treated in the home. Paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals’ homes. (8-30-16)]&lt;br /&gt;
Passive Data Analysis &amp;lt;br&amp;gt;&lt;br /&gt;
Passive Data Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
*  [http://www.cnn.com/2014/08/25/tech/innovation/alzheimers-smart-home/ Sensors let Alzheimer's patients stay at home, safely (10/12/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Therapeutic_Services Therapeutic Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
Behavioral Health&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/05/valera-health-app-shows-boost-in-engagement-from-patients-with-depression-anxiety/ Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)]&lt;br /&gt;
* [http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs/ 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/06/telepsychiatry-reduces-wait-times-psyciatric-exams-4-days-10-hours-sc-hospital/ In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)]&lt;br /&gt;
* [http://khn.org/news/telephone-therapy-helps-older-people-in-underserved-rural-areas-study-finds/ Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)]&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/study-real-time-symptom-reporting-helps-cancer-patients-live-longer Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)]&lt;br /&gt;
Cardiac Rehab &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/veterans-respond-well-home-based-cardiac-rehab-app-va-study-shows Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)] &lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2016-03/acoc-dht032216.php Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)]&lt;br /&gt;
* [http://newsnetwork.mayoclinic.org/discussion/cardiac-rehab-patients-who-use-smartphone-app-recover-better-mayo-clinic-research-shows Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092 To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/04/11/well/live/tackling-weight-loss-and-diabetes-with-video-chats.html Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)] &lt;br /&gt;
* [http://www.mobihealthnews.com/content/one-drop-shares-data-showing-app-reduces-a1c-1-percent One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)]&lt;br /&gt;
* [https://www.imedicalapps.com/2017/04/omada-humana-diabetes-study/ Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2017/03/diabetes-online-intervention-study/ Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)]&lt;br /&gt;
* [http://medcitynews.com/2016/09/mississippi-telehealth-remote-monitoring/ Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article116582423.html Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mobile-diabetes-intervention-reduced-hba1c-2-percentage-points-more-standard-care Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)]&lt;br /&gt;
Parkinson &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/nhs-study-finds-mobile-app-improves-management-quality-doctor-visits-people-parkinsons NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)]&lt;br /&gt;
Physical Therapy &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://medcitynews.com/2017/03/virtual-rehab-gain-ground-orthopedics-bundled-payments-take-hold/ Virtual rehab to gain ground in orthopedics as bundled payments take hold (3/14/17)]&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170823.061630/full/ Over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population (8/23/17)]&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0454-y Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/webmds-app-enabled-weight-loss-pilot-helped-800-verizon-employees-lose-weight App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/11/medicare-patients-lose-weight/ A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)]&lt;br /&gt;
* [http://medcitynews.com/2015/06/pwc-infograph-virtual-care-cuts-down-diabetes-costs/ Virtual care reduces diabetes costs by 9% (6/26/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Virtual_Medical_Services Virtual Medical Services] - ''What Works?''===&lt;br /&gt;
Tele-Health Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/04/how-to-measure-roi-of-telemedicine/ INTEGRIS reduced cost of treating low acuity, non-emergent medical conditions such as upper respiratory infections (URI). In 2016, the cost for onsite visits to treat URIs was $383,702. During the first three months of 2017, costs to treat URI patients virtually was only $9,744. It is expected to save hundreds of thousands of dollars annually (4/20/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-shows-telemedicine-can-improve-screening-access-efficiency-diabetes-caused JAMA study shows telemedicine can improve screening access, efficiency for diabetes-caused blindness in LA County safety net populations (4/11/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/26/519543337/telehealth-doctor-visits-may-be-handy-but-arent-cheaper-overall Telehealth Doctor Visits May Be Handy, But Aren't Cheaper Overall (3/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/how-mercy-created-a-54m-virtual-hospital-in-st-louis.html Virtual Care Center has led to a more than 33 percent decrease in Mercy's emergency room visits and hospitalizations. (9/15/16)]&lt;br /&gt;
Virtual Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/whatsapp-second-medical-opinion-diagnosing/ 20 oral pathologists gathered virtually using the WhatsApp Broadcast functionality to get a second opinions. The accuracy of the 4,940 second opinion diagnoses (SOD) was 98% correctly diagnosed. (11/22/16)]&lt;br /&gt;
&lt;br /&gt;
==[[Digital Health Technology]] - ''What Works?''==&lt;br /&gt;
[[Digital Health Technology]] that enable [[Medical Interventions]] and [[Non-Medical Interventions]] to more efficiently and effectively help improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Devices Devices] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-wearables-may-help-detect-serious-illness Study finds wearables may help detect serious illness (1/12/17)]&lt;br /&gt;
* [http://www.healthcareitnews.com/news/va-study-wearables-ai-shows-promise-heart-failure-patients VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)]&lt;br /&gt;
Activity Trackers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://mobihealthnews.com/content/study-walkadoo-increased-employee-activity-nearly-1000-steps-day Activity platform with adaptable, tailored reminders and activity trackers increased employee activity by an average of 970 steps per day compared to control group with just the trackers. (2/9/16)]&lt;br /&gt;
Continuous Glucose Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.mobihealthnews.com/content/study-dexcom-finds-cgms-can-benefit-type-2-patients-too A study published in Annals of Internal Medicine and sponsored by Dexcom shows that a continuous glucose monitor could lower the HbA1c scores of people with Type 2 diabetes (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Communications Digital Communications] - ''What Works?''===&lt;br /&gt;
* [http://www.mercurynews.com/2016/11/28/elders-who-use-tech-tools-feel-less-lonely-more-physically-fit-stanford-study-finds/ Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)]&lt;br /&gt;
* [http://stateofreform.com/wp-content/uploads/2015/12/AJMC_12_2015_Reed-final.pdf Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)]&lt;br /&gt;
* [http://www.cityam.stfi.re/230372/digital-health-wearables-and-apps-9-in-10-brazilian-doctors-use-whatsapp-to-talk-to-patients?sf=vkrgwp 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/12/mobile-health-company-offers-way-to-improve-interactions-between-medicaid-care-managers-and-patients/ Mobile health company offers way to improve interactions with Medicaid patients, care managers by demonstrating a 12% increase in prescription refills, a 40% increase in attending health appointments and a 22% increase in their knowledge of the recommended lifestyle changes for their care plan. (12/5/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/the-doctor-will-email-you-now.html Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/8/1361.abstract Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Regulating_Therapies Digital Regulating Therapies] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Mobile_Apps Mobile Apps] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Patient_Provided_Data Patient Provided Data] - ''What Works?''===&lt;br /&gt;
* [http://careathand.com/assets/attachments/Avalere-18Nov2015.pdf Three-minute surveys on mobile device by frontline personnel helped detect clinically relevant alerts for intervention. Medicare beneficiaries with 3 or more admissions in the prior year had 29.2% decrease in inpatient admissions and $28,656 reduction in Medicare A inpatient expenditures per beneficiary per year. (11/18/15)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/07/28/century-house-call/tdupWvOQI6b3dKdKcEgdGM/story.html Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Monitoring_and_Management Monitoring &amp;amp; Management] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Text_Messaging Text Messaging] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-texting-improve-medication-adherence-shows-high-engagement Study: Texting to improve medication adherence shows high engagement (5/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/using-patient-engagement-strategies-to-increase-colon-cancer-screenings Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)]&lt;br /&gt;
* [http://www.denverpost.com/2016/10/13/denver-health-text-messages/ Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2495276%20 A text-based smoking cessation intervention improve outcomes among young people. (3/2016)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2484905 Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-patients-who-receive-texts-from-physicians-more-likely-to-exercise.html Study: Patients who receive texts from physicians more likely to exercise (12/14/15)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=Feasibility+of+a+Text+Messaging+Intervention+to+Promote+Self-Management+for+Patients+Prescribed+Oral+Anticancer+Agents. Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2442937 Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)]&lt;br /&gt;
* [http://talkspace.com/online-therapy/wp-content/uploads/2015/06/Talkspace-Preliminary-Research-Study.pdf 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Virtual_Visits_Technology Virtual Visits Technology] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
==[[Support Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Caregiver_Support Caregiver Support] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/boot-camp-helps-alzheimers-dementia-caregivers-take-care-of-themselves-too/ ‘Boot Camp’ Helps Alzheimer’s, Dementia Caregivers Take Care Of Themselves, Too (5/9/17)]&lt;br /&gt;
* [http://khn.org/news/teaching-in-home-caregivers-seems-to-pay-off/amp/ Teaching In-Home Caregivers results in emergency room visits declining by 24% in the first year after caregivers were trained and 41% in the second year (8/11/16)]&lt;br /&gt;
* [http://in.reuters.com/article/us-dementia-caregivers-stress-idINKBN0GJ21920140819 More evidence adult daycare eases stress on dementia caregivers (8/20/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/605.abstract?rss=1 North Dakota Assistance Program For Dementia Caregivers Lowered Utilization, Produced Savings, And Increased Empowerment (4/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/596.abstract?rss=1 Enhanced support services for caregivers of people with dementia have been shown to improve caregivers’ capabilities and well-being and delay patients’ institutionalization (4/2014)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_Health_Worker Community Health Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.uphs.upenn.edu/news/News_Releases/2014/02/kangovi/ Penn's Innovative Community Health Worker Model Improves Outcomes for High-Risk Patients (2/10/14)]&lt;br /&gt;
* [http://medcitynews.com/2014/04/new-idea-extending-reach-care-team-hiring-training-grandparents/ A not-for-profit trains grandparents to work as grand-aides, helps reduce readmissions by over 50% and get medication adherence of 91%. (4/8/14)]&lt;br /&gt;
* [http://www.latimes.com/nation/la-na-healthcare-collaboration-20140319-dto-htmlstory.html#ixzz2wQzyYytp Northern Maine - coordination among businesses and health workers helped to improve health outcomes. (3/19/14)]&lt;br /&gt;
* [http://khn.org/news/volunteers-assist-seniors-by-taking-notes-during-medical-appointments/ Note Takers Help The Elderly At The Doctor (2/28/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_and_Social_Services Community &amp;amp; Social Services] - ''What Works?''===&lt;br /&gt;
* [http://www.dispatch.com/content/stories/local/2016/08/07/medicaid-insurer-provides-life-services-to-connect-clients-with-education-jobs.html Medicaid insurer provides ‘life services’ to connect clients with education, jobs (8/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/faithhealthnc-offers-spiritual-emotional-support-after-discharge Faith Health program has helped to reduce readmissions through a volunteer initiative aimed at helping patients get the emotional support they need after discharge. (6/27/16)] &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/5/760.abstract States with a higher ratio of social to health spending (social spending divided by Medicare and Medicaid spending) had better subsequent health outcome, including for: adult obesity, asthma, mentally unhealthy days, days with activity limitation, mortality rates for lung cancer, acute myocardial infarction and type 2 diabetes. (5/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-one-health-system-addressed-2-000-patients-social-needs-in-2-years.html  Health system addressed 2,000 patients' social needs in 2 years. Undergraduate students from local universities, called advocates, connect patients with resources for food stamps, subsidized child care or housing or payment plans and discounts for their electricity bills. (6/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/3/544.abstract Strong Social Support Services, Such As Transportation And Help For Caregivers, Can Lead To Lower Health Care Use And Costs (3/2013)]&lt;br /&gt;
* [http://www.spokesman.com/stories/2014/may/19/hospitals-say-online-language-services-help-reduce/ Providence turns to online interpreters to improve health outcomes (5/19/14)]&lt;br /&gt;
* [http://www.communityplans.net/LinkClick.aspx?fileticket=wcPKMzqiacQ%3d&amp;amp;tabid=214&amp;amp;mid=718&amp;amp;forcedownload=true Positively Impacting Social Determinants of Health - How Safety Net Health Plans Lead the Way (6/2014)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/02/12/oregon-bridges-the-gap-between-health-care-and-community-based-health/ Oregon is showing success in integrating of health care with social services and public health (2/12/15)]&lt;br /&gt;
* [http://healthyamericans.org/report/110/ 79 evidence-based disease and injury prevention programs that have saved lives and improved health. (11/2013)]&lt;br /&gt;
* [https://uwphi.pophealth.wisc.edu/programs/match/healthiest-state/what-works-rural-report-july-2015.pdf What Works? Strategies to Improve Rural Health (7/2015)]&lt;br /&gt;
* [https://www.icsi.org/_asset/pvr9ot/lessonslearned.pdf Lessons Learned: Leaders Successfully Stepping Out to Transform Health and Health Care (4/2015]&lt;br /&gt;
* [http://www.bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Research provide evidence that addressing social determinants of health can improve health and reduce health care costs. Study describes effective interventions 7 Housing examples, 5 Nutrition Assistance examples, 2 Income Support examples, public safety and education examples. (6/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Employment_Support Employment] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1098.abstract Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives. Yet funding is lacking. (6/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Financial_Counseling Financial Counseling] - ''What Works?''===&lt;br /&gt;
* [http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ Insured patients can save money by pretending to be uninsured (1/3/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Home_Support Home Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Housing_Support Housing Support] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/this-hospital-is-giving-free-housing-to-frequent-er-patients.html Hospital provides free housing to frequent ER patients. $3,000 per day to care for patients who frequently visit the emergency room or approximately $33 per day for an apartment. (6/30/16)]&lt;br /&gt;
* [http://khn.org/news/old-motels-get-new-life-helping-homeless-heal/amp/Old Motels Get New Life Helping Homeless Heal (6/29/16)]&lt;br /&gt;
* [http://www.npr.org/2015/12/10/459100751/utah-reduced-chronic-homelessness-by-91-percent-heres-how Utah Reduced Chronic Homelessness By 91 Percent; HUD estimates that annual cost of homelessness is between $30,000 and $50,000 per person because of services like emergency room visits and jail time. (12/10/15)]&lt;br /&gt;
* [http://www.leadingage.org/Affordable_Senior_Housing_Plus_Services_Program_Slows_Growth_in_Medicare_Costs.aspx Affordable Senior Housing Plus Services Program Slows Growth in Medicare Costs (12/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/homeless-navigators-help-reduce-er-use-readmissions?utm_source=feedly 'Homeless navigators' help reduce ER use, readmissions (10/25/13)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/20.abstract Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing (1/2016)]&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Housing First program for people experiencing chronic homelessness in Seattle and Boston results in $29,388 per person per year in net savings, and $8,949 per person per year in net savings, respectively (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Special Homeless Initiative (HI) Adults with serious mental illness in Boston results in 93% reduction in hospital costs, $18 million reduction in health care costs annually (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf 10th Decile Project for high-need homeless in Los Angeles 72% reduction in total health care costs; positive rate of return as every $1 invested in housing and support was estimated to reduce public and hospital costs by $2 the following year and $6 in subsequent years (6/2015])&lt;br /&gt;
* [http://www.communityplans.net/Portals/0/Fact%20Sheets/ACAP_Plans_and_Social_Determinants_of_Health.pdf UPMC developed a “shelter plus care” program through a multi-party partnership including primary care practice, local government and community services. A 23% reduction in overall per-member-per-month (PMPM) claims costs. Roughly $4,100 before program to roughly $3,200 while in program (6/2014)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Legal_Support Legal Support] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Medication_Support Medication Support] - ''What Works?''===&lt;br /&gt;
* [http://www.bizjournals.com/washington/news/2017/05/08/the-simple-way-medstar-just-found-to-get-patient.html MedStar and CVS Health may have found a simple solution. The pharmacy pre-packages and labels patients' medications in multi-dose pouches. A group of 10 primary care offices recently improved medication compliance among patients taking six or more drugs a day from 60% to more than 90%. (5/8/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Nutrition_Support Nutrition Support] - ''What Works?''===&lt;br /&gt;
* [https://www.beckershospitalreview.com/finance/study-advocate-hospitals-saved-nearly-4-9m-by-implementing-nutrition-care-program.html Advocate Health Care saved nearly $4.9 million dollars by reducing readmission rates and shortening inpatient stays after implementing a nutrition care program at four Chicago hospitals (8/11/18)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/09/20/how-community-partnerships-can-help-end-food-insecurity-part-1/ How Community Partnerships Can Help End Food Insecurity - Part 1 (9/20/16)] [http://healthaffairs.org/blog/2016/09/21/how-community-partnerships-can-help-end-food-insecurity-part-2/ Part 2 (9/21/16)]&lt;br /&gt;
* [http://www.marketplace.org/2015/06/22/health-care/new-math-healthcare-make-money-saving-money Healthy foods delivered to 5% of the patients spending 50% of money can save money (6/22/2015)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001076/ Study found that if every state were to provide home-delivered meals to an additional 1 percent of its population of adults ages sixty-five and older, would save state Medicaid programs over $109 million for the country. (10/2013)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/06/09/hospitals-reach-into-patients-homes-deliver-healthy-smoked-tofu-but-also-bbq-shrimp-scampi/QSqNQiycZUNxa9qbRWzs8I/story.html Steward Health Care] delivers three low-sodium meals and two snacks to selected heart failure patient's home each day hoping healthy food will reduce trips to the hospital. (6/10/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Prison_to_Community_Transitions Prison to Community Transitions] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1006.abstract People returning to communities from prison that were referred by correctional partners to an enhanced primary care Transitions Clinic Network (TCN) had fewer acute care visits than people referred later. (6/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Social_Workers Social Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27119772 Social-work conducted transitional care reduced all cause readmissions among all home-going Medicare FFS beneficiaries by 20%. (5/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-based-clinic-helped-reduce-ed-super-user-visits Hospital-based clinic used social workers to reduce ED super-users risk of ED use by 22% and hospitalizations by 30% (5/9/14)]&lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2013-09-26/obamacare-incentives-push-hospitals-to-keep-medicare-patients-healthy Social workers are the new frontline of the accountable-care model (9/26/13)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/10/23/451154605/a-hospital-reduces-repeat-er-visits-by-providing-social-workers Hospital Reduces Repeat ER Visits By Providing Social Workers. In four months, visits by 39 people to the ER fell by 68 percent, cost fell from $1.5 million to $440,000. (10/23/15).]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Support_Communities Support Communities] - ''What Works?''===&lt;br /&gt;
* [http://www.imedicalapps.com/2016/08/web-based-support-group-tbi-caregivers/ Online-video support group could aid in the care of patients with traumatic brain injuries (TBI). (8/5/16)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/167056/mhealth-comes-patient-support-groups Mobile Health Comes to Patient Support Groups (6/3/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/152556/one-one-cancer-support-empowers-patients One-on-One Cancer Support Empowers Patients (3/10/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/5-advantages-online-patient-communities.html 5 advantages of online patient communities (8/2/13)]&lt;br /&gt;
* [http://davidleescher.com/2013/07/11/why-online-patient-communities-are-better-than-real-life-support-groups/ Online Patient Communities] can provide many potential benefits, such as improving coping skills, reducing anxiety, depression, isolation, ignorance about the condition and finding others that are experience common conditions. (7/11/13)&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Transportation Transportation] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/caremore-lyft-collaboration-reduces-medical-transportation-waits-by-30.html CareMore, Lyft collaboration reduces medical transportation waits by 30% (9/6/16)]&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/495476/ Hospitals Are Partnering With Uber to Get Patients to Checkups (8/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] - ''What Works?''==&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Caregiver_Activity Caregiver Activity] - ''What Works?''===&lt;br /&gt;
* Caregivers - [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers States are focusing on activating them (6/22/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activation Patient Activation] - ''What Works?''===&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/06/22/these-few-things-may-stave-off-dementia-scientists-say/103119512/ There is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (6/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/22/well/live/back-pain-try-yoga.html A study of people with low to moderate lower back pain found they could use yoga to reduce back pain and functional limitations (6/22/17)] &lt;br /&gt;
* [http://www.hhnmag.com/articles/8230-Patients-increasingly-providing-self-care-improving-outcomes-reducing-cost DIY Medicine Helps Improve Outcomes, Reduce Cost. Patients avoid long inpatient stays by learning to self-administer care for chronic conditions (5/16/17)]&lt;br /&gt;
* [http://khn.org/news/with-chronic-illness-you-are-your-own-best-friend/amp/ What patients with chronic illnesses do outside the doctor’s office affect their health conditions (exercise, diet, taking their medication). Diabetic patients who participated in a online self-management program had lower blood sugar levels and took their medication more regularly (9/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-activation-influences-readmission-rates?utm_source=feedly Patient activation influences readmission rates (10/11/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activity Patient Activity] - ''What Works?''===&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-brain-training-dementia-20160724-snap-story.html Specialized brain training can help prevent Alzheimer’s Disease and other afflictions, including normal aging, that sap memory and reduce function. (7/24/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article129829184.html Simple activities, such as playing games, making crafts, socializing and reading books held off mental decline in older adults, according to a Mayo Clinic study (1/31/17)]&lt;br /&gt;
&lt;br /&gt;
Gamification &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://venturebeat.com/2017/03/08/heart-study-says-pokemon-go-makes-you-twice-as-likely-to-hit-10000-steps-a-day/ Heart study says Pokémon Go makes you twice as likely to walk 10,000 daily steps (3/8/17)]&lt;br /&gt;
&lt;br /&gt;
Nutrition &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/07/13/healthy-diet-longevity-study/ Improving Your Diet Just a Little Bit Can Help You Live Longer, Says Study (7/13/17)]&lt;br /&gt;
* [http://mashable.com/2016/09/29/mediterranean-diet-health-benefits.amp Study suggests a Mediterranean diet could prevent over 19,000 deaths a year in the UK. (9/29/16)]&lt;br /&gt;
&lt;br /&gt;
Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/these-preventive-measures-might-help-delay-dementia-or-cognitive-decline/ Scientists endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure. (7/20/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/16/magazine/losing-fat-gaining-brain-power-on-the-playground.html In children, exercise may help to improve cognition and improve waistlines. (6/16/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/24/well/move/a-1-hour-walk-3-times-a-week-has-benefits-for-dementia.html A 1 hour walk 3 times a week has benefits for dementia (5/24/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/12/well/move/an-hour-of-running-may-add-seven-hours-to-your-life.html An hour of running may add up to seven hours on your life (4/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/patients-can-save-2-500-on-medical-costs-just-by-walking.html Patients can save $2,500 on medical costs annually just by walking (9/8/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/increased-physical-activity-associated-lower-risk-13-types-cancer Increased physical activity associated with lower risk of 13 types of cancer (6/16/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/06/23/483245084/a-protein-that-moves-from-muscle-to-brain-may-tie-exercise-to-memory When muscles work, they release a protein that appears to generate new cells and connections in a part of the brain that is critical to memory (6/23/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/blog/after-hip-fracture-exercise-at-home-boosts-day-to-day-function-201402197041 After hip fracture, exercise at home boosts day-to-day function (2/19/14)]&lt;br /&gt;
* [http://www.fastcompany.com/3045862/fast-feed/sitting-all-day-will-kill-you-but-a-2-minute-walk-could-change-that New research: Breaking up your sedentary day with some light activity can prolong your life. (5/1/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/replace-sitting-with-walking/ Replace sitting with walking – it’s key to decreasing early death rate. (10/27/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Lifestyle Patient Lifestyle] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/why-retiring-after-age-65-could-help-you-live-longer.html Most people retire around age 65. But when people retire at age 66 instead, their mortality rates drop by 11 percent. (9/13/16)]&lt;br /&gt;
Healthy Lifestyle &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/02/476209760/whats-good-for-the-heart-is-good-for-the-brain What's Good For The Heart Is Good For The Brain. 7 factors known to benefit the heart and blood vessels: maintaining a normal body weight, good nutrition, not smoking, getting exercise regularly and keeping blood pressure, cholesterol and blood sugar levels under control. (5/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-a-healthy-lifestyle-could-prevent-half-of-all-deaths-attributed-to-cancer.html A healthy lifestyle could prevent half of all deaths attributed to cancer. 41% of cancer cases and 59% of cancer deaths were potentially preventable in women. 63% of cancer cases and 67% of cancer deaths were preventable, among men. (5/20/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Personal_Achievement Personal Achievement] - ''What Works?''===&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/15/470124189/to-quit-smoking-its-best-to-go-cold-turkey To Quit Smoking, It's Best To Go Cold Turkey (3/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models Health Insurance Payment Models] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Accountable_Care_Organizations Accountable Care Organizations] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/healthcare/medicare-shared-savings-program-acos-show-promise-cost-reduction-quality-improvement-oig Medicare Shared Savings Program ACOs show promise in cost reduction, quality improvement, OIG finds (8/30/17)]&lt;br /&gt;
* [https://www.beckershospitalreview.com/lists/110-acos-to-know-2017.html 110 ACOs to know | 2017 (6/12/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-finds-acos-reduce-hospitalizations-spending Study found an association between participation in an accountable care organization (ACO) and reduced rates of hospitalizations, as well as Medicare spending. (5/9/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2601418 Medicare Shared Savings Program was associated with a 9% differential reduction in postacute spending by 2014, driven by reductions in discharges to facilities, length of facility stays, and acute inpatient care. (2/15/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/1/74.abstract Two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. (1/2017)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/anthem-blue-cross-acos-realize-70m-savings Anthem Blue Cross through its 17 ACO partners accrued savings of $70.4 million over a 12-month period. (11/1/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2017/jan/aco-hospitals-reduced-rehospitalization-faster ACO-Affiliated Hospitals Reduced Rehospitalizations from Skilled Nursing Facilities Faster Than Other Hospitals (1/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/medicare-aco-hospitals-faster-at-reducing-readmissions-study-finds.html Medicare ACO hospitals faster at reducing readmissions, study finds. (1/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/cms-unveils-2015-medicare-aco-quality-financial-performance-12-things-to-know.html ACOs saved Medicare $466M in 2015. (8/26/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Episode-Based_Payments Episode-Based Payments] - ''What Works?''===&lt;br /&gt;
Commercial Health Plans &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthpayerintelligence.com/news/unitedhealthcare-adopts-bundled-payment-model-for-surgeries UnitedHealthcare’s bundled payment model for hip, knee and back surgery pilot program has shown an average savings of $10,000 or more among employers for each episode of care when compared against overall median costs for the same procedures in the same region. (1/19/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2594805 Study of 3942 patients who received joint replacement surgery, there was a decrease of $5577 (20.8%) in total spending per episode. Most of the hospital savings came from implants and supplies and most of the postacute care savings came from decreased use of institutional care. (1/3/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Care_Services Care Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient-Centered_Medical_Homes Patient-Centered Medical Homes] - ''What Works?''===&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071295/ CareFirst Patient-Centered Medical Home Program lowered annual adjusted total claims payments by $109 per participating member (95 % CI: −$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. 42% of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. (7/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-centered-medical-homes-lower-costs-reduce-healthcare-overuse Patient-centered medical homes lower costs, reduce healthcare overuse (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient_Incentives Patient Incentives] - ''What works?''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1455 Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage (8/2017)]&lt;br /&gt;
* [https://healthpayerintelligence.com/news/patient-incentives-from-payers-encourage-preventive-care-visits Patient Incentives from Payers Encourage Preventive Care Visits. MinuteMember Wellness Rewards program offer $50 incentive for members to visit their In-Plan PCP during the calendar year. “In its first year, approximately 9300 members (or 40 percent) received an incentive check. (5/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/financial-incentives-may-be-effective-for-smoking-cessation-study-finds.html Financial incentives may be effective for smoking cessation, study finds. After six months, 36% of participants who received cash and about 6% of the control group had quit smoking. (9/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aetna-pays-employees-up-to-500-per-year-for-sleeping.html Aetna pays employees up to $500 per year for sleeping. Wellness and wellness program responsible for 69 minutes more a month of worker productivity. (4/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/small-study-risk-losing-reward-works-better-reaching-activity-tracking-goals Small study shows risk of losing reward works better for reaching activity tracking goals (2/16/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1414293#t=articleBackground Financial incentives were proven effective in smoking cessation (5/28/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Performance_Based_Pricing Performance-Based Pricing] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Provider-Based_Health_Plans Provider-Based Health Plans] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Care_Programs Value-Based Care Programs] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/regulatory/study-value-based-care-programs-reduce-readmissions Study finds participation in voluntary federal programs that push for quality improvements has a greater impact on reducing readmissions than financial penalties levied against hospitals for high rates alone (4/11/17)]&lt;br /&gt;
* [https://news.umich.edu/voluntary-value-based-health-programs-dramatically-reduce-hospital-readmissions/ University of Michigan Study Links Value-Based Care Programs to Lower Readmission Rates and $32 Million in Medicare Savings in 2015 (4/10/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/sustained-participation-payforvalue-high-need-patients Blue Cross Blue Shield of Michigan members with two or more chronic diseases, including mental health problems, assigned to PCP's participating in the pay-for-performance program for at least four years to outcomes for members assigned to PCPs had almost 20% fewer 30-day hospital readmissions and 27.5% fewer 90-day readmissions. However, total spending did not decline. (3/15/17)]&lt;br /&gt;
* [http://healthpayerintelligence.com/news/anthem-cut-er-costs-by-3-with-value-based-care-reimbursement Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement (2/1/17)]&lt;br /&gt;
* [https://www.uhc.com/content/dam/uhcdotcom/en/ValueBasedCare/PDFs/VBC-Nov2016-Online-Report.pdf UnitedHealthcare expanded value-based care programs such as accountable care organizations, which led to 16.8% fewer acute inpatient admissions among mature Medicaid ACOs in Tennessee, 12.2% fewer ER visits among the longest-running Medicare ACOs and 10% fewer hospital admissions and ER visits among top performing commercial ACOs (11/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/4-strategies-bcbs-used-to-save-1b-through-patient-centered-programs.html 4 strategies BCBS used to save $1B through patient-centered programs. These programs include BCBS' accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs — emphasize prevention, wellness and coordinated care, in conjunction with reducing waste in the healthcare delivery system. (6/2/15)]&lt;br /&gt;
&lt;br /&gt;
Hospital-Acquired Condition Reduction Program &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20161212/NEWS/161219985 HHS report shows hospitals are paying off, preventing 3.1 million harmful hospital-acquired conditions and the deaths of some 125,000 people. Those improvements saved close to $28 billion in healthcare costs from 2010 through 2015. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Readmission Penalties &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/fiscal-penalties-for-low-performing-hospitals-linked-to-improved-readmission-rates.html Fiscal penalties for low-performing hospitals linked to improved readmission rates for heart failure, pneumonia and acute myocardial infarction (heart attack). For every 10,000 patients discharged annually, the lowest performing hospitals avoided 95 readmissions they would have seen before readmissions were penalized under the ACA. (12/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/every-state-but-1-lowered-hospital-readmissions-since-2010-cms-data-shows.html Every state but 1 lowered hospital readmissions since 2010, CMS data shows (9/13/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1294.abstract Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Attributed to Medicare's penalties for re-admissions. (7/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Insurance_Design Value-Based Insurance Design] - ''What Works?''===&lt;br /&gt;
Health plan benefit design to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices&lt;br /&gt;
* [http://khn.org/news/health-insurers-try-paying-more-upfront-to-pay-less-later/amp/ Enhanced insurance benefit that pays for all patients Type 1 diabetes maintenance is paying off. The state has saved about $1 million on medical services since its inception almost 10 years ago. (7/17/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/516.abstract Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan (3/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/horizon-calls-its-6-premium-increase-proof-tiers-work.html Horizon Blue Cross Blue Shield of New Jersey declared its Omnia health plans, which uses Tier 1 — or preferred — hospitals and providers for services, have some of the lowest premium rate increases nationally next year. (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-finds-eliminating-drug-co-payments-leads-to-cost-savings-among-chronically-ill.html Study finds eliminating drug co-payments leads to cost savings among chronically ill (2/17/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/637.abstract Connecticut’s Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence (4/2016)]&lt;br /&gt;
&lt;br /&gt;
Tiered Provider Network &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/870.short Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5% (5/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Wellness_Payment_Models Wellness Payment Models] - ''What Works?''===&lt;br /&gt;
* Wellness Screenings - [http://khn.org/news/medicare-payment-changes-lead-more-men-to-get-screening-colonoscopies/ Medicare Payment Changes Lead More Men To Get Screening Colonoscopies (12/24/15)]&lt;br /&gt;
&lt;br /&gt;
==[[Organization Interventions]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities] - ''What Works?''===&lt;br /&gt;
* [https://www.statnews.com/2017/02/28/health-disparities-community-action/ Decisive action by communities can reduce health disparities and improve lives (2/28/17)]&lt;br /&gt;
* [https://www.bostonglobe.com/metro/2016/12/10/the-san-antonio-way-how-one-texas-city-took-mental-health-community-and-became-national-model/08HLKSq1JdXSTZppaECk2K/story.html San Antonio has built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/10/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/role-food-systems-community.html West Oakland, one of the city’s poorest areas, improved healthy food access and economic opportunity. 640,000 lbs of produced distributed in food insecure area, 55% sourced locally and 76% of shoppers increased consumption of fruits and vegetables (11/28/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Community_.26_Social_Services_Organizations Community &amp;amp; Social Services Organizations] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Employers Employers] - ''What Works?''===&lt;br /&gt;
Employee Wellness Programs &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/human-capital-and-risk/study-suggests-wellness-programs-boost-worker-productivity-by-more-than-5.html Study shows wellness program boosted average worker productivity by more than 5% (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/nearly-60-of-employees-say-wellness-programs-have-improved-their-health-study-shows.html Nearly 60% of employees say wellness programs have improved their health, survey shows (6/1/17)]&lt;br /&gt;
* [http://m.content.healthaffairs.org/content/29/2/304.full Study of Workplace Wellness Programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent (2/21/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/229.abstract Comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees’ health risks, disease prevalence, and medical expenditures. (2/2017)]&lt;br /&gt;
* [http://www.rand.org/content/dam/rand/pubs/research_briefs/RB9700/RB9744/RAND_RB9744.pdf Disease management drives return on investment from workplace wellness programs. Two component programs reduced employer’s average health care costs by about $30 per member per month(PMPM). Disease management was responsible for 87% of those savings. Employees participating in the disease management program generated savings of $136 PMPM, with a nearly 30% reduction in hospital admissions. Only 13% of employees participated in the disease management component, compared with 87% for the lifestyle management component. (1/1/14)]&lt;br /&gt;
On-Site Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/premise-health-a-threat-or-opportunity-for-hospitals.html Coushatta Casino Resort partnered with Premise in 2011 to manage its onsite health center and improve the overall health status of Coushatta's employees and their families. The resort has seen better outcomes and has saved nearly $4 million in healthcare costs. (6/8/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Governments Governments] - ''What Works?''===&lt;br /&gt;
* [https://journals.lww.com/epidem/Citation/2017/11000/Longitudinal_Associations_of_Local_Cigarette.15.aspx A $1 increase in price was associated with a 3% reduction in risk of current smoking (11/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1016.abstract HUD Housing Assistance Associated With Lower Uninsurance Rates And Unmet Medical Need (6/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamacardiology/article-abstract/2618359 Study using data from the New York State Department of Public Health (2002-2013) found 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in counties with vs without trans-fatty acid restrictions. (4/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2017/03/13/520008877/un-sweetened-how-a-maryland-county-cut-soda-sales-without-a-soda-tax A Maryland County Cut Soda Sales Without A Soda Tax. The Unsweetened campaign led to a 20% decrease in sales of soda and a 15% decline in fruit drink sales between January 2013 and December 2015. (3/13/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2017/02/16/hlthaff.2016.1231 Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. (2/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2017/01/31/marylands-all-payer-model-achievements-challenges-and-next-steps/ The state of Maryland launched a bold approach to improve care with an All-Payer Model to slow the growth of healthcare costs.  Maryland has achieved an estimated $429 million in total Medicare hospital savings to date, exceeding the model’s five-year hospital savings requirement of $330 million (1/31/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/collections/signs-of-progress-in-reducing-childhood-obesity.html Some cities, counties, and states have started to see their childhood obesity rates go down by taking a comprehensive approach. (10/2016)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2553293 A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants (9/19/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/08/23/491104093/berkeleys-soda-tax-appears-to-cut-consumption-of-sugary-drinks Soda Tax Appears To Cut Consumption Of Sugary Drinks (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1045.abstract State prescription drug monitoring programs are sssociated with 30% reductions in opioid prescribing by physicians (6/2016)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/hec.3336/full Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers (4/4/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1932.abstract Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement - (1) sugar-sweetened beverage excise tax, (2) elimination of tax subsidy for advertising unhealthy food to children, (3) nutritional standards for food and beverages in schools outside of meals (11/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Health_Insurers Health Insurers]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Advocacy_Organizations Healthcare Advocacy Organizations]===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Provider_Organizations Healthcare Provider Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Support_Services_Organizations Support Services Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Vendor_Partners Vendor Partners]  - ''What Works?''===&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T22:00:03Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated Devices - continuous glucose monitoring (CGM)&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T21:59:08Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* May include devices like continuous glucose monitoring (CGM)&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T21:58:17Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Digital_Therapeutics</id>
		<title>Digital Therapeutics</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Digital_Therapeutics"/>
				<updated>2019-07-16T21:57:01Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Behavioral Health &lt;br /&gt;
* [http://www.mobihealthnews.com/content/digital-behavioral-health-company-ableto-launches-app-based-screening-tool AbleTo is a tech-enabled behavioral health company that offers a digital platform to connect people with licensed therapists and coaches. It has a three-minute assessment tool designed to screen people for common behavioral health conditions such as anxiety and depression. (4/4/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/silvercloud-raises-81m-digital-behavioral-health-platform SilverCloud makes an online platform of mental health and wellbeing programs for health systems and healthcare organizations (1/18/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/digital-cognitive-assessment/ Cognitive Screening App - Savonix a digital cognitive screening tool for things like stress, depression, anxiety and memory issues linked to conditions like Alzheimer’s disease (12/9/15)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/lantern-raises-17m-its-mobile-based-mental-health-coaching-program Cognitive Behavior Therapy App - Lantern offers web and mobile programs using cognitive behavioral therapy for anxiety and stress. Lantern offers coaching to help people with stress, anxiety, and body image, and the company plans to add mood tracking. (2/10/16)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://techcrunch.com/2017/03/16/smart-diabetes-management-service-livongo-health-raises-52-5m-and-looks-to-new-markets/amp/ Livongo Health offers a blood glucose monitor accompanied with a service designed to intervene and help coach people through managing diabetes. (3/16/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/backed-37m-startup-virta-launches-aim-reverse-type-2-diabetes-through-digital-coaching-and Virta Health has a mission to reverse type 2 diabetes by using personalized nutrition, one-on-one coaching and remote monitoring to reverse the disease rather than medication or surgery. (3/8/17)]&lt;br /&gt;
&lt;br /&gt;
Medication Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.mobihealthnews.com/content/propeller-health-gsk-expand-partnership-target-asthma-and-copd Propeller Inhaler clip-on sensor automatically records medication use to provide adherence insight to physicians and patients (8/24/17)]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Services#Digital_Therapeutics Return to Digital Therapeutics]&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Digital_Therapeutics</id>
		<title>Digital Therapeutics</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Digital_Therapeutics"/>
				<updated>2019-07-16T21:56:01Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: Created page with &amp;quot;Behavioral Health  * [http://www.mobihealthnews.com/content/digital-behavioral-health-company-ableto-launches-app-based-screening-tool AbleTo is a tech-enabled behavioral heal...&amp;quot;&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Behavioral Health &lt;br /&gt;
* [http://www.mobihealthnews.com/content/digital-behavioral-health-company-ableto-launches-app-based-screening-tool AbleTo is a tech-enabled behavioral health company that offers a digital platform to connect people with licensed therapists and coaches. It has a three-minute assessment tool designed to screen people for common behavioral health conditions such as anxiety and depression. (4/4/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/silvercloud-raises-81m-digital-behavioral-health-platform SilverCloud makes an online platform of mental health and wellbeing programs for health systems and healthcare organizations (1/18/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/digital-cognitive-assessment/ Cognitive Screening App - Savonix a digital cognitive screening tool for things like stress, depression, anxiety and memory issues linked to conditions like Alzheimer’s disease (12/9/15)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/lantern-raises-17m-its-mobile-based-mental-health-coaching-program Cognitive Behavior Therapy App - Lantern offers web and mobile programs using cognitive behavioral therapy for anxiety and stress. Lantern offers coaching to help people with stress, anxiety, and body image, and the company plans to add mood tracking. (2/10/16)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://techcrunch.com/2017/03/16/smart-diabetes-management-service-livongo-health-raises-52-5m-and-looks-to-new-markets/amp/ Livongo Health offers a blood glucose monitor accompanied with a service designed to intervene and help coach people through managing diabetes. (3/16/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/backed-37m-startup-virta-launches-aim-reverse-type-2-diabetes-through-digital-coaching-and Virta Health has a mission to reverse type 2 diabetes by using personalized nutrition, one-on-one coaching and remote monitoring to reverse the disease rather than medication or surgery. (3/8/17)]&lt;br /&gt;
&lt;br /&gt;
Medication Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.mobihealthnews.com/content/propeller-health-gsk-expand-partnership-target-asthma-and-copd Propeller Inhaler clip-on sensor automatically records medication use to provide adherence insight to physicians and patients (8/24/17)]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Services#Therapeutic_Services Return to Therapeutic Services]&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T21:55:38Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Therapeutics */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
&lt;br /&gt;
See [[Digital Therapeutics]] examples&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T21:54:07Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Digital Regulating Therapies */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Therapeutics==&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Insight</id>
		<title>Health Insight</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Insight"/>
				<updated>2019-07-16T21:50:43Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Non-Medical Interventions Activity Insight */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday there is new insight into our understanding of [[Health Determinants]] and [[barriers]] that impact patient outcomes. This page will curate new insight. While health care is likely the most important determinant of health when a patient has an acute condition, studies show it represents only a part of an overall health outcomes:&lt;br /&gt;
&lt;br /&gt;
[[Health Determinants Insight]]&lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Mission (Health Goals) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Personal Goals Insight===&lt;br /&gt;
===Health Goals (Care Goals) Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Mission_.26_Care_Goals_Determinants Health Goals (Care Goals) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Advanced Directives &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/1-3-u-s-adults-have-completed-advance-directive-study-finds 2 out of 3 adults fail to complete an advance directive (7/6/17)]&lt;br /&gt;
* [http://www.cbsnews.com/news/being-prepared-for-the-final-days/ Being prepared for the final days (4/27/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/lack-advance-directives-leads-to-unwanted-care Lack of advance directives leads to unwanted care (11/2/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/national-healthcare-decisions-day-11-statistics-on-end-of-life-decision-making.html Only 20% of Americans have an advanced directive documenting their wishes for end-of-life medical care. (4/16/15)]&lt;br /&gt;
&lt;br /&gt;
Care Goals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/12/defining-patients-goals-care.html Defining the patient’s goals of care (12/11/13)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1113631#t=article Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)]&lt;br /&gt;
&lt;br /&gt;
End of Life Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/end-life-care-planning-fails-patients End-of-life care, planning fails patients (2/5/15)]&lt;br /&gt;
* [https://www.minnpost.com/second-opinion/2014/06/few-doctors-discuss-end-life-planning-heart-failure-patients-mayo-study-finds Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)]&lt;br /&gt;
* [http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx ''Dying in America'' - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)]&lt;br /&gt;
* [http://khn.org/news/too-many-people-die-in-hospital-instead-of-home-heres-why/ Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)]&lt;br /&gt;
&lt;br /&gt;
Health Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/28/what-outcomes-matter-to-patients-with-rheumatoid-arthritis/ What outcomes matter to patients with Rheumatoid Arthritis? (8/28/17)]&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Strategy (Health Plan) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) Insight===&lt;br /&gt;
====Medical Interventions Insight====&lt;br /&gt;
====Non-Medical Interventions Insight====&lt;br /&gt;
====Intervention Changes Insight====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures===&lt;br /&gt;
===Strategy - Impacting People Insight===&lt;br /&gt;
===Strategy - Impacting Realities Insight===&lt;br /&gt;
===Strategy - Impacting Activities Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Health Conditions ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Physical Conditions ''Insight''==== &lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Physical_Conditions_Determinants Physical Conditions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.cbsnews.com/news/more-u-s-kids-have-chronic-health-problems-study The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest (5/2/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/jan/analysis-of-death-rates-for-middle-aged-whites A lack of progress since 1999 against common illnesses such as heart disease, diabetes, and respiratory disease was largely responsible for higher-than-expected death rates for middle-aged (45–54) white adults in 2014. (1/29/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/07/study-on-aging/ Don’t judge a person on their chronological age; their biological age might be a lot older than you think, aging study says (7/7/15)]&lt;br /&gt;
&lt;br /&gt;
Arthritis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/stateline-states-asthma/ Nationwide, one in 10 children has asthma. (4/16/14)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/science/archive/2017/03/no-cancer-isnt-mostly-bad-luck/521049/ Scientists don't agree 66% of cancer is due to bad luck (3/28/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521219318/cancer-is-partly-caused-by-bad-luck-study-finds Study: Causes of cancer, 66% from random mutations during cell division (bad luck), about 29% from environment and remaining 5% due to heredity. (3/23/17)]&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-cancer-drop-20170105-story.html Death rate from cancer now 25% lower than it was 25 years ago, report says (1/5/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-brain-cancer-now-killing-more-children-than-leukemia.html CDC: Brain cancer now killing more children than leukemia (9/16/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cancer-overtakes-heart-disease-as-leading-cause-of-death-in-22-states-3-things-to-know.html Cancer overtakes heart disease as leading cause of death in 22 states (8/25/16)]&lt;br /&gt;
* [https://www.sciencedaily.com/releases/2015/01/150101142318.htm Study shows two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes, while the remaining third are due to environmental factors and inherited genes. (1/1/15)]&lt;br /&gt;
&lt;br /&gt;
Chronic Pain &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/4-things-to-know-about-the-rising-rates-of-chronic-pain-in-the-us.html Number of Americans in their 60s reporting chronic pain increased from 10% in 1998 to 37% in 2010. (3/16/17)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain Estimated 25.3 million adults (11.2%) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6%) experience severe levels of pain. (8/11/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/04/chronic-pain-effect-patients-families.html Chronic pain and the effect on patients’ families (4/17/14)]&lt;br /&gt;
&lt;br /&gt;
COPD &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/copd/index.html Chronic lower respiratory disease, primarily COPD, is the third leading cause of death in the United States (3/12/15)]&lt;br /&gt;
&lt;br /&gt;
Cystic Fibrosis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/03/13/cystic-fibrosis-canadians-americans/ Canadians with cystic fibrosis outlive Americans by a decade (3/13/17)]&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-more-deadly-than-previously-thought-researchers-say.html Diabetes causes 12 percent of deaths in the United States, making it the third-leading cause of death in the country, according to a new study (1/26/17)] &lt;br /&gt;
* [http://khn.org/news/health-claims-on-the-rise-for-kids-with-type-2-diabetes-obesity-related-conditions/amp/ Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions (1/2/17)]&lt;br /&gt;
* [http://khn.org/news/diabetes-linked-to-risk-of-mental-health-hospitalization-in-young-adults-study/amp/ Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease (7/22/16)]&lt;br /&gt;
* [http://khn.org/news/as-childhood-diabetes-rates-rise-so-do-costs-and-families-feel-the-pinch-study/amp/ Childhood diabetes rates are on the rise. The spent $2,173 per capita in out-of-pocket health care costs in 2014. Nearly five times higher than that of kids without the illness. (6/20/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/americans-diabetes-reach-21-million Americans with diabetes reach 21 million (4/15/14)]&lt;br /&gt;
* [http://www.latimes.com/science/la-sci-sn-diabetes-study-20150908-story.html About half of all Americans have either diabetes or pre-diabetes. (9/8/15)]&lt;br /&gt;
&lt;br /&gt;
Heart Attack Risk &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/depression-among-heart-attack-survivors-can-be-deadly-yet-is-often-ignored/ Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (7/20/17)]&lt;br /&gt;
* [http://www.wsj.com/articles/heart-attacks-are-linked-to-what-patients-were-doing-feeling-1477923373 Performing heavy physical activity in a highly emotional state sharply raised the risk of a heart attack. (10/31/16)]&lt;br /&gt;
&lt;br /&gt;
High Blood Pressure &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cdc.gov/bloodpressure/facts.htm About 70 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults. (6/16/16)]&lt;br /&gt;
&lt;br /&gt;
Life Expectancies &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/death-rates-for-americans-in-prime-years-rise-after-century-of-decline.html The death rate for Americans between the ages of 25 and 44 rose by 8% between 2010 and 2015 after a century of decline. (6/14/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair The mortality rate for white Americans, ages 45 to 54, increased by a half percent each year from 1999 to 2013, attributed to increase in suicide, drugs and alcohol. (3/23/17)]&lt;br /&gt;
Non-Communicable Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-diseases-that-kill-16m-people-cost-the-world-economy-2-35t-annually.html Five non-communicable diseases that kill 16 million people around the world each year, cost the world economy $2.35T annually. 1) Cardiovascular disease, 2) Mental illness, 3) Cancer, 4) Chronic respiratory disease, 5) Diabetes. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
Obesity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/30/506433671/the-wrong-eating-habits-can-hurt-your-brain-not-just-your-waistline Being overweight can raise your blood pressure, cholesterol and risk for developing diabetes. It could be bad for your brain, too. (12/30/16)]&lt;br /&gt;
* [http://www.onemednews.com/2016/12/18/nyt-obesity/ Researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, are many. (12/12/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2016/12/01/nearly-half-of-americas-overweight-people-dont-realize-theyre-overweight/?utm_term=.2963e8177870 Nearly half of America’s overweight people don’t realize they’re overweight (12/1/16)]&lt;br /&gt;
* [http://khn.org/news/another-reason-to-diet-experts-find-additional-evidence-of-obesity-cancer-link/amp/ Experts Find Additional Evidence Of Obesity-Cancer Link (8/24/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/obesity-rates-up-in-us-women-stable-in-men.html Obesity rates up in US women, stable in men. Obesity was 35 percent among men and 40 percent among women in 2013-14 (6/7/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html American obesity rate continues consistent trend upward in 2015 with estimated 30.4% of Americans over 20 years of age obese, more than a 10% increase from 1997 (5/26/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1923.abstract Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013 (11/2015)]&lt;br /&gt;
&lt;br /&gt;
Sepsis &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/sepsis-causes-more-readmissions-than-copd-heart-failure-heart-attack-and-pneumonia.html Sepsis causes more hospital readmissions than COPD, heart failure, heart attack and pneumonia. (1/23/17)]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Mental_Health_Conditions_Determinants Mental Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
Childhood Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/06/01/disruptive-behavior-disorders-children/ Childhood disruptive behavior disorders increases risk for substance use, violent behaviors, victimization, incarceration, and even premature death. An estimated 50 to 75% of youths who move through the juvenile justice system could be diagnosed with a mental health disorder. (6/1/17)]&lt;br /&gt;
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Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/who-depression-leading-cause-of-illness-disability-worldwide.html Depression is the leading cause of illness, disability worldwide according to the World Health Organization (3/31/17)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878#T1 The prevalence of major depressive episodes (MDEs) in adolescents (age 12-17) has increased from 13.1% for girls and 4.5% for boys in 2005 to 17.3% for girls and 5.7% for boys in 2014 (11/2016)]  &lt;br /&gt;
&lt;br /&gt;
Dementia &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/16/536935957/stress-and-poverty-may-explain-high-rates-of-dementia-in-african-americans Stress And Poverty May Explain High Rates Of Dementia In African-Americans (7/16/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-alzheimer-s-deaths-up-by-more-than-50.html In 1999, the rate of Alzheimer's deaths was 16.5 per 100,000 individuals. By 2014, this rate had increased to 25.4 deaths per 100,000, marking a 54.5% increase. (5/26/17)]&lt;br /&gt;
* [http://www.alz.org/documents_custom/2017-facts-and-figures.pdf Estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. By 2025, Alzheimer’s dementia is estimated to reach 7.1 million. By 2050, the number of people with Alzheimer’s dementia may nearly triple to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure Alzheimer’s disease. (3/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587084 Dementia prevalence among US adults 65 years or older declined significantly, from 11.6% in 2000 to 8.8% in 2012. (11/21/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/10-alzheimer-s-patients-had-preventable-hospital-stays One in 10 Alzheimer’s patients have preventable hospital stays (7/27/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/30/472295791/big-financial-costs-are-part-of-alzheimers-toll-on-families Big Financial Costs Are Part Of Alzheimer's Toll On Families (3/30/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2016/02/10/study-finds-dementia-rates-decline/80016390/ Rates of dementia dropped 44% from the late 1970s to the early 2010s. (2/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-dementia-drives-er-visits-admissions-and-mortality-rates How dementia drives ER visits, admissions and mortality rates (11/16/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1642.abstract Dementia has a disproportionate impact on family and unpaid caregiving to older adults] (10/2015)&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1637.abstract Adults with probable dementia received 171 hours of monthly informal care, versus 89 hours for cognitively impaired adults without dementia and 66 hours for cognitively normal adults 10/2015)]&lt;br /&gt;
&lt;br /&gt;
Emotions &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Mental Health Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1024.abstract Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. Innovative federal, state, and local programs have combined social services with mental health interventions to try addressing this. (6/2017)] &lt;br /&gt;
* [http://healthaffairs.org/blog/2016/07/25/patients-with-severe-schizophrenia-arent-getting-the-help-they-need/ Patients With Severe Schizophrenia Aren’t Getting The Help They Need (7/25/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/mind-and-mood/the-prevalence-and-treatment-of-mental-illness-today An estimated 26% of American adults live with a mental disorder in any given year, and 46% will have a mental disorder in their lifetime.] (11/2005)&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html 18% of adults in the U.S. have a mental, behavioral or emotional disorder. Most common are specific phobias (8.7%), such as those related to heights, spiders or flying, social phobia (6.8%) and major depression (6.6%) (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Impact on Health Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.businessinsurance.com/article/20170306/NEWS08/912312232/Detecting-mental-health-issues-can-cut-workers-comp-claims-costs Detecting mental health issues can cut workers comp claims costs. Hartford Financial Services Group analyzed its workers comp claim data from 2002 to 2015 and found that 10% of claims featured at least one psychosocial issue, and that those claims account for 60% of claims costs. (3/6/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/nov/behavioral-health-high-need-adults High-need adults—defined as those with three or more chronic conditions and a functional limitation—who have a diagnosed behavioral health condition among their multiple chronic conditions make greater use of some health care services than their counterparts without a behavioral health condition (11/22/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/36.abstract Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients (1/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/most-readmissions-aren-t-linked-to-suboptimal-care-study-finds.html A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness. (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
Opioid Addiction &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/ Patients With Mental Disorders Get Half Of All Opioid Prescriptions (6/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/ahrq-report-us-hospitals-see-sharp-rise-in-opioid-related-inpatient-stays-ed-visits.html Between 2005 and 2014, opioid-related emergency department visits nearly doubled and opioid-related inpatient stays increased 64% (6/20/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/cdc-likelihood-of-opioid-addiction-spikes-after-a-few-days-of-use.html CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days (3/17/17)]&lt;br /&gt;
* [http://khn.org/news/study-health-spending-related-to-opioid-treatment-rose-more-than-1300-percent/amp/ Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent In Four Year Period (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/prior-authorization-a-hurdle-for-patients-overcoming-opioid-dependency Insurer rules a hurdle for patients overcoming opioid dependency (8/5/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/15/patient-centered-research-can-improve-chronic-pain-care-and-address-opioid-abuse/ Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse (5/15/15)]&lt;br /&gt;
&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf Americans reporting at least one symptom of stress over the past month rose from 71% in August 2016 to 80% in January 2017. This includes headache (34%), feeling overwhelmed (33%), feeling nervous or anxious (33%), or feeling depressed or sad (32%). (2/15/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/12/chronic-stress-heart-attacks-study.amp Emotional stress has long been considered a major risk factor for heart disease. A new study suggests that heightened activity in the amygdala (the brain's fear and stress region) is associated with a greater risk of heart disease and stroke. (1/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/09/27/494922257/chill-out-stress-can-override-benefits-of-healthy-eating Stress Can Override Benefits Of Healthful Eating (9/27/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.technologyreview.com/s/603073/big-pharma-and-distracted-driving-are-killing-americans-early/amp/ Accidental poisoning increased 13%. 97% percent of accidental poisoning was from drug overdoses and alcohol (12/9/16)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin,methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Suicide &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/suicide-rates-for-teen-girls-hits-40-year-high.html Suicide rates for teen girls hits 40-year high (8/8/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-machine-learning-shows-promise-toward-accurately-identifying-suicidal-behavior Study found machine learning is 93% accurate in correctly identifying a suicidal person, and 85% accurate in determining differential diagnosis of mental illness (11/8/16)]&lt;br /&gt;
* [http://www.npr.org/sections/ed/2016/11/04/500659746/middle-school-suicides-reach-an-all-time-high Middle School Suicides Reach An All-Time High (11/4/16)]&lt;br /&gt;
&lt;br /&gt;
Treating Mental Health &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2016/05/13/hlthaff.2015.1659.abstract Mental Disorders top the list of the most costly conditions in the United States: $201 Billion] (5/2016)&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
* [http://hrsonline.isr.umich.edu/ Health and Retirement Study (HRS) surveys 20,000 people in America about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and health care expenditures. (3/2007)]&lt;br /&gt;
&lt;br /&gt;
Chronic Diesease &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/21/the-association-between-observed-mobility-and-quality-of-life-in-the-near-elderly/ Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life. (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Daily Activities Assistance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 6.9% of adults in 2015 over the age of 65 required assistance with personal care. (5/26/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/howardgleckman/2014/10/08/nearly-half-of-all-seniors-need-help-with-daily-activities-far-more-than-we-thought/ Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought] (10/8/14)&lt;br /&gt;
&lt;br /&gt;
Disabilities &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/4/626.abstract If all five risk factors were eliminated, 53% of disability could be prevented nationally if five risk factors were eliminated. The largest were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). (4/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/18/challenges-for-people-with-disabilities-within-the-health-care-safety-net/ Challenges For People With Disabilities Within The Health Care Safety Net. Nearly 57 million Americans had disabilities in 2010. (11/18/14)]&lt;br /&gt;
&lt;br /&gt;
Functional Independence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patients-functional-independence-may-predict-readmissions Patients' functional independence may predict readmissions (5/6/14)]&lt;br /&gt;
&lt;br /&gt;
Healthcare Costs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 The average healthcare cost for adults in the United States (2009-2011) was $4,845, for adults with 3 or more chronic conditions and no functional limitations was $7,526, for adults with 3 or more chronic conditions and functional limitation was $21,021 (8/29/16)]&lt;br /&gt;
&lt;br /&gt;
Homebound &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/26010119 An estimated 1.9 million U.S. adults age 65 or older are completely or mostly homebound, while another 5.3 million have functional limitations that make it hard to  leave their homes. (7/2015)]&lt;br /&gt;
* Homebound - [http://content.healthaffairs.org/content/34/1/21.abstract Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care.] (1/2015)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/q-and-a/2015/jan/invisible-homebound Treating the “Invisible Homebound”: Setting Standards for Health Care Provided at Home (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
Impairments &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. 44% of people with arthritis report activity limitations of everyday tasks, such as walking or lifting bags. (3/7/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/09/hearing-loss-linked-to-increased-risk-of-death/ Adults ages 70 years or older with moderate or more severe hearing impairment have a 54% increased risk of all causes of death (9/25/15)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Usual Activities&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 39.7 million persons (12%) were limited in their usual activities due to one or more chronic health conditions (12/2013)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/books/NBK92521/ About 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis limiting their functional status and adversely impacting their quality of life. The total financial cost of pain to society (health care and productivity estimates) ranges from $560 to $635 billion (2011 Study)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Work&lt;br /&gt;
* [https://www.theatlantic.com/business/archive/2017/03/mortality-of-american-men-and-the-labor-force/520329/ 43% of men in America ages 25 to 54 who are out of the labor force report their health as fair or poor, compared with 12% of employed men and 16% of unemployed men. (3/22/17)]&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 13.8 million adults aged 18–69 (6%) were unable to work due to health problems, and 6.7 million (3%) were limited in the kind or amount of work they could do because of their health (12/2013)]&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Genomic_Profiles_Determinants Genomic Profiles Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [https://www.ted.com/talks/moshe_szyf_how_early_life_experience_is_written_into_dna Epigenetics research suggests living things reprogram their genome in response to social factors like stress and lack of food. The biochemical signals passed from mothers to offspring tell the child what kind of world they're going to live in, changing the expression of genes. (7/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877678/ Scientists believe most, if not all, diseases arise from interactions between the genome, the epigenome (controls gene expression), and the environment (broadly defined to include social, behavioral, and physical agents). (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====High Need, High Cost Patients ''Insight''====&lt;br /&gt;
High-Need, High-Cost Patients &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-superusers-pennsylvania-ring-up-1-25b-tab-0 Superusers represent 3% of hospitalized patients in Pennsylvania consumed $1.25 billion in health care costs. (6/21/17)]&lt;br /&gt;
* [https://www.theatlantic.com/theplatinumpatients/ Each year, 1 in every 20 Americans racks up just as much in medical bills as another 19 combined. (6/15/17)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% did not have good access to services that could help them manage their daily living activities. 58% did not have good access to an informed and up-to-date care coordinator. (12/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 1.2% of employees are high cost claimants who comprise 31% of total health care spending according to a report on 26 large employers. (9/15/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1608511 Caring for High-Need, High-Cost Patients — An Urgent Priority (9/8/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps2 Health care spending for high-need adults exceeded $21,000 per person, nearly three times the average for adults with multiple chronic diseases only ($7,526) and more than four times that of all adults ($4,845). (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/aug/high-need-high-cost-meps Report Profiles The 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs (8/25/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/jun/listening-to-those-living-with-chronic-conditions Top concerns of high-need patients include: Paying for Care, Accessing Care, Insurance Frustrations,  Technology Can Be Helpful, Getting Help at Home (6/16/16)]  &lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2015/dec/primary-care-physicians-in-ten-countries Nearly 25% of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84% say they are not well prepared to manage patients with serious mental illness (12/7/15)]&lt;br /&gt;
* [http://features.commonwealthfund.org/improving-care-for-those-who-need-it-most Researchers are focusing on high-need, high-cost patients—both because they need the most help and because they have the biggest impact on national health spending. 5 percent of the U.S. population accounts for 50 percent of the nation’s health care costs. (11/11/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/8/1312.abstract?=right For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary. Only 28% of super-utilizers remained on top of the list at the end of a year. (8/2015)]&lt;br /&gt;
* [https://hcttf.org/wp-content/uploads/2018/01/WhitePaper-ProactivelyIdentifyingtheHighCostPopulation.pdf Proactively	Identifying the	High Cost Population - White Paper Insights from Health Care Transforamtion Task Force 5/14/15)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1315568?query=TOC&amp;amp; Hospital-dependent patient's medical problems cannot be managed outside the hospital. (2/20/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/challenge-frequent-fliers-20-er-visits-per-year-progress/ The challenge of frequent fliers: 20 ER visits per year is progress (11/11/13)]&lt;br /&gt;
* [http://khn.org/news/one-percent-of-costliest-patients/ Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending (10/7/13)]&lt;br /&gt;
* [http://berkeleyhealthcareforum.berkeley.edu/report/executive-summary/ 53% of California's healthcare expenditures are spent by just 5% of the population (2/2013)]&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Competencies_Determinants Competencies Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Literacy_Determinants Health Literacy Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.georgiahealthnews.com/2016/10/health-literacy-life-or-death-matter/ Health literacy can be a life-or-death matter. 1 out of 3 adult Georgians is functionally illiterate. Without a clear understanding of their health condition, these adults are more likely to skip necessary medical tests and have a harder time with diabetes management or high blood pressure numbers. (10/31/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/guide-surviving-chronic-disease.html A guide to surviving chronic disease (8/3/16)]&lt;br /&gt;
* Education - A [http://www.reuters.com/article/2013/06/26/us-cancer-cure-idUSBRE95P15320130626 survey] of patients with terminal lung cancer found nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. (6/26/13)&lt;br /&gt;
* [http://www.imedicalapps.com/2014/09/knee-guide-app-educates-engages-patients-total-knee-arthroplasty-care/ My Knee Guide App Educates and Engages Patients in Total Knee Arthroplasty Care (9/25/14)]&lt;br /&gt;
* [http://medcitynews.com/2015/05/video-replay-patient-education/ Surgeon entrepreneur develops video replay for specialist appointments to boost patient education (5/28/15)]&lt;br /&gt;
* [https://health.gov/communication/literacy/issuebrief/ 77 Million Adults Have Basic or Below Basic Health Literacy (2003)]&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Education &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/07/patients-need-education-role-care.html Patients need education about their role in care (7/3/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 39% patients admit they’re only somewhat knowledgeable, at best, about how to effectively manage their chronic condition. (7/2017)] from [http://www.jonespr.net/strengthening-chronic-care-download West] Study.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-addressing-alzheimer-s-risk-factors-could-lead-to-medicare-medicaid-savings.html Preventing and effectively managing obesity, diabetes, hypertension and cardiovascular disease can reduce onset and duration of dementia and reduce healthcare costs. (4/11/14)]&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/12/536519077/took-the-wrong-medicine-by-mistake-study-finds-such-errors-are-on-the-rise More People Are Making Mistakes With Medicines At Home (7/12/17)]&lt;br /&gt;
* [http://www.reuters.com/article/us-medication-errors-health-literacy-idUSKBN0FN1SK20140718 More than half of heart patients made mistakes taking their medications or misunderstood instructions (7/18/14)]&lt;br /&gt;
* [http://www.bbc.com/news/health-30556329 Only 7% of asthma sufferers were found to use asthma inhalers in the right way (12/20/14)]&lt;br /&gt;
&lt;br /&gt;
Physician Office Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/can-help-doctor-diagnose.html How a patient can help their physician diagnose them. 3/19/17)]&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Functional Competencies Determinants] that can decisively affect a patient's overall health and well-being. &lt;br /&gt;
&lt;br /&gt;
Literacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.kevinmd.com/blog/2017/08/literacy-health-care-problem-no-one-talks.html It is estimated that there are 23 million adults in the U.S. with limited literacy, defined as below basic literacy or non-literate. (8/18/17)]&lt;br /&gt;
&lt;br /&gt;
====Education ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Education_Determinants Education Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Social ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Patient_.28About_.26_History.29_Determinants Patient (About &amp;amp; History) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-death-rate-rises-for-first-time-in-decade-7-things-to-know.html American death rate rises for first time in decade. Rises in death rates from: Alzheimer's disease, heart diseases, suicide and unintentional injuries (auto accidents and drug overdoses) (6/1/16)]&lt;br /&gt;
* [http://www.pnas.org/content/112/49/15078.full.pdf Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (9/17/15)]&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Events_Determinants Adverse Events Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Adverse Childhood Events (ACEs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/09/29/444451363/childhood-stress-may-prime-pump-for-chronic-disease-later Childhood Stress May Prime Pump For Chronic Disease Later (9/29/15)]&lt;br /&gt;
* [http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime How childhood trauma affects health across a lifetime (9/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/12/2106.abstract Adverse Childhood Events (ACEs) on attributed to higher rates of chronic disease among children (12/2014)]&lt;br /&gt;
&lt;br /&gt;
Elder Abuse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf A study found an elder abuse incidence rate in New York State was nearly 24 times greater than the number of cases referred to social service, law enforcement or legal authorities. (see Page 2) (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Beliefs_Determinants Beliefs Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/aug/improving-population-health-management Patients who don't feel they can manage their health or navigate the health care system are more likely to develop a chronic disease over a three-year period than “activated” patients with good self-management skills. Low patient-activation levels are linked to significantly more hospitalizations and emergency department (ED) use. (8/23/16)]&lt;br /&gt;
&lt;br /&gt;
====Determination ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Determination_Determinants Determination Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Insight''====&lt;br /&gt;
* See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight People]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Resilience_Determinants_-_.28Psychological_Fitness.29 Resilience Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Optimism &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/07/504709736/a-brighter-outlook-could-translate-to-a-longer-life A Brighter Outlook Could Translate To A Longer Life (12/7/16)]&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/490841/ Psychological resilience plays a role in the molecular impact of traumatic experiences. Promoting resilience may have benefits for physical and mental health (7/12/16)]&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2015/10/stressful-jobs-makes-life-shorter/412951/ Study: Stressful Jobs Make Life Shorter. Researchers found that unhealthy workplaces can affect mortality. (10/29/15)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/10/how-stress-makes-you-sick/412699/ How Stress Makes You Sick. Feeling overwhelmed affects everything from digestion to stroke risk. (10/28/15)]&lt;br /&gt;
* [http://www.nature.com/news/bacteria-implicated-in-stress-related-heart-attacks-1.15396 Emotional or physical stress can trigger heart attacks may now have a scientific explanation (6/10/14)]&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Responsibilities_Determinants Responsibilities Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://mobile.reuters.com/article/idUSKCN0VO21Q Family caregivers may be sacrificing their own health to help loved ones (2/15/16)]&lt;br /&gt;
* [http://www.mhealthtalk.com/a-guide-for-the-older-caregiver/?utm_source=rss&amp;amp;utm_medium=rss&amp;amp;utm_campaign=a-guide-for-the-older-caregiver A caregiving spouse who is between the ages of 66 and 96 and under excessive mental or emotional strain has a 63% greater risk of dying compared to those who are not tasked with caregiving. (1/17/14)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282240/ Quality of life: impact of chronic illness on the partner (11/2001)]&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Well-Being_Determinants Social Well-Being Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Defining Well-Being &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2330497 Most medical research focuses on disease rather than wellness. The diverse and interconnected dimensions of physical, emotional and social well-being. It includes achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. (7/14/15)]&lt;br /&gt;
* [http://voxeu.org/article/origins-happiness Depression and Anxiety explains the largest variance in life satisfaction. Study shows eliminating Depression and Anxiety would have 4 times the impact of eliminating poverty in improving life satisfaction. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Competence &amp;amp; Control &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/11/30/independence-its-what-older-people-want/ Independence—It’s What Older People Want (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Loneliness &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/08/07/loneliness-public-health/ Why Loneliness Is a Public Health Threat. People with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles. (8/7/17)] &lt;br /&gt;
* [http://khn.org/news/social-isolation-may-worsen-breast-cancer-prospects/amp/ Social Isolation May Worsen Breast Cancer Prospects. Women with fewer social ties — to friends, family, community and religious groups, as well as spouses or romantic partners — were 43% more likely to see their breast cancer return, 64% more likely to die from breast cancer and 69% more likely to die from any cause (12/13/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors) 37% felt socially isolated and lacked companionship compared to 15% of other adults. (12/9/12)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/loneliness-a-bigger-risk-factor-for-death-than-obesity.html Loneliness a bigger risk factor for death than obesity (9/6/16)]&lt;br /&gt;
* [http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=137534&amp;amp;WT.mc_id=USNSF_51&amp;amp;WT.mc_ev=click The profound power of loneliness can depression and other serious health problems (2/3/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/12/loneliness-social-isolation-and-health/418395/ How Loneliness Wears on the Body. New research supports the idea that social isolation is detrimental to physical health—and that companionship may improve it. (12/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems Loneliness May Warp Our Genes, And Our Immune Systems (11/29/15)]&lt;br /&gt;
* [http://time.com/3747784/loneliness-mortality/ Loneliness increases risk of death by 26%. Social isolation — or lacking social connection — and living alone were found to be even more devastating to a person’s health than feeling lonely, respectively increasing mortality risk by 29% and 32% (3/18/15)]&lt;br /&gt;
* [http://www.pnas.org/content/110/15/5797.full Social isolation and loneliness are associated with increased mortality (9/12/12)]&lt;br /&gt;
&lt;br /&gt;
Love &amp;amp; Connection &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2014/05/isolation-and-death/362063/ Stressful relationships might be significantly shortening your life, are you better off alone? (5/13/14)]&lt;br /&gt;
&lt;br /&gt;
Purpose &amp;amp; Meaning &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/soul-purpose-seniors-with-strong-reasons-to-live-often-live-stronger/ Soul Purpose: Seniors With Strong Reasons To Live Often Live Stronger (8/31/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/28/479751942/could-thinking-positively-about-aging-be-the-secret-of-health People with a sense of purpose and having positive view about aging in late middle age lived about 7 and half years longer than the people who saw aging in a negative light. (5/28/16)]&lt;br /&gt;
&lt;br /&gt;
Social Influence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.time.com/time/health/article/0,8599,1646997,00.html If a friend is obese, there is a 57% greater chance of becoming obese. (7/25/07)]&lt;br /&gt;
&lt;br /&gt;
Social Via Smartphones &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/08/07/542016165/how-smartphones-are-making-kids-unhappy How Smartphones Are Making Kids Unhappy. Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. (8/7/17)]&lt;br /&gt;
&lt;br /&gt;
====Support ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Determinants Support Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Asking For Help &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/alone-and-aging-creating-a-safety-net-for-isolated-seniors/amp/ A growing number of seniors who find themselves alone just when aging and end-of-life care becomes real. They don’t know how to approach a casual acquaintance to ask for help when they need it most. (11/28/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/population-health-means-asking-about-basic-needs-are-your-providers-ready-for-that.html Population Health Means Asking About Basic Needs: Are Your Providers Ready for That? (11/20/13)]&lt;br /&gt;
&lt;br /&gt;
Addressing Social Determinants&lt;br /&gt;
* [http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/ Improving population health will require broader approaches that address social, economic, and environmental factors that influence health. (11/4/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/21/with-the-aca-secure-its-time-to-focus-on-social-determinants/ Literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral, and environmental factors. It’s Time To Focus On Social Determinants. (7/21/15)] &lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/05/why-its-time-to-improve-the-social-determinants-of-health.html Why it’s time to improve the social determinants of health (5/1/15)]&lt;br /&gt;
* [https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf Going Beyond Clinical Walls to address the other 80% of determinants that are often challenging to address in clinical visits. (10/2014)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/may/addressing-patients-social-needs Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment (5/29/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 70 percent of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease. (7/2017)]&lt;br /&gt;
&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://morningconsult.com/opinions/importance-nonemergency-medical-transportation-vulnerable-patients/ The Importance of Nonemergency Medical Transportation for Vulnerable Patients. One patient has to take two bus rides and walk a mile just to get herself and two young children to the doctor. (1/25/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/antifraud/fierce-exclusive-beneath-patient-transportation-arrangements-a-subtle-layer-fraud Unreliable or inaccessible transportation has emerged as a significant patient care issue. Legal experts say healthcare systems providing rides to patients raises concerns that they could be violating the Anti-Kickback Statute or providing a beneficiary inducement. (8/31/16)]&lt;br /&gt;
&lt;br /&gt;
===Socioeconomic ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Socioeconomic_Determinants Socioeconomic Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
*[https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/ If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. (8/17/17)]&lt;br /&gt;
====Can't Afford Treatments ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Can.27t_Afford_Treatments_Determinants Can't Afford Treatments Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Delay Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-half-of-millennials-have-delayed-medical-care-because-of-cost.html Half of millennials have delayed medical care because of cost (1/1/16)]&lt;br /&gt;
* [http://www.gallup.com/poll/187190/cost-delays-healthcare-one-three.aspx 31% Americans say that they or a family member have put off any sort of medical treatment in the past year because of the cost (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Reduce Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-half-of-aca-exchange-customers-skimp-on-healthcare-to-reduce-costs.html Half of ACA exchange customers skimp on healthcare to reduce costs (10/28/16)]&lt;br /&gt;
&lt;br /&gt;
Skip Medical Care &amp;lt;Br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-1-in-3-older-millennials-skips-medical-care-because-of-costs.html Survey: 1 in 3 older millennials skips medical care because of costs (6/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/nov/international-survey-release About one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. (11/16/16)]&lt;br /&gt;
* [http://archpedi.jamanetwork.com/article.aspx?articleid=1872780 Financial Barriers to Care Among Low-Income Children With Asthma (7/2014)]* [http://money.cnn.com/2013/04/26/news/economy/health-care-cost/ 80 million people (43% of America's working-age adults) didn't go to the doctor or access other medical services last year because of the cost (4/26/13)]&lt;br /&gt;
&lt;br /&gt;
====Financial ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Financial_Determinants Financial Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Annual Healthcare Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2016/05/24/annual-healthcare-cost-for-family-of-four-now-at-25826/#33aa77f75226 Healthcare Costs in 2016 for a Family of Four Will Be $25,826 (5/24/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2015/05/19/annual-healthcare-cost-for-family-of-four-now-at-24671/#29d013444dfb Annual Healthcare Cost For Family Of Four Now At $24,671 (5/19/15)]&lt;br /&gt;
&lt;br /&gt;
Fear of Healthcare Costs&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/53-of-americans-equate-unaffordable-medical-bills-to-being-diagnosed-with-a-serious-illness.html 53% of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness (3/21/17)]&lt;br /&gt;
* [http://www.healthpopuli.com/2017/02/08/health-care-worries-top-terrorism-far-americans-minds/ Health Care Worries Top Terrorism, By Far, In Americans’ Minds (2/8/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/healthcare-finances-a-source-of-fear-for-75-of-consumers.html Healthcare finances a source of fear for 75% of consumers (2/7/17)]&lt;br /&gt;
* [http://www.businesswire.com/news/home/20141006006149/en/Cigna-Consumer-Survey-%E2%80%98Health-Costs-Derail-Financial#.VDg8PvldXng 75% fear health costs could ruin prospects for secure retirement (10/6/14)]&lt;br /&gt;
&lt;br /&gt;
Financial Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthpopuli.com/2017/04/26/financial-stress-health-risk-factor-impacts-americans/ Financial Stress As A Health Risk Factor Impacts More Americans (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% of high-need said they experience stress about their ability to afford housing, utilities or nutritious meals compared to 32% of other adults. (12/9/16)]  &lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-bills-lead-to-serious-debt-for-some-americans-6-things-to-know.html 85% of employees in survey in 2015 reported at least some level of financial stress. 33% were assessed as having serious debt, such as student debt, medical bills and/or credit card debt. (7/20/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/federal-reserve-board-47-of-americans-struggle-to-pay-unexpected-400-bill.html  47% of Americans struggle to pay unexpected $400 bill (6/8/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/54.abstract For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships (1/2016)]&lt;br /&gt;
* [http://www.pwc.com/us/en/private-company-services/publications/financial-well-being-retirement-survey.html Survey shows 52% of employees stressed about their finances. 45% saying that financial matters cause the most stress, nearly as many as stress from job, health, or relationships combined. (2016 Employee Financial Wellness Survey)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/more-americans-struggle-healthcare-costs 46% of Americas described paying for care as a hardship rather than affordable (12/19/14)]&lt;br /&gt;
&lt;br /&gt;
Health Inequality &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2017/06/05/america-is-a-world-leader-in-health-inequality/?utm_term=.7c7983e42f5c People in households making less than $22,500 a year, 38% reported being in poor or fair health. That's more than three times the rate of health troubles faced by individuals in households making more than $47,700 a year. (6/5/17)]&lt;br /&gt;
* [http://www.hhnmag.com/articles/7416-look-to-income-inequality-to-help-explain-population-health Having less money is linked to poorer health regardless of personal habits. (7/5/16)]&lt;br /&gt;
* [https://www.brookings.edu/research/what-growing-life-expectancy-gaps-mean-for-the-promise-of-social-security/ Life expectancy is higher for the wealthiest. Among American men born in 1940, the wealthiest 10% are expected to live on average 12 years longer than the poorest 10%. (2/12/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/costs-deter-low-income-patients-from-participating-in-clinical-trials.html Costs deter low-income patients from participating in clinical trials (11/3/15)]&lt;br /&gt;
* [http://www.nytimes.com/2014/04/06/health/even-small-medical-advances-can-mean-big-jumps-in-bills.html?from=homepage&amp;amp;_r=0 New innovative treatments and technology is often out of the reach of low income patients. (4/5/14)]&lt;br /&gt;
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Medical Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/half-of-uninsured-people-face-problems-with-their-medical-bills-9-survey-findings.html Half of uninsured people face problems with their medical bills (8/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/61-of-patients-confused-by-medical-bills-survey-finds.html 61% of patients confused by medical bills, survey finds (7/14/16)]&lt;br /&gt;
* [http://www.cbsnews.com/news/cdc-one-in-five-americans-cant-pay-medical-bills/ CDC: One in five Americans can't pay medical bills (9/30/13)]&lt;br /&gt;
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Prescription Drugs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/sticker-shock-forces-thousands-of-cancer-patients-to-skip-drugs-skimp-on-treatment/amp/ Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (3/15/17)]&lt;br /&gt;
* [http://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/ Faced With Unaffordable Drug Prices, Tens Of Millions Buy Medicine Outside U.S. (12/20/16)]&lt;br /&gt;
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Price Shopping for Medical Services &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.marketwired.com/press-release/survey-finds-healthcare-providers-benefit-from-up-front-cost-estimates-yet-many-patients-nyse-tru-2192070.htm Survey found 43% said it was somewhat or very difficult to get information on costs, while another 21% of patients had never tried to get procedure cost information. (1/31/17)]&lt;br /&gt;
* [http://khn.org/news/consumer-choices-have-limited-impact-on-u-s-health-care-spending-study/ Less than 7% of total health care spending in 2011 was paid by consumers for “shoppable” services. (3/4/16)]&lt;br /&gt;
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====Food Insecurity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Food_Insecurity_Determinants Food Insecurity Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.hpoe.org/resources/ahahret-guides/3058 Social Determinants of Health Series: Food Insecurity(8/3/17)]&lt;br /&gt;
* [http://online.liebertpub.com/doi/abs/10.1089/pop.2015.0127 Study of food insecurity in patients with high rates of inpatient hospitalization (“super-utilizers”). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed. Using USDA definition of food insecurity, 30% were food insecure and 25% were marginally food secure. 40% responded that, in the past 30 days, they worried that their food would run out; 17.5% that they did not eat for a full day. 75% were unable to shop for food on their own and 58% were unable to prepare their own food. (12/1/16)]&lt;br /&gt;
* [http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html 42.2 million Americans lived in food insecure households in 2015 (29.1 million adults and 13.1 million children). (2016)]&lt;br /&gt;
* [http://pdf.aarpfoundation.org/i/455086-aarp-foundation-findings-on-nutrition-knowledge-and-food-insecurity-among-older-adults Nearly 9 million older adults in the United States experience food insecurity. (12/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1949.abstract Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1830.abstract Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. (11/2015)]&lt;br /&gt;
* [http://khn.org/news/in-sunlit-paradise-seniors-go-hungry/ In Sunlit Paradise, Seniors Go Hungry (5/26/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/03/food-insecurity-undiagnosed-medical-problem.html Food insecurity is an undiagnosed medical problem (3/6/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/1/116.abstract Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia (1/2014)]&lt;br /&gt;
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====Health Insurance ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Insurance_Determinants Health Insurance Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [https://www.nytimes.com/2017/05/08/upshot/a-medicare-drug-incentive-that-leads-to-greater-hospitalizations.html For sicker Medicare beneficiaries, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits (5/8/17)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/09/16/494139538/studies-link-cancer-patients-survival-time-to-insurance-status Studies Link Cancer Patients' Survival Time To Insurance Status (9/16/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/958.abstract?=right Insurance is paying for more of the cost of treating mental health conditions (68%) but not for Substance Use Disorders (46%) (6/2016)]&lt;br /&gt;
* [http://khn.org/news/new-health-plans-offer-discounts-for-diabetes-care/ New health plans offer discounts and give gift cards to encourage patients to use diabetes care (11/17/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aca-health-plans-limit-access-to-specialists-7-findings.html ACA health plans limit access to specialists: 7 findings (10/28/15)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2015/09/21/insurance-healthy-behavior-key-reducing-cost-chronic-disease/72563266/ Study showed total cost for insured members with no chronic conditions was $3,024 a year ($2,204 out-of-pocket) and members with two or more chronic conditions was $11,940 a year ($3,500 out-of-pocket). (9/21/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/why-doctors-must-discuss-costly-treatment-before-patients-receive-bills Why doctors must discuss costly treatment before patients receive bills (10/18/13)]&lt;br /&gt;
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Denied Coverage &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/many-patients-chronic-illnesses-find-insurance-providers-deny-treatment-new-survey-says 'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says (8/16/17)]&lt;br /&gt;
Dual Eligible Patients (Qualify for Medicare and Medicaid) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://files.kff.org/attachment/Testimony-of-Gretchen-Jacobson-Ways-and-Means-Committee-Subcommittee-on-Health Low-income people on Medicare who receive assistance from Medicaid tend to have more chronic conditions, as well as cognitive and functional limitations, than others on Medicare: 61% vs. 33% need assistance with one or more activities of daily living, such as eating, bathing, and dressing; more than half, 58% vs. 29% have a mental condition or cognitive impairment; 37% vs. 27% have five or more chronic conditions; 18% vs 6% rate their health status as poor. (6/7/17)]&lt;br /&gt;
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Employer Sponsored Health Insurance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/interactives-and-data/maps-and-data/employer-health-insurance-premiums State-by-State Look at Employer Health Insurance Costs Finds Workers’ Premium Contributions and Deductibles Growing More Slowly But Eating Up Greater Share of Incomes (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/employer-family-plan-premiums-soar-above-18k-in-2016.html Employer family health plan premiums soar above $18k in 2016 (9/14/16)]&lt;br /&gt;
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High Deductable Health Plans (HDHPs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/10-things-to-know-about-2016-healthcare-consumer-payment-trends.html Consumers insured through high-deductible health plans increased from 10 million in 2010 to 75 million in 2016. The average deductible for individuals with employer-based coverage doubled from $735 in 2010 to $1,478 in 2016. Patient payments to providers increased 58% from 2013 to 2016. (6/13/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/cdc-nearly-40-of-us-adults-have-high-deductible-health-plans.html CDC: Nearly 40% of US adults have high-deductible health plans (6/7/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patients-with-chronic-illness-and-high-deductibles-more-likely-to-delay-care-study-finds.html Patients with chronic illness and high deductibles more likely to delay care, study finds. People with three or more chronic conditions were also nearly three times as likely to delay or avoid care as those without chronic conditions (25% compared to 9%) (11/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/given-the-choice-34-of-employees-choose-hdhps.html Given the choice, 34% of employees choose HDHPs (5/3/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly one-quarter of workers are enrolled in an High Deductable Health Plan, up from 4% in 2006. (2/4/16)]&lt;br /&gt;
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Medicaid &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://healthpayerintelligence.com/news/spike-in-late-stage-cancer-diagnosis-related-to-medicaid-cut Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut (7/5/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare Beneficiaries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/ Half of all Medicare beneficiaries had incomes below $26,200 in 2016 (4/21/17)]&lt;br /&gt;
Patient Out-of-Pocket Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medicare-cancer-patients-without-additional-coverage-hit-with-high-out-of-pocket-costs-4-things-to-know.html Medicare cancer patients without additional coverage hit with high out-of-pocket costs (11/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patient-payment-responsibility-spiked-13-in-2015.html Patient payment responsibility spiked 13% in 2015 (6/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/may/on-medicare-but-at-risk 16 percent of Medicare beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. (5/10/16)]&lt;br /&gt;
* [http://www.healthsystemtracker.org/insight/payments-for-cost-sharing-increasing-rapidly-over-time/?utm_campaign=KFF-2016-Peterson-Cost-Sharing-Analysis&amp;amp;utm_medium=email&amp;amp;_hsenc=p2ANqtz-_fzaJSkoJE-fetaUk0iwQOwPP__Fpq1BkKAV4WPcOHEuKp1Ww3jVG7Fl41gr19-i_hWcUPOy The average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. (4/12/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly half of workers are covered by an insurance plan with a general annual deductible of at least $1,000 for individual coverage. (2/4/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/high-out-pocket-expenses-narrow-insurance-networks-send-more-patients-to-ers High out-of-pocket expenses, narrow insurance networks send more patients to ERs (10/26/15)]&lt;br /&gt;
* [http://kff.org/report-section/ehbs-2015-summary-of-findings/ Workers with health insurance covered by their employers have an annual deductible amount for single coverage of $1,318. (9/22/15)]&lt;br /&gt;
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Surprise Out-of-Network Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/many-medicare-advantage-members-burned-by-out-of-network-bills.html Many Medicare Advantage members burned by out-of-network bills due to changes in network providers (11/28/16)]&lt;br /&gt;
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Uninsured &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/lists/2016/remaining-uninsured Why Do Millions of U.S. Adults Remain Uninsured? 1) The ACA excludes undocumented immigrants; 2) Nineteen states have not expanded Medicaid eligibility; 3) Many people still don’t know about the health insurance marketplaces; 4) Affordability is a concern; 5) Selecting a plan can be difficult: 6) Many aren’t getting the help they need. (10/21/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/federal-estimate-of-uninsured-falls-to-record-low-7-statistics.html Federal estimate of uninsured falls to record low 8.6% (9/7/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/who-are-the-remaining-uninsured Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? (8/18/16)]&lt;br /&gt;
* [http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf The percentage uninsured in 2015 was 10.5% (28.4 million) (5/2016)]&lt;br /&gt;
* [http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Uninsured nonelderly Americans in 2014 was 32 million. 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Over 5 in 10 of uninsured have family income below 200% of poverty. (10/5/15).]&lt;br /&gt;
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====Income &amp;amp; Work ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Income_.26_Work_Determinants Income &amp;amp; Work Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-working-night-shifts-furthers-health-disparities.html How working night shifts furthers health disparities (10/25/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3064755/work-smart/study-finds-work-life-balance-could-be-a-matter-of-life-and-death Study found that those who work in high-stress jobs with little control are more likely to die sooner than those who have more control over and balance in their work. (10/20/16)]&lt;br /&gt;
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* [http://healthcare-economist.com/2016/09/26/effect-of-job-loss-on-physical-and-mental-health/ Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results similar for mental health. (9/26/16)]&lt;br /&gt;
* [http://khn.org/news/low-income-patients-face-hurdles-to-care-at-public-hospital-in-miami/ Low-Income Patients Face Hurdles To Care At Public Hospital (8/28/14)]&lt;br /&gt;
* [http://www.nccp.org/topics/childpoverty.html More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level]&lt;br /&gt;
&lt;br /&gt;
Labor Force Participation &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2016-10-07/why-are-so-many-men-not-working-they-re-in-pain A large share of American men between the ages of 25 and 54 who aren’t in the labor force may suffer from serious health conditions that are “a barrier to work” and suffer physical pain, sadness, and stress in their daily lives. (10/7/16)]&lt;br /&gt;
Lack of Sick Leave &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.wbur.org/npr/484960907/hassle-of-being-a-patient-can-turn-into-a-crisis-without-sick-leave Hassle Of Being A Patient Can Turn Into A Crisis Without Sick Leave. Third of working Americans say their jobs don't offer paid sick days (7/11/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/3/520.abstract Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. 3.0 times more likely to forego medical care for themselves and 1.6 times more likely to forego care for family (3/2016)] &lt;br /&gt;
&lt;br /&gt;
Low Income Impact on Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/socioeconomic-hardships-hurt-dual-eligibles-health-outcomes Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid (4/2/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/03/screening-poverty-included-medical-curriculum.html Low socioeconomic status (SES) is a risk factor for a multitude of medical conditions including cardiovascular disease, respiratory disease, cancer, and mental illness. (3/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/employment-status-top-socioeconomic-factor-readmissions Employment status top socioeconomic factor in readmissions (12/11/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/08/29/exhibit-of-the-month-income-related-disparities-associated-with-negative-health-outcomes/ Income-Related Disparities Associated With Negative Health Outcomes (8/29/14)]&lt;br /&gt;
* [http://hin.com/Healthcare_Business_Weekly_Update/2014/06/06/data-dive-uncovers-socioeconomics-driving-er-visits-readmissions/ Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions (6/6/14)]&lt;br /&gt;
&lt;br /&gt;
Work environment &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/258.abstract?=right Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence (2/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1761.abstract Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups (10/2015)]&lt;br /&gt;
&lt;br /&gt;
====Legal ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Legal_Determinants Legal Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Jail Involved &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/05/499775644/helping-ex-inmates-stay-out-of-the-er-brings-multiple-benefits Early access to primary care for ex-inmates can bring down healthcare costs by keeping them out of the ER (12/5/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/443.abstract The Critical Link Between Health Care And Jails (3/2014)]&lt;br /&gt;
&lt;br /&gt;
===Environmental ''Insight''===&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Access &amp;amp; Logistics ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Access_.26_Logistics_Determinants Access &amp;amp; Logistics Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Disability &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.mentalhealthamerica.net/sites/default/files/Parity%20or%20Disparity%20Report%20FINAL.pdf There is only 1 mental health provider for every 790 individuals. One out of three adults with disability could not see a doctor because of costs. (2015)]&lt;br /&gt;
Rural or Remote Area &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/patients-lacking-pharmacy-access-likely-to-readmitted-to-hospital Patients in rural or remote communities with lack of access to a pharmacy may be more likely to end up back in the hospital (8/4/16)]&lt;br /&gt;
* [https://www.minnpost.com/health/2014/06/late-life-live-home-rural-seniors-need-food-socialization-support Late-in-life: To live at home, rural seniors need food, socialization, support (6/23/14)]&lt;br /&gt;
* [http://www.rand.org/pubs/research_reports/RR578.html Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care. (2015)]&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/ Transportation barriers to health care access are common, and greater for vulnerable populations. (12/2013)]&lt;br /&gt;
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====Communication ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Communication_Determinants Communication Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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====Community ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Community_Determinants Community Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://cdnfiles.americashealthrankings.org/SiteFiles/Reports/2015_Am_Health_Ranking.pdf America’s Health Rankings of Behaviors, Community &amp;amp; Environment, Policy, and Clinical Care determinants of health that directly influence health outcomes (2015 Edition)]&lt;br /&gt;
* [http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Apr/Community-Factors-and-Hospital-Readmission-Rates.aspx Community factors most strongly associated with lower hospital readmission rates include more general practitioners and fewer specialists per capita and the presence of high-quality nursing home care. (4/17/14)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html Time to Act: Investing in the Health of Our Children and Communities (1/13/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/29/3/503.long Children had a 20-60% higher likelihood of being obese or overweight if living in neighborhoods with unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers. (3/2010)]&lt;br /&gt;
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Clean Air &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html The surprising link between air pollution and Alzheimer’s disease (1/31/17)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/world/air-pollution-smog-who.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ More Than 9 in 10 People Breathe Bad Air, W.H.O. Study Says (9/28/16)]&lt;br /&gt;
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Clean Water &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/08/14/63-million-americans-exposed-unsafe-drinking-water/564278001/ 63 million Americans exposed to unsafe drinking water (8/14/17)]&lt;br /&gt;
* [http://www.reuters.com/investigates/special-report/usa-lead-testing/ Water testing for lead levels found almost 3,000 areas with poisoning rates far higher than in Flint Michigan. Yet many of these lead hotspots are receiving little attention or funding. (12/19/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/as-water-infrastructure-ages-cost-treating-infections-rise Researchers believe as much as $2 billion of healthcare costs each year is tied to the treatment of infections that lurk in water distribution systems. (9/19/16)]&lt;br /&gt;
&lt;br /&gt;
Community Related - Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1571 Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990–2013 (8/2017)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/05/08/u-s-life-expectancy-varies-by-more-than-20-years-from-county-to-county/ U.S. life expectancy varies by more than 20 years from county to county (5/8/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/tackling_life_expect.html A person born in Princeton, NJ can expect to live 87 years, his or her neighbor a dozen miles away in Trenton has a life expectancy of 73 years (11/9/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thetwo-way/2016/04/11/473749157/its-not-just-what-you-make-its-where-you-live-says-study-on-life-expectancy Life Expectancy Study: It's Not Just What You Make, It's Where You Live (4/11/16)]&lt;br /&gt;
&lt;br /&gt;
Countries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/when-it-comes-to-healthcare-u-s-once-again-ranks-last-quality-care-compared-to-other When it comes to healthcare, U.S. once again ranks last in quality care compared to other wealthy nations (7/14/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/global-study-700k-smartphone-users-shows-link-between-obesity-and-activity-inequality Global study of 700K smartphone users shows link between obesity and activity inequality within country (7/11/17)]&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.revealnews.org/blog/14-million-kids-could-be-exposed-to-toxic-pcbs-at-school/ 14 million US kids could be exposed to toxic PCBs at school (10/12/16)] &lt;br /&gt;
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Food Deserts &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0122 Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14 (8/2017)]&lt;br /&gt;
* [http://www.ers.usda.gov/amber-waves/2010-march/access-to-affordable,-nutritious-food-is-limited-in-%E2%80%9Cfood-deserts%E2%80%9D.aspx Some neighborhoods in US, mostly in low-income areas, have been dubbed “food deserts” because they don't have supermarkets or other food retailers that carry affordable and nutritious food. (3/1/2010)]&lt;br /&gt;
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Food Safety &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lead-detected-in-20-of-baby-food-samples-surprising-even-researchers/ Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers (6/15/17)]&lt;br /&gt;
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Low Income Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/999.abstract One’s neighborhood may drive or influence health disparities, which can be understood as disadvantages in health associated with one’s social, racial, economic, or physical environment, originate in childhood and persist across an individual’s life course. (6/2017)]&lt;br /&gt;
*[http://www.theatlantic.com/business/archive/2016/04/why-the-poor-die-young/477846/ A massive study of health and income found that smoking, obesity, and exercise are the most important determinants of longevity. Poor neighborhoods score worse in all of them. (4/12/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1383.abstract People who live in lower-income neighborhoods have a higher rate of diabetic lower-extremity amputations than those in more affluent areas (8/2014)]&lt;br /&gt;
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Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/06/13/well/live/noise-may-raise-blood-pressure-risk.html Noise May Raise Blood Pressure Risk based on a study of people who lived near Athens International Airport (6/13/17)]&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
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Walkable Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27218630 Higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012 (5/24/16)]&lt;br /&gt;
&lt;br /&gt;
====Home ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Home_Determinants Home Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.mhealthtalk.com/common-problems-solutions/ The most common problems as you age in your home. (8/7/16)]&lt;br /&gt;
&lt;br /&gt;
Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.miamiherald.com/opinion/op-ed/article113730634.html Affordable housing, quality healthcare can let seniors age in place (11/9/16)]&lt;br /&gt;
* [http://www.stltoday.com/lifestyles/health-med-fit/health/want-a-better-chance-to-stay-out-of-a-nursing/article_c1b66d15-7afd-5b85-8e95-d83cc13d8f16.html Want a better chance to stay out of a nursing home? Modify your home (11/6/16)]&lt;br /&gt;
* [http://www.nytimes.com/2015/06/23/health/at-home-many-seniors-are-imprisoned-by-their-independence.html?ref=health&amp;amp;_r=3 Many seniors living at home feel imprisoned by their independence] (6/19/15)&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2016/07/gas-leaks-mold-and-rats-millions-of-americans-live-in-hazardous-homes/492689/ Gas Leaks, Mold, and Rats: Millions of Americans Live in Hazardous Homes (7/25/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/01/important-lesson-personalized-patient-care.html Controlling environmental allergens can reduce sneezing and nasal congestion that trigger asthma (1/1/14)]&lt;br /&gt;
* [http://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet Scientists estimate that lung cancer deaths could be reduced by 2 to 4% by addressing the one in 15 homes the EPA believes has too much radon exposure]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/multi-faceted-home-ventilation-intervention-reduces-copd-readmissions-study-finds Multi-faceted home ventilation intervention reduces COPD readmissions, study finds (7/15/15)]&lt;br /&gt;
* [http://www.cdc.gov/nceh/lead/ At least 4 million households have children living in them that are being exposed to high levels of lead (1/29/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2009/07/improving-the-health-of-all-americans-through-safe-and-healthy-h.html Approximately 40% of the 6.7 million children with diagnosed asthma are believed to be attributable to residential exposures (7/2009)]&lt;br /&gt;
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Homelessness &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://academic.oup.com/jpubhealth/article-abstract/doi/10.1093/pubmed/fdx034/3074503/Lifetime-and-1-year-prevalence-of-homelessness-in?redirectedFrom=fulltext Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2% and 1.5%, respectively (3/18/17)]&lt;br /&gt;
&lt;br /&gt;
Home Injuries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commissiononhealth.org/PDF/e434bb61-64d3-4267-9dca-705b9d80ddaa/HousingFactSheetJun09.pdf An estimated 4 million emergency department visits and 70,000 hospital admissions were attributed to injuries at home. (6/2009)]&lt;br /&gt;
&lt;br /&gt;
Housing Instability &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/housing-instability-will-cost-healthcare-industry-111b-over-next-decade.html Housing instability will cost healthcare industry $111B over next decade (8/10/17)]&lt;br /&gt;
&lt;br /&gt;
Housing Quality &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.sciencedirect.com/science/article/pii/S1353829214001087 NYC heat-mortality rates are associated with poverty and poor housing quality. (11/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Security ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Security_Determinants Security Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
Neighborhood Violence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/chicagoans-rank-violence-as-top-concern-in-health-needs-assessment.html Injury and violence was ranked as top concerns among Chicago's South and West Side residents, along with diabetes, nutrition, physical activity and weight, substance abuse and tobacco use, according to a health needs survey. (6/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-link-between-neighborhood-violence-and-biological-stress-in-children.html Study finds link between neighborhood violence and biological stress in children (11/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Content_Determinants Digital Content &amp;amp; Technology Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Records_Determinants Medical Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [http://medcitynews.com/2014/01/trends-healthcare-giving-access-doctor-notes-can-stimulate-patient-engagement/ Giving access to doctor notes can stimulate patient engagement (1/6/14)]&lt;br /&gt;
* [https://www.healthit.gov/patients-families/blue-button/about-blue-button Medicare provides medical history on a mobile app (Blue Button) for patients and caregivers to share with doctors]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Determinants_Records Health Determinants Records] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Records_Determinants Health Interventions Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Outcomes_Records_Determinants Health Outcomes Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Technology_.26_Apps_Determinants Technology &amp;amp; Apps Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.chicagotribune.com/lifestyles/health/sc-devices-to-track-wandering-kids-with-autism-health-0517-20170508-story.html 96% of parents surveyed who said they were using an electronic tracking device for their child with autism claimed it improved their quality of life (5/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/may/mobile-health-and-patient-engagement-in-the-safety-net Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics (5/13/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Making and Condition Management&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/new-apps-aim-guide-men-through-treatment-symptom-management-prostate-cancer New apps aim to guide men through treatment, symptom management of prostate cancer (9/10/16)]&lt;br /&gt;
&lt;br /&gt;
Devices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-patients-often-misuse-wrist-blood-pressure-monitors-leading-inaccurate-readings Study finds patients often misuse wrist blood pressure monitors, leading to inaccurate readings (9/7/16)]&lt;br /&gt;
&lt;br /&gt;
Digital Health Apps &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.engadget.com/amp/2017/07/11/lumosity-does-not-improve-cognitive-skills/ Lumosity doesn’t actually improve your cognitive skills (7/11/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/internet-mobile-disease-interventions-seem-work-longterm-studies-are-lacking Internet, mobile disease interventions seem to work, but long term studies are lacking (9/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-health-apps-near-meaningless-for-low-income-patients-with-chronic-conditions.html Study: Health apps near meaningless for low-income patients with chronic conditions (7/20/16)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/03/rehab-app-shoulder-rotator-cuff/ Rehab App Aims to Improve Shoulder &amp;amp; Rotator Cuff Repair Rehabilitation (3/21/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/commonwealth-fund-reasonably-small-number-chronic-health-apps-are-useful Some 43 percent of iOS health apps and 27 percent of Android health apps are useful. (2/22/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/copd-management-apps/ 5 digital health tools that could improve COPD management (12/3/15)]&lt;br /&gt;
* [http://www.imedicalapps.com/2014/11/cardiosmart-explorer-great-tool-educating-patients-clinic/ CardioSmart Explorer is a great tool for educating patients with cardiac disease (11/21/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/oct/vision-digital-health-tech A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System (10/1/14)]&lt;br /&gt;
* A [http://mobihealthnews.com/23418/most-patients-want-their-doctors-to-prescribe-apps/ study] from Digitas Health found that 90 percent of chronic patients in the US would accept a mobile app prescription as opposed to only 66 percent willing to accept a prescription of medication. (7/1/13)&lt;br /&gt;
&lt;br /&gt;
Digital Health Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-technology-self-monitor-blood-glucose-levels-no-better-traditional-management JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/content/study-patients-are-more-compliant-alivecor-devices-traditional-event-monitors Patients are more compliant to  smartphone-connected heart monitor devices than traditional event monitors (5/5/16)]&lt;br /&gt;
* [http://journals.lww.com/neurologynow/Citation/2015/11040/Wearing_the_Detectives__Wristbands,_smartwatches,.23.aspx Wristbands, smartwatches, and other wearable devices allow for more real-time monitoring of seizures and other neurologic symptoms—and, possibly, more precise treatment. (8/2015)]&lt;br /&gt;
&lt;br /&gt;
Home Automation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/top-home-tech-for-seniors-infographic/ Top Home Tech for Seniors (7/28/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/home-automation-and-home-health-care/ Home automation and in-home care aid gives patients independence without sacrificing their health needs. (3/25/14)]&lt;br /&gt;
&lt;br /&gt;
Internet Access &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/a-growing-number-people-chronic-conditions-also-lack-internet-access A growing number of people with chronic conditions also lack internet access (6/9/17)]&lt;br /&gt;
* [http://www.huffingtonpost.com/jane-sarasohnkahn/broadband-connectivity-is_b_11059720.html Broadband Connectivity Is A Social Determinant Of Health (7/22/16)]&lt;br /&gt;
&lt;br /&gt;
Technology Efficacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/smart-pill-bottles-didn-t-improve-adherence-for-heart-attack-patients-but-researchers-say Smart pill bottles didn’t improve medication adherence for heart attack patients, but earlier intervention could help (6/26/17)]&lt;br /&gt;
&lt;br /&gt;
==Impacting People Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Physicians ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Disciplines_.26_Resources_Determinants Physician Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Primary Care Physicians &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/many-americans-don-t-have-a-primary-care-doctor Some 28% of U.S. men and 17% of women don’t have a personal doctor or healthcare provider, according to a government survey. (1/12/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Team Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_.26_Resources_Determinants Care Team &amp;amp; Resources Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
====Credentialed Care Specialists Insight====&lt;br /&gt;
Nurses &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/how-a-specialist-nurse-can-help-with-dementia/ How a Specialist Nurse can Help with Dementia (6/21/14)]&lt;br /&gt;
&lt;br /&gt;
====Credentialed Support Providers Insight====&lt;br /&gt;
&lt;br /&gt;
====Team-Based Approach====&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/04/526475132/to-bring-down-stubbornly-high-blood-pressure-it-helps-to-have-a-team To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team (5/4/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/team-based-care-can-have-negative-financial-impact-on-primary-care-in-ffs-environment.html Team-based care can have negative financial impact on primary care in FFS environment (8/10/16)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2016/06/15/the-team-sport-of-diagnosis-a-culture-shift-can-reduce-missed-diagnoses/ The Team Sport of Diagnosis: A Culture Shift Can Reduce Missed Diagnoses (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Insight''===&lt;br /&gt;
Caregiver &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170807.061390/full/ More than a million youngsters ages 8–18 are caregivers taking on challenging tasks to help a parent, grandparent, sibling, or other relative. (8/7//17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-70-percent-caregivers-say-tech-plays-no-role-or-minor-role-their-work Survey: 70 percent of caregivers say tech plays no role or a minor role in their work (6/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/new-pennsylvania-law-requires-hospitals-to-educate-caregivers-upon-patient-discharge.html  New Pennsylvania law requires hospitals to educate caregivers upon patient discharge (4/27/17)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family-caregiving-cost-survey-res-ltc.pdf Study: Many Caregivers Spend $7K Annually Out Of Pocket, which is 20% of their income (11/14/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3065403/the-future-of-work/the-hidden-caregiving-crisis-that-the-election-wont-solve The number of U.S. workers struggling to care for ill or aging loved ones is growing fast. But the support they need isn't. (11/8/16)]&lt;br /&gt;
* [http://khn.org/news/study-elderlys-family-caregivers-need-help-too/amp/ Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones (9/14/16)]&lt;br /&gt;
* [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers In Some States, a New Focus on Family Caregivers. Nearly half of family caregivers administer multiple medications, treat wounds or operate specialized medical equipment. (6/22/16)]&lt;br /&gt;
* [http://khn.org/news/who-are-americas-caregivers-nearly-a-quarter-are-millennials/ Who Are The 40 Million American Caregivers? Nearly A Quarter Are Millennials (12/3/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/15-things-to-know-about-caregivers.html 15 things to know about caregivers (11/3/15)]&lt;br /&gt;
* [http://mobihealthnews.com/48054/new-council-will-guide-family-caregivers-to-available-tools/ New council will guide family caregivers to available tools (10/28/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/caregiver-frustration/ Nearly one-third struggle in their caregiving role and want tools to help them and their family members. 64% feel stressed and overwhelmed; nearly half struggle with balancing personal needs and caregiving. (10/24/15)]&lt;br /&gt;
* [http://khn.org/news/dementia-also-takes-toll-on-unpaid-caregivers-study-shows/ Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia (10/16/2015)]&lt;br /&gt;
* [http://www.usnews.com/news/us/articles/2015/07/14/ap-norc-poll-many-californians-unaware-of-caregiver-program Many Californians unaware of caregiver program for low-income seniors, disabled (7/14/15)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-undeniable-progress.pdf In 2013, about 40 million family caregivers in the US provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013. (7/2015)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf An estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the 12 months period in 2014 and 2015. (6/2015)]&lt;br /&gt;
* [http://medcitynews.com/2015/04/care-caregiver/ How Do We Care for the Caregiver (4/23/15)]&lt;br /&gt;
* [https://www.caring.com/about/news-room/costs-of-caregiving-2014 Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs (9/15/14)]&lt;br /&gt;
&lt;br /&gt;
Home Care (Non-Credentialed) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/ Lots Of Responsibility For In-Home Care Providers — But No Training Required (1/6/15)]&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends Determinants] that can decisively affect a patient's overall health and well-being. &amp;lt;br&amp;gt;&lt;br /&gt;
Spouse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.asco.org/about-asco/press-center/news-releases/large-study-finds-association-between-marriage-and-cancer Large Study Finds Association Between Marriage and Cancer Outcomes (9/23/13)]&lt;br /&gt;
&lt;br /&gt;
===Support Team Insight===&lt;br /&gt;
&lt;br /&gt;
Community Health Workers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/ Hospitals Eye Community Health Workers To Cultivate Patients’ Successes (4/11/16)]&lt;br /&gt;
* [http://khn.org/news/in-l-a-community-health-workers-are-part-of-the-medical-team/ In L.A., Community Health Workers Are Part Of The Medical Team (10/26/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/16/how-community-health-workers-can-reinvent-health-care-delivery-in-the-us/ How Community Health Workers Can Reinvent Health Care Delivery In The US (1/16/15)]&lt;br /&gt;
&lt;br /&gt;
Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html How Social Spending Affects Health Outcomes (8/17/16)]&lt;br /&gt;
* [https://thehealthcaremarketer.wordpress.com/2016/08/11/the-health-impact-in-5-years-hi-5-initiative/ Centers for Disease Control and Prevention (CDC) launches new initiative – Health Impact in 5 Years (HI-5). Promotes list of proven non-clinical, community-wide interventions that improved health within five years and are cost-effective or have cost-saving over the lifetime of the population. (8/11/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/politics/2016/05/02/social-service-shortfalls-hinder-health-boost-medical-spending/83625264/ Social service shortfalls hinder health, boost medical spending (5/3/16)] &lt;br /&gt;
* [https://www.icsi.org/_asset/nsnyw1/sharingknowledgedata.pdf Sharing Knowledge and Data at the Community/System Level To Address Social Determinants (4/2015)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/14/to-lower-the-cost-of-health-care-invest-in-social-services/ To Lower The Cost Of Health Care, Low-tech social services also should be considered a key factor in our health care equation. (7/14/15)]&lt;br /&gt;
* [http://www.cdc.gov/chinav/ CDC launches Community Health Improvement Navigator (CHI Navigator) website (5/2015)] with tools and resources from [http://www.thecommunityguide.org/ The Guide to Community Preventive Services], the [http://whatworksforhealth.wisc.edu/ What Works for Health database (on the University of Wisconsin website)], the [https://innovations.ahrq.gov/ AHRQ Health Care Innovations Exchange], the [http://cdc.thehcn.net/index.php?module=promisepractice&amp;amp;controller=index&amp;amp;action=index Healthy Communities Institute Promising Practices] and the [http://healthyamericans.org/ New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/11/understanding-intersection-health-care-social-services.html Understanding the intersection of health care and social services (11/10/13)]&lt;br /&gt;
&lt;br /&gt;
===Organizations Insight===&lt;br /&gt;
====Healthcare Organizations Insight====&lt;br /&gt;
====Government Organizations Insight====&lt;br /&gt;
====Employer Insight====&lt;br /&gt;
====Community and Social Services Organizations Insight====&lt;br /&gt;
====Support Resources Organizations Insight====&lt;br /&gt;
===Other Contributors Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Healthy Lifestyle ''Insight''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1569 The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed (8/2017)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1605086#t=article A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor). Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle. (12/15/16)]&lt;br /&gt;
* [http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract Study finds 2.7% of U.S. adults meet criteria for ‘healthy lifestyle’ (4/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ Scientist assert Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Only 5–10% of all cancer cases were attributed to genetic defects, whereas the remaining 90–95% is lifestyle factors including tobacco (25–30%), diet (30–35% - fried foods, red meat), infections (15–20%) the remaining alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity. (7/15/2008)]&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Insight''===&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/06/26/teenagers-are-as-sedentary-as-60-year-olds-by-age-19/?utm_term=.127016b508d0 Teenagers are as sedentary as 60-year-olds by age 19 (6/26/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/15/why-being-a-weekend-warrior-is-still-good-for-your-health/#EQ6NSxU86kqy Researchers found that the weekend warriors who met physical activity guidelines were less likely to die during the nine-year study period, compared with people who didn't get any exercise. A total of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity over one or two days a week. (1/15/17)]&lt;br /&gt;
* [https://www.technologyreview.com/s/602706/pokemon-go-increased-us-activity-levels-by-144-billion-steps-in-just-30-days/ Pokemon Go Increased U.S. Activity Levels by 144 Billion Steps in Just 30 Days (10/21/16)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ Brain Benefits of Exercise Diminish After Short Rest (9/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-more-than-a-quarter-of-adults-over-50-get-no-exercise-outside-of-daily-life-activities.html CDC: More than a quarter of adults over 50 get no exercise outside of daily life activities (9/20/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/27/study-suggests-new-formula-for-physical-activity-8-hours-of-sitting-means-1-hour-of-exercise/ Study suggests 1 hour of activity per 8 hours of sitting (7/27/16)]&lt;br /&gt;
&lt;br /&gt;
* [https://medlineplus.gov/podcast/transcript071816.html Moderate exercise is associated with a reduced risk of 13 types of cancer (7/18/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html The percentage of adults over 18 who met the 2008 federal physical activity guidelines for aerobic activity increased from 41.4 percent in 2006 to 49.5 percent in 2012. That rate has remained stable through 2015. (5/26/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-common-fund-launches-physical-activity-research-program NIH Common Fund launches physical activity research program to identify biological molecules that change in response to exercise (6/11/15)]&lt;br /&gt;
* [http://www.reuters.com/article/us-sedentary-television-mortality-idUSKBN0F65BW20140701 Too much TV tied to premature death (7/1/14)]&lt;br /&gt;
Children Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/recruiting-insider/wp/2017/09/06/youth-sports-study-declining-participation-rising-costs-and-unqualified-coaches/?utm_term=.39fd187136e1 Youth sports study: Declining participation, rising costs and unqualified coaches (9/6/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/johns-hopkins-us-could-save-21b-in-healthcare-costs-if-kids-played-outside-every-day.html Johns Hopkins: US could save $21B in healthcare costs if kids played outside every day (5/15/17)]&lt;br /&gt;
* [https://www.usatoday.com/story/news/health/2017/05/06/kids-inactivity-rises-creating-health-care-time-bomb/101245982/ The percent of children aged six to 12 who were physically active three or more times a week had its biggest drop in five years and is now under 25% (5/6/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/03/well/move/childs-play-is-good-for-all-of-us.html If all of the children who currently are sedentary started exercising every day in the United States alone, we could expect to save more than $120 billion every year in health care and associated expenses. (5/3/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/902 Modeling The Economic And Health Impact Of Increasing Children’s Physical Activity In The United States (5/2017)]&lt;br /&gt;
&lt;br /&gt;
Sitting &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/09/04/547580952/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later Study of sitting and walking ability over 8 to 10 years, those who sit the most and move the least had more than three times the risk of difficulty walking by the end of the study (9/4/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/sitting-can-be-bad-especially-if-you-do-it-for-more-than-10-hours-a-day/2016/07/22/43f7f228-4f77-11e6-aa14-e0c1087f7583_story.html Sitting can be bad, especially if you do it for more than 10 hours a day (7/24/16)]&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities Insight===&lt;br /&gt;
===Nutrition ''Insight''===&lt;br /&gt;
* [http://fortune.com/2017/07/17/artificial-sweeteners-weight-loss-study/ Artificial Sweeteners Won't Help You Lose Weight, According to a Sad but Important New Study (7/17/17)]&lt;br /&gt;
* [http://ajcn.nutrition.org/content/early/2017/06/07/ajcn.117.154872.abstract?papeto The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. (6/7/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1 Pediatricians Advise No Fruit Juice Until Kids Are 1 (5/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/15/well/eat/red-meat-increases-risk-of-dying-from-8-diseases.html Red meat increase risk of dying from 8 diseases (5/15/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/26/well/diet-sodas-tied-to-dementia-and-stroke.html Diet soda tied to dementia and stroke (4/26/17)] &lt;br /&gt;
* [https://www.statnews.com/2017/01/26/soda-sugary-drinks/ The number of calories per day that children and adults have been getting from soda and other sugar-sweetened beverages has been dropping for steadily for nearly 20 years, but new data show that since 2009 that number has plateaued. (1/26/17)] &lt;br /&gt;
* [http://www.alzheimersanddementia.com/article/S1552-5260(17)30050-X/fulltext Excess sugar consumption has been linked with Alzheimer's disease (AD) pathology in animal models. (1/24/17)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2529628 Dietary Intake Among US Adults, 1999-2012 Improved. The American Heart Association (AHA) primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). (6/21/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2016/03/more-than-half-of-what-americans-eat-is-ultra-processed/472791/ More Than Half of What Americans Eat Is 'Ultra-Processed'. And those foods account for 90 percent of U.S. added sugar intake, new research says.(3/10/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1916.abstract Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; Overall Diet Remains Poor (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1940.abstract Foods with the largest positive associations with three-year excess weight gain (among children and adolescents) were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages (11/2015)]&lt;br /&gt;
* [http://now.tufts.edu/news-releases/sugary-drinks-linked-high-death-tolls-worldwide Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year (6/29/15)]&lt;br /&gt;
* [http://openheart.bmj.com/content/2/1/e000196.full US and UK governments dietary guidelines introduced in 1977 and 1983 to reduce coronary heart disease (CHD) by reducing fat intake didn't have studies to support it. (2/9/15)]&lt;br /&gt;
&lt;br /&gt;
===Functional Activities Insight===&lt;br /&gt;
&lt;br /&gt;
Digital Health Usage &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-21-percent-americans-have-used-virtual-healthcare-78-percent-are-interested Survey: 21 percent of Americans have used virtual healthcare, 78 percent are interested (2/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/senior-citizens-rarely-use-digital-health-resources-5-study-findings.html Seniors rarely use digital health resources: 5 study findings (8/3/16)]&lt;br /&gt;
* [http://mobihealthnews.com/39189/parks-41-percent-of-caregivers-use-a-digital-health-device 41 percent of caregivers use a digital health device (12/18/14)]&lt;br /&gt;
* [http://mobihealthnews.com/38904/kaiser-members-who-use-app-are-more-adherent-satisfied-and-loyal/ Kaiser now has 70% of its 9 million members as active users of its online and mobile offerings, patients are more adherent, satisfied, and loyal (12/10/14)]&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Insight''===&lt;br /&gt;
* [https://www.alz.org/aaic/releases_2017/AAIC17-Tues-Briefing-Sleep.asp Interrupted sleep may lead to Alzheimer’s. Research found significant associations between sleep disordered breathing (SDB) and the accumulation of biomarkers for Alzheimer's disease. (7/18/18)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/06/504448639/drivers-beware-crash-rate-spikes-with-every-hour-of-lost-sleep Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep (12/6/16)]&lt;br /&gt;
* [http://mashable.com/2016/11/30/sleep-deprivation-economic-cost.amp In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death (11/30/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/08/24/432764792/snooze-alert-a-sleep-disorder-may-be-harming-your-body-and-brain Snooze Alert: A Sleep Disorder May Be Harming Your Body And Brain A Sleep Disorder May Be Harming Your Body And Brain. More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea. (8/24/15)]&lt;br /&gt;
* [http://articles.latimes.com/2013/aug/29/science/la-sci-sn-sleeping-pill-use-cdc-20130830 One in 25 American adults takes sleeping pills to help them fall asleep and stay asleep at night (8/29/13)]&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-things-to-know-about-america-s-unhealthy-behaviors.html More than 70 percent of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. (4/5/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-overweight-heart-uspstf-idUSKBN0GP1XA20140825 Overweight patients with risk factors for heart disease need &amp;quot;intensive behavioral counseling&amp;quot; about '''diet''' or '''exercise''', according to USPSTF. (8/25/14)]&lt;br /&gt;
* [https://georgevanantwerp.com/2013/12/30/8-risks-drive-15-conditions-and-80-of-healthcare-costs/ 8 Behavior Risks Drive 15 Conditions And 80% Of Healthcare Costs (12/30/13)]&lt;br /&gt;
&lt;br /&gt;
Alcohol &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/28793133 One in eight Americans abuses alcohol, a new study finds, a 50 percent increase since the start of the century (9/1/17)]&lt;br /&gt;
* [https://www.bloomberg.com/news/articles/2017-08-09/america-s-drinking-problem-is-much-worse-this-century The number of adults who binge drink at least once a week could be as high as 30 million, according to a study published on Wednesday in JAMA Psychiatry. (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 32% of Americans had a minimum of one heavy drinking day in the last year. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. (5/27/16)]&lt;br /&gt;
* Alcohol Consumption - [https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ The top 10% of American drinkers consume, on average, 74 alcoholic drinks per week. (9/25/14)]&lt;br /&gt;
&lt;br /&gt;
Falls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-elderly-patients-treated-for-falls-may-be-more-likely-to-suffer-later-adverse Elderly patients treated for falls may be more likely to suffer later adverse events, study finds (7/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/among-the-elderly-an-epidemic-of-falling.html The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. (9/21/16)] &lt;br /&gt;
* [http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/ The use of 4 or more medications was associated with increased risk of falling and the risk of recurrent falls (9/27/13)]&lt;br /&gt;
&lt;br /&gt;
Risky Behaviors &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/05/29/health/car-accidents-child-deaths-seat-belts.html Car Accidents Remain a Top Child Killer, and Belts a Reliable Savior (5/29/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-high-risk-behaviors-often-persist-even-after-cancer-diagnoses.html Study finds high-risk behaviors often persist after cancer diagnoses. 19.8% of women cancer survivors smoked, compared with 15.8% of women without cancer. No differences existed for fruit and vegetable consumption or body mass index. (9/6/16)]&lt;br /&gt;
&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/01/10/smoking-costs-the-world-economy-1-trillion-per-year-world-health-organization-says/?utm_term=.378ab21f3e8c Smoking costs the world economy $1 trillion per year, World Health Organization says (1/10/17)]&lt;br /&gt;
* [https://directorsblog.nih.gov/2016/12/13/study-finds-no-safe-level-of-smoking/ New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. (12/13/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall Centers for Disease Control and Prevention says smoking rates have fallen from 21% of the adult population in 2005 to 15% in 2015 (11/10/16)]&lt;br /&gt;
* [http://www.sanger.ac.uk/news/view/smoking-pack-day-year-causes-150-mutations-lung-cells Smoking a pack a day for a year causes 150 mutations in lung cells (11/3/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cigarettes-linked-to-nearly-30-of-cancer-deaths-6-things-to-know.html Cigarettes linked to nearly 30% of cancer deaths: 6 things to know (10/24/16)]&lt;br /&gt;
* [http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002020 A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. (5/10/16)]&lt;br /&gt;
* [https://www.boston.com/news/health/2016/05/24/kicking-habit-adult-smoking-rate-us-falling-fast CDC reports smoking rate among adults in the U.S. fell to 15% in 2015, down two percentage points from 2014. (5/24/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/04/19/opioid-addiction-relapse-science/ How drug use changes the brain — and makes relapse all too common (4/19/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://health.usnews.com/health-care/articles/2017-04-19/many-heart-attack-patients-fail-to-stick-with-statins Many Heart Attack Patients Fail to Stick With Statins (4/19/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/25/more-than-half-of-adults-misuse-medications-study-finds/ More than half of adults and 44% of children drug-tested by a national clinical laboratory last year misused their prescription medications, either taking too much, too little or none of their medications. 45 percent of adults were taking drugs (including illicit drugs) that were not prescribed. (7/25/16)]&lt;br /&gt;
* [http://www.mcolblog.com/kcblog/2016/7/12/factors-attributed-to-medication-non-adherence.html 30% of prescriptions are never filled. 69% of nonadherence is due to behavioral issues, such as forgetfulness or procrastination, 16% was due to cost, and 15% say it was medication side effects (7/12/16)]&lt;br /&gt;
*  [http://www.imshealth.com/en/about-us/news/ims-health-study:-low-levels-of-adherence-and-persistence-remain-barriers-to-reducing-the-costs-of-diabetes-complications The U.S. could save $4 billion a year if more seniors with type 2 diabetes followed their doctor’s orders, according to a report by the IMS (7/12/16)]&lt;br /&gt;
* [http://www.hindawi.com/journals/ijfm/2013/901845/ Study found that only 6.5% of patients (only 46 in study) adhered completely to the discharge medication list after average hospital stay of 4.3 days. The average patient age was 76, prescription medications was 10 and number of chronic diseases was 7. (2/24/13)] &lt;br /&gt;
* [http://medcitynews.com/2014/11/study-medication-adherence-prompts/ Study: Medication adherence improved with proper prompts (11/17/14)]&lt;br /&gt;
* [http://well.blogs.nytimes.com/2012/11/15/when-the-patient-is-noncompliant/ When the patient is non-compliant (11/15/12)]&lt;br /&gt;
* [http://healthcare-economist.com/2015/05/31/patient-adherence-to-antipsychotic-medications/ About 40% of patients with schizophrenia are adhering to antipsychotic medications (5/31/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Activation Levels &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/mar/patient-self-management-capability In 2012, ED costs were 37% lower for those at highest activation level versus the lowest ($1,126 vs. $711). In 2014, the difference was 28% (3/8/16)]&lt;br /&gt;
* [http://hpr.weill.cornell.edu/divisions/biostatistics/pdf/Gerber-Research_Seminar_Talk-5-10-07.pdf Effect of the Patient Activation Measure (PAM) on Chronic Care: Baseline Findings from a Cluster Randomized Study (5/10/07)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/3/431 When Patient Activation Levels Change, Health Outcomes And Costs Change, Too (3/2015)]&lt;br /&gt;
&lt;br /&gt;
Prevention &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.ajc.com/news/local/study-finds-percent-sunscreens-don-even-work-how-find-one-that-does/ergzPOJyVv0nM7ZG88yBHK/ Study finds 73 percent of sunscreens don’t even work — how to find one that does (5/26/17)]&lt;br /&gt;
&lt;br /&gt;
Preventive Screening and Vaccinations&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentages of adults who received an influenza vaccination in 2015 was 65.8% for adults aged 65 and over, 46% for ages 50 to 64 and 31.2% for those aged 18 to 49. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentage of adults over 65 years old vaccinated for pneumonia increased rapidly from 42.4% in 1997 to 53.1% in 2000. In 2015, the percentage rose to 63.5% (5/26/16)]&lt;br /&gt;
&lt;br /&gt;
Self Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.reuters.com/article/us-pressure-management-study-idUSKBN0GR2C220140827 Self management may reduce blood pressure (8/27/14)]&lt;br /&gt;
&lt;br /&gt;
Treatment Delays &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://go.americanwell.com/rs/335-QLG-882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf 67% of consumers say they have delayed seeking care for a health problem. They delay because: It costs too much (23%), It takes too long to get in to see a doctor or nurse (23%), They thought the problem would go away on its own (36%), They are too busy (13%) (1/2017)]&lt;br /&gt;
&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-fewer-americans-diet-20170308-story.html American adults either overweight or obese rose from about 53% a generation ago to roughly 66% more recently. 56% of overweight or obese adults reported in 1988 to 1994 they had tried to lose weight in the last year, it has declined to 49% in 2009 to 2014. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Wellness Programs&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/279396/will-every-human-be-health-reward-program-when-it-comes-health-rewards-it-seems 74 percent of employers use health reward program (12/1/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/193551/amount-reward-consumer-health-behavior What Size Reward Drives a Consumer to Take a Desired Health Behavior? (9/9/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/25/workplace-wellness-produces-no-savings/ Workplace Wellness Produces No Savings (11/25/14)]&lt;br /&gt;
&lt;br /&gt;
===Care Planning Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/05/10/addressing-triggers-of-decline-in-older-adults-physical-cognitive-or-mental-health/ “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/07/02/family-caregiving-and-palliative-care-closing-the-policy-gap/ Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)]&lt;br /&gt;
&lt;br /&gt;
Care Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/02/implementing-a-care-planning-system-how-to-fix-the-most-pervasive-errors-in-health-care/ Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/630.abstract Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)] &lt;br /&gt;
* [http://familiesusa.org/press-release/2016/proven-best-choices-guides-health-care-options-launched-icer-and-families-usa Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)]&lt;br /&gt;
* [https://decisionaid.ohri.ca/odsf.html The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/october-november/in-focus Helping Patients Make Better Treatment With Decision Aids (10/2012)]&lt;br /&gt;
&lt;br /&gt;
Evidence-Based Practice &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/primary-care-docs-may-struggle-to-find-high-quality-evidence-to-support-clinical Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/22/credibility-of-evidence-a-reconsideration-of-the-logic-and-strength-of-our-healthcare-decisions/ Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)]&lt;br /&gt;
&lt;br /&gt;
Medical Advocates &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/medical-advocates-can-help-guide-patients-on-difficult-care-choices/ Medical Advocates Can Help Guide Patients On Difficult Care Choices  (1/27/16)]&lt;br /&gt;
&lt;br /&gt;
Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/partners-expands-second-opinion-service-health-advocate-partnership Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/88-of-second-opinions-from-mayo-physicians-result-in-different-diagnosis-study-finds.html 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)]&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/patients-with-more-say-in-treatment-have-fewer-side.html Patients with more say in treatment have fewer side effects (7/13/16)]&lt;br /&gt;
*  [http://khn.org/news/inviting-patients-to-help-decide-their-own-treatment/ Inviting Patients To Help Decide Their Own Treatment (3/16/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/17/shared-decision-making-and-the-use-of-patient-decision-aids/ Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/doctors-patients-critically-medical-decisions.html How should doctors and patients look critically at medical decisions?] (8/16/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/medical-interventions-5050-informs-patient.html Many medical interventions are 50/50: Who informs the patient? (8/13/2013)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management - Communications Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Communicating Instructions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/most-patients-don-t-understand-post-discharge-care-plans-study-finds Most patients don't understand post-discharge care plans, study finds (1/6/2016)]&lt;br /&gt;
&lt;br /&gt;
Difficult Dialog &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/03/377569539/even-some-doctors-fear-these-10-questions The difficulty of asking questions about &amp;quot;adverse childhood experiences&amp;quot; that identifies health risks (3/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/24/394927484/many-doctors-who-diagnose-alzheimers-fail-to-tell-the-patient Many Doctors Who Diagnose Alzheimer's Fail To Tell The Patient (3/24/15)]&lt;br /&gt;
&lt;br /&gt;
Digital Communications &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cio.com/article/3195891/cio-role/kaiser-cio-shares-it-lessons-for-the-future-of-healthcare.html Kaiser Permanente crossed an important threshold last year when 52 percent of its patient interactions were digital. (5/10/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/mhealth-monitor-patients-physicians/ 58% of people in the U.S. with a smartphone shared information with a medical professional using a mobile or wearable device. And 25% used email or text to send a photo of a medical issue to their doctor. (11/15/16)]&lt;br /&gt;
* [http://www.huffingtonpost.com/2015/06/29/doctors-facebook-telehealth_n_7662774.html Communicating With Your Doctor On Facebook May Be The Future Of Healthcare (6/29/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/07/healthcrowd-pilot-finds-mobile-engagement-medicaid-patients-cost-effective/ Pilot project finds mobile engagement with Medicaid patients ‘most cost-effective’ (7/29/14)]&lt;br /&gt;
* [http://mobihealthnews.com/35160/nearly-half-of-kaiser-permanentes-members-use-my-health-manager/ Nearly half of Kaiser Permanente's members use online health management platform (7/25/14)]&lt;br /&gt;
* Electronic Communication - [http://link.springer.com/article/10.1007%2Fs11606-012-2329-5 71% of vulnerable patient populations want to use electronic communication with health care providers.] (2/20/13)&lt;br /&gt;
&lt;br /&gt;
Doctor Patient Discussions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/language-doctors-use-to-talk-to-diabetes-patients-makes-a-difference The language doctors use to talk to diabetes patients makes a difference to success (6/14/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/prudent-antibiotic-prescribing-lowers-patient-satisfaction.html How prudent antibiotic prescribing lowers patient satisfaction (9/13/16)]&lt;br /&gt;
* [http://khn.org/news/attending-to-the-human-element-is-key-to-keeping-patients-healthy/amp/ Study recommends improving communication with racial minorities and lower-income patients, such as better bedside manner (so patients trust their doctors), communication that is easily understood by everyday people and willingness to discuss how price fits into consumers’ health decisions. (9/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/physicians-spend-twice-as-much-time-on-ehr-desk-work-than-with-patients.html Physicians spend twice as much time on EHR, desk work than with patients (9/6/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/06/costs_of_care_getti.html Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. (6/15/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/get-10-minutes-doctor-2/ Why Do I Only Get 10 Minutes With My Doctor? (9/18/14)]&lt;br /&gt;
* [http://khn.org/news/15-minute-doctor-visits/ 15-Minute Visits Take A Toll On The Doctor-Patient Relationship (4/21/14)]&lt;br /&gt;
&lt;br /&gt;
Patient Portals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/ehr/despite-federal-push-to-offer-ehr-access-patient-engagement-low Just 15% of hospital patients electronically accessed their medical records despite 88% of hospitals offering access. Nearly one-third of patients accessed EHRs offered by physician practices. (3/16/17)]&lt;br /&gt;
&lt;br /&gt;
Patient Provided Data&lt;br /&gt;
* [http://www.fiercehealthcare.com/analytics/how-university-rochester-medical-center-uses-patient-generated-data-to-set-expectations University of Rochester Medical Center (URMC) collects patient-reported outcomes by using a Patient-Reported Outcomes Measurement Information System (PROMIS), which requires patients to answer five to seven questions on a tablet. (7/6/17)] &lt;br /&gt;
* [http://www.annfammed.org/content/15/2/158.abstract Patients Typing Their Own Visit Agendas Into an Electronic Medical Record. Patients and clinicians agreed that the agendas improved patient-clinician communication. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Remote Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2488923#Results Study finds readmissions nearly the same for heart failure patients using remote patient monitoring (3/2016)]&lt;br /&gt;
* [http://mobihealthnews.com/content/scripps-wired-health-study-results-show-no-clinical-or-economic-benefit-digital-health Scripps Wired for Health study shows no clinical or economic benefit from digital health monitoring (1/19/16)]&lt;br /&gt;
* [http://khn.org/news/making-the-human-condition-computable/ Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to enable doctors to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails. (12/11/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/can-fall-monitoring-technology-keep-elders-safe/ Can Fall Monitoring Technology Keep Elders Safe? (4/7/14)]&lt;br /&gt;
* [http://www.mddionline.com/article/digital-health-dominates-ces-2014-%E2%80%93-3-trends-watch-3 Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. (1/9/14)]&lt;br /&gt;
&lt;br /&gt;
Screenings &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/doctors-should-screen-patients-for-social-isolation-to-address-loneliness-epidemic Doctors must screen patients for social isolation to address 'loneliness epidemic' (8/8/17)]&lt;br /&gt;
* [https://nam.edu/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool/ Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool. (5/30/17)] [https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf See PDF] &lt;br /&gt;
&lt;br /&gt;
Text Messaging &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/despite-privacy-hoops-text-messaging-offers-unprecedented-convenience Despite privacy hoops, text messaging offers ‘unprecedented convenience’ (5/11/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management - Operational Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/474.abstract Breaking Down Silos Between Health Care And Criminal Justice (3/2014)]&lt;br /&gt;
&lt;br /&gt;
Behavioral Health Integration&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/10/1808.abstract Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care (10/2014)]&lt;br /&gt;
* [http://docs.house.gov/meetings/IF/IF02/20150211/102944/HHRG-114-IF02-Wstate-KohnL-20150211.pdf About 10 million—or 4.2%—of adults in the United States suffered from a serious mental illness in 2013 were supported by 112 different federal programs (2/11/15)]&lt;br /&gt;
&lt;br /&gt;
Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-acute-care-needs-to-be-coordinated-but-it-often-not Only 30% of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7% reported they were fully coordinated. (11/131/6)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/07/20/peds.2015-4182 Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. (7/2016)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/09/difficult-transition-hospital-nursing-home.html The difficult transition between the hospital and nursing home (9/5/13)]&lt;br /&gt;
* [http://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/ One of the most dangerous junctures in medical care: patients leaving the hospital. Nearly a quarter had inadequately reviewed or tracked medications, sometimes even causing fatal events. (5/2/16)] &lt;br /&gt;
* [https://psnet.ahrq.gov/primers/primer/11 Nearly 20% of patients experience adverse events within 3 weeks of hospital discharge, nearly three-quarters of which could have been prevented or ameliorated. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-discharge-risks-persist-for-elderly-patients The transition from hospital to home poses significant risks to patients, especially the elderly, and gaps persist in care during this crucial time. (7/11/16)]&lt;br /&gt;
&lt;br /&gt;
Coordinated Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/nov/healthcare-fragmentation-frequency-diagnostic-tests Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, linked to high rates of hospitalization and emergency department visits as well as lower satisfaction. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients. (11/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/on-lok Program of All-Inclusive Care for the Elderly (PACE) cares for frail elders in the community (8/12/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/12/poor-interoperability-affects-patients.html How poor interoperability affects patients. It often requires duplicate testing that is not only costly (e.g., CT scans), but also invasive and not without risk to the patient (e.g., bronchoscopy, biopsies). (12/17/15)]&lt;br /&gt;
* [http://www.jhsph.edu/news/news-releases/2015/four-in-ten-older-adults-burdened-by-demands-of-health-care-system.html Four in Ten Older Adults Burdened by Demands of Health Care System] (10/14/15)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2014/nov/international-survey-of-older-adults International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care (11/19/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/special-report/5-pieces-care-coordination-puzzle 5 pieces of the care coordination puzzle (6/11/14)]&lt;br /&gt;
* [http://www.healthcare-informatics.com/news-item/lack-coordinated-care-problem-older-patients-survey-says Lack of Coordinated Care is a Problem for Older Patients, Survey Says (4/3/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/10/coordinated-care-critical-reducing-u-s-health-spending/ Coordinated care critical for reducing U.S. health spending  (10/8/13)]&lt;br /&gt;
&lt;br /&gt;
Managing [http://www.patientdeterminants.org/index.php?title=Health_Insight#High_Need.2C_High_Cost_Patients_Insight High Cost High Need Patients] &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? (8/7/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/care-high-need-high-cost-patients Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis (10/29/15)] &lt;br /&gt;
&lt;br /&gt;
Palliative Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/44.abstract Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities (1/2016)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/29/the-challenge-of-financing-sustainable-community-based-palliative-care-programs/ The Challenge Of Financing Sustainable Community-Based Palliative Care Programs (12/29/14)]&lt;br /&gt;
&lt;br /&gt;
Partnering With Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/what-organizations-do-hospitals-partner-with-for-population-health.html What Organizations do Hospitals Partner With for Population Health? (12/5/13)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2014/12/28/the-trouble-with-home-health-care-care-coordination/ The Trouble with Home Health Care &amp;amp; Care Coordination (12/28/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2104.abstract Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Coordinating care and communicating with specialists, hospitals, home care and social service providers. (12/2015)]&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Determinants Health Strategy Activities Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Interventions Activities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Interventions_Determinants Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being. [[Medical Interventions]] Activities are impacted by:&lt;br /&gt;
&lt;br /&gt;
* [[Medical Intervention Access|Access]]&lt;br /&gt;
* [[Medical Intervention Diagnosis|Diagnosis]]&lt;br /&gt;
* [[Medical Intervention Efficacy|Efficacy]]&lt;br /&gt;
* Testing&lt;br /&gt;
* [[Medical Intervention Treatments|Treatments]]&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions Activity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Non-Medical_Interventions_Determinants Non-Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Cardiac Rehabilitation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/cardiac-rehab-improves-health-but-cost-and-access-issues-complicate-success/amp/ Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (8/31/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/07/18/485871530/cardiac-rehab-works-great-so-why-don-t-people-do-it Despite research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer; fewer than a third do. (7/18/16)]&lt;br /&gt;
&lt;br /&gt;
Employee Wellness Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/ Large firms (at least 200 employees) are more likely to offer Employee Wellness Programs than smaller firms (81% vs. 49%) in an effort to promote employee health and productivity and reduce health related cost (5/19/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/71.abstract Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study (1/2016)]&lt;br /&gt;
&lt;br /&gt;
Fall Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-step-up-to-help-seniors-avoid-falls/ Hospitals Step Up To Help Seniors Avoid Falls (1/12/16)]&lt;br /&gt;
&lt;br /&gt;
Health Coaching &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/the-underrated-value-of-coaching-in-healthcare-4-thoughts-from-population-health-expert-dr-william-appelgate.html The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William Appelgate (1/25/17)]&lt;br /&gt;
&lt;br /&gt;
Legal Counseling &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/legal-regulatory-issues/ku-kansas-hospital-to-offer-free-legal-counsel-to-low-income-patients.html Kansas hospital offers free legal counsel to low-income patients (8/18/16)]&lt;br /&gt;
&lt;br /&gt;
Music Therapy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthworkscollective.com/anxiety-relief-through-music-therapy/ Music Therapy can be an Effective Treatment for Patients With Anxiety Disorders (9/6/17)]&lt;br /&gt;
&lt;br /&gt;
Obesity Counseling &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://khn.org/news/few-seniors-benefitting-from-medicare-obesity-counseling/ Few Seniors Benefiting From Medicare Obesity Counseling (2/23/15)]&lt;br /&gt;
* [http://khn.org/news/seniors-obesity-counseling-benefit-goes-largely-unused/ Seniors’ Obesity-Counseling Benefit Goes Largely Unused (11/20/14)]&lt;br /&gt;
&lt;br /&gt;
Opioid Alternative&lt;br /&gt;
* [http://www.denverpost.com/2016/11/30/battling-opioid-epidemic/ How a Colorado health care provider is battling the opioid epidemic with non-pill pain treatments (11/30/16)]&lt;br /&gt;
&lt;br /&gt;
Virtual Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fastcompany.com/3047894/the-future-of-work/how-to-turn-your-smartphone-into-your-personal-therapist Smartphone As A Personal Therapist. Could the technology that causes so much of our stress and anxiety also be the cure? (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence Insight====&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T21:46:15Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Consumer Diagnostic Services */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* In-home Testing&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Medical_Intervention_Efficacy</id>
		<title>Medical Intervention Efficacy</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Medical_Intervention_Efficacy"/>
				<updated>2019-07-16T21:41:26Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Medical Interventions]] Efficacy are  [[Health Determinants|health determinants]] that impact patients health.&lt;br /&gt;
&lt;br /&gt;
Adverse Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/30-percent-rehabilitation-hospital-patients-experience-harm-study-finds OIG report: 30% of rehab hospital patients experience harm (7/21/16)]&lt;br /&gt;
* [http://khn.org/news/elderly-hospital-patients-arrive-sick-often-leave-disabled/amp/ About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived (8/9/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/06/29/time-to-fix-the-black-hole-in-medicare-data/ Medicare pays for nearly 500,000 hip and knee replacement surgeries each year. Approximately 25,000 patients undergo procedures to remove and replace a previous artificial joint. Medicare program is unable to identify product failures, patient safety problems or performance of medical devices. (6/29/16)]&lt;br /&gt;
* [http://www.nytimes.com/2015/03/03/upshot/if-patients-only-knew-when-more-information-means-less-treatment.html If Patients Only Knew How Often Treatments Could Harm Them (3/2/15)]&lt;br /&gt;
&lt;br /&gt;
Cancer Treatments &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/one-in-three-women-with-breast-cancer-treated-unnecessarily-study-concludes/amp/ One In Three Women With Breast Cancer Treated Unnecessarily, Study Concludes (1/9/17)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1606220?af=R&amp;amp;rss=currentIssue&amp;amp; At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. (10/13/16)]&lt;br /&gt;
&lt;br /&gt;
Low-Value Care &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/18-low-value-tests-cost-minnesota-patients-54-9m-mayo-and-state-study.html 18 'low-value' tests cost Minnesota patients $54.9M, Mayo and state study finds (6/2/17)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/12/03/taking-stock-of-choosing-wisely/ Roughly 93 percent of quality measures and initiatives have focused on underuse. Choosing Wisely focuses on the overuse that impacts quality and safety (12/3/15)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=1868536 Medicare spent $8.5 billion on 26 measures of low-value care (7/2014)]&lt;br /&gt;
&lt;br /&gt;
Medical Errors &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/physicians-prescribe-wrong-antibiotic-half-of-the-time.html Physicians prescribe wrong antibiotic half of the time (10/25/16)]&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20160504/NEWS/160509962/medical-errors-may-kill-250000-a-year-but-problem-not-being-tracked Medical errors may kill 250,000 a year, but problem not being tracked (5/4/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/medical-errors-officially-third-leading-cause-death-u-s-study-finds Medical errors officially the third leading cause of death in U.S., study finds (5/3/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/medication-errors-occur-half-surgeries-mgh-study-finds Medication errors or unintended drug side effects occurred in about half of all surgeries done at Boston's Massachusetts General Hospital (10/26/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/study-medical-error-deaths-4-5-times-more-likely-than-iom-estimate.html Study: Medical Error Deaths 4.5 Times More Likely Than IOM Estimate 9/20/13)]''Medical Decisions''' &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Physician Preference Sensitive Treatments &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/6/993.abstract Physician Characteristics Strongly Predict Patient Enrollment In Hospice (6/2015)]&lt;br /&gt;
&lt;br /&gt;
Surgeries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/for-knee-pain-experts-say-dont-think-about-scoping-it/ A review of 13 studies, involving nearly 1,700 patients, found that arthroscopic surgery for patients with degenerative knee problems did not provide lasting pain relief or improve function. (5/10/17)]&lt;br /&gt;
* [http://www.bmj.com/content/356/bmj.j1131 Total knee replacement of patients with knee osteoarthritis had minimal effects on quality of life. If procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use. (3/28/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/why-medically-unnecessary-surgeries-still-happen.html 400,000 middle-aged and older Americans undergo meniscus surgery. Studies have concluded that meniscus surgery offers no additional benefits regular exercise could not. (8/5/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/05/01/403611589/who-keeps-track-if-your-surgery-goes-well-or-fails For 99 percent of people in America, when they go in to have surgery, the outcome of that operation is not measured (5/3/15)]&lt;br /&gt;
* [http://www.reuters.com/article/us-knee-replacement-inappropriate-idUSKBN0F52LC20140630 One-third of knee replacements in the U.S. may be inappropriate (6/30/14)]&lt;br /&gt;
&lt;br /&gt;
Unnecessary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181970 Overtreatment in the United States - Study finds physicians believe that 20.6 percent of all medical care was unnecessary, including 22 percent of prescriptions, 24.9 percent of tests and 11.1 percent of procedures. (9/6/17)]&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170801.061337/full/ Professional Athletes And Back Surgery: A Teachable Moment On Overuse In Health Care? (8/1/17)]&lt;br /&gt;
* [http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande OVERKILL: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? (5/11/15)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2015/jan/choosing-wisely-a-growing-international-campaign Choosing Wisely: In addition to wasting valuable resources, the unnecessary use of medical tests, treatments, and procedures can sometimes harm patients (1/20/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/study-fear-lawsuits-drives-docs-order-unnecessary-diagnostics-hospitalization/ Study of 4,215 orders shows $226 spent per patient on unnecessary care (9/16/14)]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Insight</id>
		<title>Health Insight</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Insight"/>
				<updated>2019-07-16T21:31:05Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Physical Activities Insight */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday there is new insight into our understanding of [[Health Determinants]] and [[barriers]] that impact patient outcomes. This page will curate new insight. While health care is likely the most important determinant of health when a patient has an acute condition, studies show it represents only a part of an overall health outcomes:&lt;br /&gt;
&lt;br /&gt;
[[Health Determinants Insight]]&lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Mission (Health Goals) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Personal Goals Insight===&lt;br /&gt;
===Health Goals (Care Goals) Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Mission_.26_Care_Goals_Determinants Health Goals (Care Goals) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Advanced Directives &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/1-3-u-s-adults-have-completed-advance-directive-study-finds 2 out of 3 adults fail to complete an advance directive (7/6/17)]&lt;br /&gt;
* [http://www.cbsnews.com/news/being-prepared-for-the-final-days/ Being prepared for the final days (4/27/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/lack-advance-directives-leads-to-unwanted-care Lack of advance directives leads to unwanted care (11/2/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/national-healthcare-decisions-day-11-statistics-on-end-of-life-decision-making.html Only 20% of Americans have an advanced directive documenting their wishes for end-of-life medical care. (4/16/15)]&lt;br /&gt;
&lt;br /&gt;
Care Goals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/12/defining-patients-goals-care.html Defining the patient’s goals of care (12/11/13)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1113631#t=article Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)]&lt;br /&gt;
&lt;br /&gt;
End of Life Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/end-life-care-planning-fails-patients End-of-life care, planning fails patients (2/5/15)]&lt;br /&gt;
* [https://www.minnpost.com/second-opinion/2014/06/few-doctors-discuss-end-life-planning-heart-failure-patients-mayo-study-finds Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)]&lt;br /&gt;
* [http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx ''Dying in America'' - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)]&lt;br /&gt;
* [http://khn.org/news/too-many-people-die-in-hospital-instead-of-home-heres-why/ Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)]&lt;br /&gt;
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Health Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/28/what-outcomes-matter-to-patients-with-rheumatoid-arthritis/ What outcomes matter to patients with Rheumatoid Arthritis? (8/28/17)]&lt;br /&gt;
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==Strategy (Health Plan) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Strategy (Health Plan) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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===Strategy Solutions (Interventions) Insight===&lt;br /&gt;
====Medical Interventions Insight====&lt;br /&gt;
====Non-Medical Interventions Insight====&lt;br /&gt;
====Intervention Changes Insight====&lt;br /&gt;
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===Strategy Measures===&lt;br /&gt;
===Strategy - Impacting People Insight===&lt;br /&gt;
===Strategy - Impacting Realities Insight===&lt;br /&gt;
===Strategy - Impacting Activities Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
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===Health Conditions ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Physical Conditions ''Insight''==== &lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Physical_Conditions_Determinants Physical Conditions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.cbsnews.com/news/more-u-s-kids-have-chronic-health-problems-study The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest (5/2/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/jan/analysis-of-death-rates-for-middle-aged-whites A lack of progress since 1999 against common illnesses such as heart disease, diabetes, and respiratory disease was largely responsible for higher-than-expected death rates for middle-aged (45–54) white adults in 2014. (1/29/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/07/study-on-aging/ Don’t judge a person on their chronological age; their biological age might be a lot older than you think, aging study says (7/7/15)]&lt;br /&gt;
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Arthritis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. (3/7/17)]&lt;br /&gt;
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Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/stateline-states-asthma/ Nationwide, one in 10 children has asthma. (4/16/14)]&lt;br /&gt;
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Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/science/archive/2017/03/no-cancer-isnt-mostly-bad-luck/521049/ Scientists don't agree 66% of cancer is due to bad luck (3/28/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521219318/cancer-is-partly-caused-by-bad-luck-study-finds Study: Causes of cancer, 66% from random mutations during cell division (bad luck), about 29% from environment and remaining 5% due to heredity. (3/23/17)]&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-cancer-drop-20170105-story.html Death rate from cancer now 25% lower than it was 25 years ago, report says (1/5/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-brain-cancer-now-killing-more-children-than-leukemia.html CDC: Brain cancer now killing more children than leukemia (9/16/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cancer-overtakes-heart-disease-as-leading-cause-of-death-in-22-states-3-things-to-know.html Cancer overtakes heart disease as leading cause of death in 22 states (8/25/16)]&lt;br /&gt;
* [https://www.sciencedaily.com/releases/2015/01/150101142318.htm Study shows two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes, while the remaining third are due to environmental factors and inherited genes. (1/1/15)]&lt;br /&gt;
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Chronic Pain &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/4-things-to-know-about-the-rising-rates-of-chronic-pain-in-the-us.html Number of Americans in their 60s reporting chronic pain increased from 10% in 1998 to 37% in 2010. (3/16/17)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain Estimated 25.3 million adults (11.2%) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6%) experience severe levels of pain. (8/11/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/04/chronic-pain-effect-patients-families.html Chronic pain and the effect on patients’ families (4/17/14)]&lt;br /&gt;
&lt;br /&gt;
COPD &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/copd/index.html Chronic lower respiratory disease, primarily COPD, is the third leading cause of death in the United States (3/12/15)]&lt;br /&gt;
&lt;br /&gt;
Cystic Fibrosis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/03/13/cystic-fibrosis-canadians-americans/ Canadians with cystic fibrosis outlive Americans by a decade (3/13/17)]&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-more-deadly-than-previously-thought-researchers-say.html Diabetes causes 12 percent of deaths in the United States, making it the third-leading cause of death in the country, according to a new study (1/26/17)] &lt;br /&gt;
* [http://khn.org/news/health-claims-on-the-rise-for-kids-with-type-2-diabetes-obesity-related-conditions/amp/ Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions (1/2/17)]&lt;br /&gt;
* [http://khn.org/news/diabetes-linked-to-risk-of-mental-health-hospitalization-in-young-adults-study/amp/ Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease (7/22/16)]&lt;br /&gt;
* [http://khn.org/news/as-childhood-diabetes-rates-rise-so-do-costs-and-families-feel-the-pinch-study/amp/ Childhood diabetes rates are on the rise. The spent $2,173 per capita in out-of-pocket health care costs in 2014. Nearly five times higher than that of kids without the illness. (6/20/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/americans-diabetes-reach-21-million Americans with diabetes reach 21 million (4/15/14)]&lt;br /&gt;
* [http://www.latimes.com/science/la-sci-sn-diabetes-study-20150908-story.html About half of all Americans have either diabetes or pre-diabetes. (9/8/15)]&lt;br /&gt;
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Heart Attack Risk &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/depression-among-heart-attack-survivors-can-be-deadly-yet-is-often-ignored/ Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (7/20/17)]&lt;br /&gt;
* [http://www.wsj.com/articles/heart-attacks-are-linked-to-what-patients-were-doing-feeling-1477923373 Performing heavy physical activity in a highly emotional state sharply raised the risk of a heart attack. (10/31/16)]&lt;br /&gt;
&lt;br /&gt;
High Blood Pressure &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cdc.gov/bloodpressure/facts.htm About 70 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults. (6/16/16)]&lt;br /&gt;
&lt;br /&gt;
Life Expectancies &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/death-rates-for-americans-in-prime-years-rise-after-century-of-decline.html The death rate for Americans between the ages of 25 and 44 rose by 8% between 2010 and 2015 after a century of decline. (6/14/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair The mortality rate for white Americans, ages 45 to 54, increased by a half percent each year from 1999 to 2013, attributed to increase in suicide, drugs and alcohol. (3/23/17)]&lt;br /&gt;
Non-Communicable Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-diseases-that-kill-16m-people-cost-the-world-economy-2-35t-annually.html Five non-communicable diseases that kill 16 million people around the world each year, cost the world economy $2.35T annually. 1) Cardiovascular disease, 2) Mental illness, 3) Cancer, 4) Chronic respiratory disease, 5) Diabetes. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
Obesity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/30/506433671/the-wrong-eating-habits-can-hurt-your-brain-not-just-your-waistline Being overweight can raise your blood pressure, cholesterol and risk for developing diabetes. It could be bad for your brain, too. (12/30/16)]&lt;br /&gt;
* [http://www.onemednews.com/2016/12/18/nyt-obesity/ Researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, are many. (12/12/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2016/12/01/nearly-half-of-americas-overweight-people-dont-realize-theyre-overweight/?utm_term=.2963e8177870 Nearly half of America’s overweight people don’t realize they’re overweight (12/1/16)]&lt;br /&gt;
* [http://khn.org/news/another-reason-to-diet-experts-find-additional-evidence-of-obesity-cancer-link/amp/ Experts Find Additional Evidence Of Obesity-Cancer Link (8/24/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/obesity-rates-up-in-us-women-stable-in-men.html Obesity rates up in US women, stable in men. Obesity was 35 percent among men and 40 percent among women in 2013-14 (6/7/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html American obesity rate continues consistent trend upward in 2015 with estimated 30.4% of Americans over 20 years of age obese, more than a 10% increase from 1997 (5/26/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1923.abstract Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013 (11/2015)]&lt;br /&gt;
&lt;br /&gt;
Sepsis &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/sepsis-causes-more-readmissions-than-copd-heart-failure-heart-attack-and-pneumonia.html Sepsis causes more hospital readmissions than COPD, heart failure, heart attack and pneumonia. (1/23/17)]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Mental_Health_Conditions_Determinants Mental Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
Childhood Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/06/01/disruptive-behavior-disorders-children/ Childhood disruptive behavior disorders increases risk for substance use, violent behaviors, victimization, incarceration, and even premature death. An estimated 50 to 75% of youths who move through the juvenile justice system could be diagnosed with a mental health disorder. (6/1/17)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/who-depression-leading-cause-of-illness-disability-worldwide.html Depression is the leading cause of illness, disability worldwide according to the World Health Organization (3/31/17)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878#T1 The prevalence of major depressive episodes (MDEs) in adolescents (age 12-17) has increased from 13.1% for girls and 4.5% for boys in 2005 to 17.3% for girls and 5.7% for boys in 2014 (11/2016)]  &lt;br /&gt;
&lt;br /&gt;
Dementia &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/16/536935957/stress-and-poverty-may-explain-high-rates-of-dementia-in-african-americans Stress And Poverty May Explain High Rates Of Dementia In African-Americans (7/16/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-alzheimer-s-deaths-up-by-more-than-50.html In 1999, the rate of Alzheimer's deaths was 16.5 per 100,000 individuals. By 2014, this rate had increased to 25.4 deaths per 100,000, marking a 54.5% increase. (5/26/17)]&lt;br /&gt;
* [http://www.alz.org/documents_custom/2017-facts-and-figures.pdf Estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. By 2025, Alzheimer’s dementia is estimated to reach 7.1 million. By 2050, the number of people with Alzheimer’s dementia may nearly triple to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure Alzheimer’s disease. (3/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587084 Dementia prevalence among US adults 65 years or older declined significantly, from 11.6% in 2000 to 8.8% in 2012. (11/21/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/10-alzheimer-s-patients-had-preventable-hospital-stays One in 10 Alzheimer’s patients have preventable hospital stays (7/27/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/30/472295791/big-financial-costs-are-part-of-alzheimers-toll-on-families Big Financial Costs Are Part Of Alzheimer's Toll On Families (3/30/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2016/02/10/study-finds-dementia-rates-decline/80016390/ Rates of dementia dropped 44% from the late 1970s to the early 2010s. (2/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-dementia-drives-er-visits-admissions-and-mortality-rates How dementia drives ER visits, admissions and mortality rates (11/16/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1642.abstract Dementia has a disproportionate impact on family and unpaid caregiving to older adults] (10/2015)&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1637.abstract Adults with probable dementia received 171 hours of monthly informal care, versus 89 hours for cognitively impaired adults without dementia and 66 hours for cognitively normal adults 10/2015)]&lt;br /&gt;
&lt;br /&gt;
Emotions &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Mental Health Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1024.abstract Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. Innovative federal, state, and local programs have combined social services with mental health interventions to try addressing this. (6/2017)] &lt;br /&gt;
* [http://healthaffairs.org/blog/2016/07/25/patients-with-severe-schizophrenia-arent-getting-the-help-they-need/ Patients With Severe Schizophrenia Aren’t Getting The Help They Need (7/25/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/mind-and-mood/the-prevalence-and-treatment-of-mental-illness-today An estimated 26% of American adults live with a mental disorder in any given year, and 46% will have a mental disorder in their lifetime.] (11/2005)&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html 18% of adults in the U.S. have a mental, behavioral or emotional disorder. Most common are specific phobias (8.7%), such as those related to heights, spiders or flying, social phobia (6.8%) and major depression (6.6%) (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Impact on Health Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.businessinsurance.com/article/20170306/NEWS08/912312232/Detecting-mental-health-issues-can-cut-workers-comp-claims-costs Detecting mental health issues can cut workers comp claims costs. Hartford Financial Services Group analyzed its workers comp claim data from 2002 to 2015 and found that 10% of claims featured at least one psychosocial issue, and that those claims account for 60% of claims costs. (3/6/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/nov/behavioral-health-high-need-adults High-need adults—defined as those with three or more chronic conditions and a functional limitation—who have a diagnosed behavioral health condition among their multiple chronic conditions make greater use of some health care services than their counterparts without a behavioral health condition (11/22/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/36.abstract Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients (1/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/most-readmissions-aren-t-linked-to-suboptimal-care-study-finds.html A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness. (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
Opioid Addiction &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/ Patients With Mental Disorders Get Half Of All Opioid Prescriptions (6/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/ahrq-report-us-hospitals-see-sharp-rise-in-opioid-related-inpatient-stays-ed-visits.html Between 2005 and 2014, opioid-related emergency department visits nearly doubled and opioid-related inpatient stays increased 64% (6/20/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/cdc-likelihood-of-opioid-addiction-spikes-after-a-few-days-of-use.html CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days (3/17/17)]&lt;br /&gt;
* [http://khn.org/news/study-health-spending-related-to-opioid-treatment-rose-more-than-1300-percent/amp/ Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent In Four Year Period (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/prior-authorization-a-hurdle-for-patients-overcoming-opioid-dependency Insurer rules a hurdle for patients overcoming opioid dependency (8/5/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/15/patient-centered-research-can-improve-chronic-pain-care-and-address-opioid-abuse/ Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse (5/15/15)]&lt;br /&gt;
&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf Americans reporting at least one symptom of stress over the past month rose from 71% in August 2016 to 80% in January 2017. This includes headache (34%), feeling overwhelmed (33%), feeling nervous or anxious (33%), or feeling depressed or sad (32%). (2/15/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/12/chronic-stress-heart-attacks-study.amp Emotional stress has long been considered a major risk factor for heart disease. A new study suggests that heightened activity in the amygdala (the brain's fear and stress region) is associated with a greater risk of heart disease and stroke. (1/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/09/27/494922257/chill-out-stress-can-override-benefits-of-healthy-eating Stress Can Override Benefits Of Healthful Eating (9/27/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.technologyreview.com/s/603073/big-pharma-and-distracted-driving-are-killing-americans-early/amp/ Accidental poisoning increased 13%. 97% percent of accidental poisoning was from drug overdoses and alcohol (12/9/16)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin,methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Suicide &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/suicide-rates-for-teen-girls-hits-40-year-high.html Suicide rates for teen girls hits 40-year high (8/8/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-machine-learning-shows-promise-toward-accurately-identifying-suicidal-behavior Study found machine learning is 93% accurate in correctly identifying a suicidal person, and 85% accurate in determining differential diagnosis of mental illness (11/8/16)]&lt;br /&gt;
* [http://www.npr.org/sections/ed/2016/11/04/500659746/middle-school-suicides-reach-an-all-time-high Middle School Suicides Reach An All-Time High (11/4/16)]&lt;br /&gt;
&lt;br /&gt;
Treating Mental Health &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2016/05/13/hlthaff.2015.1659.abstract Mental Disorders top the list of the most costly conditions in the United States: $201 Billion] (5/2016)&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
* [http://hrsonline.isr.umich.edu/ Health and Retirement Study (HRS) surveys 20,000 people in America about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and health care expenditures. (3/2007)]&lt;br /&gt;
&lt;br /&gt;
Chronic Diesease &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/21/the-association-between-observed-mobility-and-quality-of-life-in-the-near-elderly/ Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life. (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Daily Activities Assistance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 6.9% of adults in 2015 over the age of 65 required assistance with personal care. (5/26/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/howardgleckman/2014/10/08/nearly-half-of-all-seniors-need-help-with-daily-activities-far-more-than-we-thought/ Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought] (10/8/14)&lt;br /&gt;
&lt;br /&gt;
Disabilities &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/4/626.abstract If all five risk factors were eliminated, 53% of disability could be prevented nationally if five risk factors were eliminated. The largest were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). (4/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/18/challenges-for-people-with-disabilities-within-the-health-care-safety-net/ Challenges For People With Disabilities Within The Health Care Safety Net. Nearly 57 million Americans had disabilities in 2010. (11/18/14)]&lt;br /&gt;
&lt;br /&gt;
Functional Independence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patients-functional-independence-may-predict-readmissions Patients' functional independence may predict readmissions (5/6/14)]&lt;br /&gt;
&lt;br /&gt;
Healthcare Costs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 The average healthcare cost for adults in the United States (2009-2011) was $4,845, for adults with 3 or more chronic conditions and no functional limitations was $7,526, for adults with 3 or more chronic conditions and functional limitation was $21,021 (8/29/16)]&lt;br /&gt;
&lt;br /&gt;
Homebound &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/26010119 An estimated 1.9 million U.S. adults age 65 or older are completely or mostly homebound, while another 5.3 million have functional limitations that make it hard to  leave their homes. (7/2015)]&lt;br /&gt;
* Homebound - [http://content.healthaffairs.org/content/34/1/21.abstract Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care.] (1/2015)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/q-and-a/2015/jan/invisible-homebound Treating the “Invisible Homebound”: Setting Standards for Health Care Provided at Home (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
Impairments &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. 44% of people with arthritis report activity limitations of everyday tasks, such as walking or lifting bags. (3/7/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/09/hearing-loss-linked-to-increased-risk-of-death/ Adults ages 70 years or older with moderate or more severe hearing impairment have a 54% increased risk of all causes of death (9/25/15)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Usual Activities&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 39.7 million persons (12%) were limited in their usual activities due to one or more chronic health conditions (12/2013)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/books/NBK92521/ About 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis limiting their functional status and adversely impacting their quality of life. The total financial cost of pain to society (health care and productivity estimates) ranges from $560 to $635 billion (2011 Study)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Work&lt;br /&gt;
* [https://www.theatlantic.com/business/archive/2017/03/mortality-of-american-men-and-the-labor-force/520329/ 43% of men in America ages 25 to 54 who are out of the labor force report their health as fair or poor, compared with 12% of employed men and 16% of unemployed men. (3/22/17)]&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 13.8 million adults aged 18–69 (6%) were unable to work due to health problems, and 6.7 million (3%) were limited in the kind or amount of work they could do because of their health (12/2013)]&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Genomic_Profiles_Determinants Genomic Profiles Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [https://www.ted.com/talks/moshe_szyf_how_early_life_experience_is_written_into_dna Epigenetics research suggests living things reprogram their genome in response to social factors like stress and lack of food. The biochemical signals passed from mothers to offspring tell the child what kind of world they're going to live in, changing the expression of genes. (7/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877678/ Scientists believe most, if not all, diseases arise from interactions between the genome, the epigenome (controls gene expression), and the environment (broadly defined to include social, behavioral, and physical agents). (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====High Need, High Cost Patients ''Insight''====&lt;br /&gt;
High-Need, High-Cost Patients &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-superusers-pennsylvania-ring-up-1-25b-tab-0 Superusers represent 3% of hospitalized patients in Pennsylvania consumed $1.25 billion in health care costs. (6/21/17)]&lt;br /&gt;
* [https://www.theatlantic.com/theplatinumpatients/ Each year, 1 in every 20 Americans racks up just as much in medical bills as another 19 combined. (6/15/17)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% did not have good access to services that could help them manage their daily living activities. 58% did not have good access to an informed and up-to-date care coordinator. (12/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 1.2% of employees are high cost claimants who comprise 31% of total health care spending according to a report on 26 large employers. (9/15/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1608511 Caring for High-Need, High-Cost Patients — An Urgent Priority (9/8/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps2 Health care spending for high-need adults exceeded $21,000 per person, nearly three times the average for adults with multiple chronic diseases only ($7,526) and more than four times that of all adults ($4,845). (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/aug/high-need-high-cost-meps Report Profiles The 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs (8/25/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/jun/listening-to-those-living-with-chronic-conditions Top concerns of high-need patients include: Paying for Care, Accessing Care, Insurance Frustrations,  Technology Can Be Helpful, Getting Help at Home (6/16/16)]  &lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2015/dec/primary-care-physicians-in-ten-countries Nearly 25% of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84% say they are not well prepared to manage patients with serious mental illness (12/7/15)]&lt;br /&gt;
* [http://features.commonwealthfund.org/improving-care-for-those-who-need-it-most Researchers are focusing on high-need, high-cost patients—both because they need the most help and because they have the biggest impact on national health spending. 5 percent of the U.S. population accounts for 50 percent of the nation’s health care costs. (11/11/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/8/1312.abstract?=right For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary. Only 28% of super-utilizers remained on top of the list at the end of a year. (8/2015)]&lt;br /&gt;
* [https://hcttf.org/wp-content/uploads/2018/01/WhitePaper-ProactivelyIdentifyingtheHighCostPopulation.pdf Proactively	Identifying the	High Cost Population - White Paper Insights from Health Care Transforamtion Task Force 5/14/15)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1315568?query=TOC&amp;amp; Hospital-dependent patient's medical problems cannot be managed outside the hospital. (2/20/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/challenge-frequent-fliers-20-er-visits-per-year-progress/ The challenge of frequent fliers: 20 ER visits per year is progress (11/11/13)]&lt;br /&gt;
* [http://khn.org/news/one-percent-of-costliest-patients/ Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending (10/7/13)]&lt;br /&gt;
* [http://berkeleyhealthcareforum.berkeley.edu/report/executive-summary/ 53% of California's healthcare expenditures are spent by just 5% of the population (2/2013)]&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Competencies_Determinants Competencies Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Literacy_Determinants Health Literacy Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.georgiahealthnews.com/2016/10/health-literacy-life-or-death-matter/ Health literacy can be a life-or-death matter. 1 out of 3 adult Georgians is functionally illiterate. Without a clear understanding of their health condition, these adults are more likely to skip necessary medical tests and have a harder time with diabetes management or high blood pressure numbers. (10/31/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/guide-surviving-chronic-disease.html A guide to surviving chronic disease (8/3/16)]&lt;br /&gt;
* Education - A [http://www.reuters.com/article/2013/06/26/us-cancer-cure-idUSBRE95P15320130626 survey] of patients with terminal lung cancer found nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. (6/26/13)&lt;br /&gt;
* [http://www.imedicalapps.com/2014/09/knee-guide-app-educates-engages-patients-total-knee-arthroplasty-care/ My Knee Guide App Educates and Engages Patients in Total Knee Arthroplasty Care (9/25/14)]&lt;br /&gt;
* [http://medcitynews.com/2015/05/video-replay-patient-education/ Surgeon entrepreneur develops video replay for specialist appointments to boost patient education (5/28/15)]&lt;br /&gt;
* [https://health.gov/communication/literacy/issuebrief/ 77 Million Adults Have Basic or Below Basic Health Literacy (2003)]&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Education &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/07/patients-need-education-role-care.html Patients need education about their role in care (7/3/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 39% patients admit they’re only somewhat knowledgeable, at best, about how to effectively manage their chronic condition. (7/2017)] from [http://www.jonespr.net/strengthening-chronic-care-download West] Study.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-addressing-alzheimer-s-risk-factors-could-lead-to-medicare-medicaid-savings.html Preventing and effectively managing obesity, diabetes, hypertension and cardiovascular disease can reduce onset and duration of dementia and reduce healthcare costs. (4/11/14)]&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/12/536519077/took-the-wrong-medicine-by-mistake-study-finds-such-errors-are-on-the-rise More People Are Making Mistakes With Medicines At Home (7/12/17)]&lt;br /&gt;
* [http://www.reuters.com/article/us-medication-errors-health-literacy-idUSKBN0FN1SK20140718 More than half of heart patients made mistakes taking their medications or misunderstood instructions (7/18/14)]&lt;br /&gt;
* [http://www.bbc.com/news/health-30556329 Only 7% of asthma sufferers were found to use asthma inhalers in the right way (12/20/14)]&lt;br /&gt;
&lt;br /&gt;
Physician Office Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/can-help-doctor-diagnose.html How a patient can help their physician diagnose them. 3/19/17)]&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Functional Competencies Determinants] that can decisively affect a patient's overall health and well-being. &lt;br /&gt;
&lt;br /&gt;
Literacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.kevinmd.com/blog/2017/08/literacy-health-care-problem-no-one-talks.html It is estimated that there are 23 million adults in the U.S. with limited literacy, defined as below basic literacy or non-literate. (8/18/17)]&lt;br /&gt;
&lt;br /&gt;
====Education ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Education_Determinants Education Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Social ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Patient_.28About_.26_History.29_Determinants Patient (About &amp;amp; History) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-death-rate-rises-for-first-time-in-decade-7-things-to-know.html American death rate rises for first time in decade. Rises in death rates from: Alzheimer's disease, heart diseases, suicide and unintentional injuries (auto accidents and drug overdoses) (6/1/16)]&lt;br /&gt;
* [http://www.pnas.org/content/112/49/15078.full.pdf Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (9/17/15)]&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Events_Determinants Adverse Events Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Adverse Childhood Events (ACEs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/09/29/444451363/childhood-stress-may-prime-pump-for-chronic-disease-later Childhood Stress May Prime Pump For Chronic Disease Later (9/29/15)]&lt;br /&gt;
* [http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime How childhood trauma affects health across a lifetime (9/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/12/2106.abstract Adverse Childhood Events (ACEs) on attributed to higher rates of chronic disease among children (12/2014)]&lt;br /&gt;
&lt;br /&gt;
Elder Abuse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf A study found an elder abuse incidence rate in New York State was nearly 24 times greater than the number of cases referred to social service, law enforcement or legal authorities. (see Page 2) (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Beliefs_Determinants Beliefs Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/aug/improving-population-health-management Patients who don't feel they can manage their health or navigate the health care system are more likely to develop a chronic disease over a three-year period than “activated” patients with good self-management skills. Low patient-activation levels are linked to significantly more hospitalizations and emergency department (ED) use. (8/23/16)]&lt;br /&gt;
&lt;br /&gt;
====Determination ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Determination_Determinants Determination Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Insight''====&lt;br /&gt;
* See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight People]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Resilience_Determinants_-_.28Psychological_Fitness.29 Resilience Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Optimism &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/07/504709736/a-brighter-outlook-could-translate-to-a-longer-life A Brighter Outlook Could Translate To A Longer Life (12/7/16)]&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/490841/ Psychological resilience plays a role in the molecular impact of traumatic experiences. Promoting resilience may have benefits for physical and mental health (7/12/16)]&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2015/10/stressful-jobs-makes-life-shorter/412951/ Study: Stressful Jobs Make Life Shorter. Researchers found that unhealthy workplaces can affect mortality. (10/29/15)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/10/how-stress-makes-you-sick/412699/ How Stress Makes You Sick. Feeling overwhelmed affects everything from digestion to stroke risk. (10/28/15)]&lt;br /&gt;
* [http://www.nature.com/news/bacteria-implicated-in-stress-related-heart-attacks-1.15396 Emotional or physical stress can trigger heart attacks may now have a scientific explanation (6/10/14)]&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Responsibilities_Determinants Responsibilities Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://mobile.reuters.com/article/idUSKCN0VO21Q Family caregivers may be sacrificing their own health to help loved ones (2/15/16)]&lt;br /&gt;
* [http://www.mhealthtalk.com/a-guide-for-the-older-caregiver/?utm_source=rss&amp;amp;utm_medium=rss&amp;amp;utm_campaign=a-guide-for-the-older-caregiver A caregiving spouse who is between the ages of 66 and 96 and under excessive mental or emotional strain has a 63% greater risk of dying compared to those who are not tasked with caregiving. (1/17/14)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282240/ Quality of life: impact of chronic illness on the partner (11/2001)]&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Well-Being_Determinants Social Well-Being Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Defining Well-Being &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2330497 Most medical research focuses on disease rather than wellness. The diverse and interconnected dimensions of physical, emotional and social well-being. It includes achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. (7/14/15)]&lt;br /&gt;
* [http://voxeu.org/article/origins-happiness Depression and Anxiety explains the largest variance in life satisfaction. Study shows eliminating Depression and Anxiety would have 4 times the impact of eliminating poverty in improving life satisfaction. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Competence &amp;amp; Control &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/11/30/independence-its-what-older-people-want/ Independence—It’s What Older People Want (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Loneliness &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/08/07/loneliness-public-health/ Why Loneliness Is a Public Health Threat. People with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles. (8/7/17)] &lt;br /&gt;
* [http://khn.org/news/social-isolation-may-worsen-breast-cancer-prospects/amp/ Social Isolation May Worsen Breast Cancer Prospects. Women with fewer social ties — to friends, family, community and religious groups, as well as spouses or romantic partners — were 43% more likely to see their breast cancer return, 64% more likely to die from breast cancer and 69% more likely to die from any cause (12/13/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors) 37% felt socially isolated and lacked companionship compared to 15% of other adults. (12/9/12)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/loneliness-a-bigger-risk-factor-for-death-than-obesity.html Loneliness a bigger risk factor for death than obesity (9/6/16)]&lt;br /&gt;
* [http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=137534&amp;amp;WT.mc_id=USNSF_51&amp;amp;WT.mc_ev=click The profound power of loneliness can depression and other serious health problems (2/3/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/12/loneliness-social-isolation-and-health/418395/ How Loneliness Wears on the Body. New research supports the idea that social isolation is detrimental to physical health—and that companionship may improve it. (12/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems Loneliness May Warp Our Genes, And Our Immune Systems (11/29/15)]&lt;br /&gt;
* [http://time.com/3747784/loneliness-mortality/ Loneliness increases risk of death by 26%. Social isolation — or lacking social connection — and living alone were found to be even more devastating to a person’s health than feeling lonely, respectively increasing mortality risk by 29% and 32% (3/18/15)]&lt;br /&gt;
* [http://www.pnas.org/content/110/15/5797.full Social isolation and loneliness are associated with increased mortality (9/12/12)]&lt;br /&gt;
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Love &amp;amp; Connection &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2014/05/isolation-and-death/362063/ Stressful relationships might be significantly shortening your life, are you better off alone? (5/13/14)]&lt;br /&gt;
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Purpose &amp;amp; Meaning &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/soul-purpose-seniors-with-strong-reasons-to-live-often-live-stronger/ Soul Purpose: Seniors With Strong Reasons To Live Often Live Stronger (8/31/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/28/479751942/could-thinking-positively-about-aging-be-the-secret-of-health People with a sense of purpose and having positive view about aging in late middle age lived about 7 and half years longer than the people who saw aging in a negative light. (5/28/16)]&lt;br /&gt;
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Social Influence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.time.com/time/health/article/0,8599,1646997,00.html If a friend is obese, there is a 57% greater chance of becoming obese. (7/25/07)]&lt;br /&gt;
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Social Via Smartphones &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/08/07/542016165/how-smartphones-are-making-kids-unhappy How Smartphones Are Making Kids Unhappy. Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. (8/7/17)]&lt;br /&gt;
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====Support ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Determinants Support Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Asking For Help &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/alone-and-aging-creating-a-safety-net-for-isolated-seniors/amp/ A growing number of seniors who find themselves alone just when aging and end-of-life care becomes real. They don’t know how to approach a casual acquaintance to ask for help when they need it most. (11/28/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/population-health-means-asking-about-basic-needs-are-your-providers-ready-for-that.html Population Health Means Asking About Basic Needs: Are Your Providers Ready for That? (11/20/13)]&lt;br /&gt;
&lt;br /&gt;
Addressing Social Determinants&lt;br /&gt;
* [http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/ Improving population health will require broader approaches that address social, economic, and environmental factors that influence health. (11/4/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/21/with-the-aca-secure-its-time-to-focus-on-social-determinants/ Literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral, and environmental factors. It’s Time To Focus On Social Determinants. (7/21/15)] &lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/05/why-its-time-to-improve-the-social-determinants-of-health.html Why it’s time to improve the social determinants of health (5/1/15)]&lt;br /&gt;
* [https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf Going Beyond Clinical Walls to address the other 80% of determinants that are often challenging to address in clinical visits. (10/2014)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/may/addressing-patients-social-needs Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment (5/29/14)]&lt;br /&gt;
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Managing Chronic Conditions &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 70 percent of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease. (7/2017)]&lt;br /&gt;
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Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://morningconsult.com/opinions/importance-nonemergency-medical-transportation-vulnerable-patients/ The Importance of Nonemergency Medical Transportation for Vulnerable Patients. One patient has to take two bus rides and walk a mile just to get herself and two young children to the doctor. (1/25/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/antifraud/fierce-exclusive-beneath-patient-transportation-arrangements-a-subtle-layer-fraud Unreliable or inaccessible transportation has emerged as a significant patient care issue. Legal experts say healthcare systems providing rides to patients raises concerns that they could be violating the Anti-Kickback Statute or providing a beneficiary inducement. (8/31/16)]&lt;br /&gt;
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===Socioeconomic ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Socioeconomic_Determinants Socioeconomic Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
*[https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/ If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. (8/17/17)]&lt;br /&gt;
====Can't Afford Treatments ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Can.27t_Afford_Treatments_Determinants Can't Afford Treatments Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Delay Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-half-of-millennials-have-delayed-medical-care-because-of-cost.html Half of millennials have delayed medical care because of cost (1/1/16)]&lt;br /&gt;
* [http://www.gallup.com/poll/187190/cost-delays-healthcare-one-three.aspx 31% Americans say that they or a family member have put off any sort of medical treatment in the past year because of the cost (11/30/15)]&lt;br /&gt;
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Reduce Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-half-of-aca-exchange-customers-skimp-on-healthcare-to-reduce-costs.html Half of ACA exchange customers skimp on healthcare to reduce costs (10/28/16)]&lt;br /&gt;
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Skip Medical Care &amp;lt;Br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-1-in-3-older-millennials-skips-medical-care-because-of-costs.html Survey: 1 in 3 older millennials skips medical care because of costs (6/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/nov/international-survey-release About one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. (11/16/16)]&lt;br /&gt;
* [http://archpedi.jamanetwork.com/article.aspx?articleid=1872780 Financial Barriers to Care Among Low-Income Children With Asthma (7/2014)]* [http://money.cnn.com/2013/04/26/news/economy/health-care-cost/ 80 million people (43% of America's working-age adults) didn't go to the doctor or access other medical services last year because of the cost (4/26/13)]&lt;br /&gt;
&lt;br /&gt;
====Financial ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Financial_Determinants Financial Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Annual Healthcare Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2016/05/24/annual-healthcare-cost-for-family-of-four-now-at-25826/#33aa77f75226 Healthcare Costs in 2016 for a Family of Four Will Be $25,826 (5/24/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2015/05/19/annual-healthcare-cost-for-family-of-four-now-at-24671/#29d013444dfb Annual Healthcare Cost For Family Of Four Now At $24,671 (5/19/15)]&lt;br /&gt;
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Fear of Healthcare Costs&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/53-of-americans-equate-unaffordable-medical-bills-to-being-diagnosed-with-a-serious-illness.html 53% of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness (3/21/17)]&lt;br /&gt;
* [http://www.healthpopuli.com/2017/02/08/health-care-worries-top-terrorism-far-americans-minds/ Health Care Worries Top Terrorism, By Far, In Americans’ Minds (2/8/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/healthcare-finances-a-source-of-fear-for-75-of-consumers.html Healthcare finances a source of fear for 75% of consumers (2/7/17)]&lt;br /&gt;
* [http://www.businesswire.com/news/home/20141006006149/en/Cigna-Consumer-Survey-%E2%80%98Health-Costs-Derail-Financial#.VDg8PvldXng 75% fear health costs could ruin prospects for secure retirement (10/6/14)]&lt;br /&gt;
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Financial Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthpopuli.com/2017/04/26/financial-stress-health-risk-factor-impacts-americans/ Financial Stress As A Health Risk Factor Impacts More Americans (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% of high-need said they experience stress about their ability to afford housing, utilities or nutritious meals compared to 32% of other adults. (12/9/16)]  &lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-bills-lead-to-serious-debt-for-some-americans-6-things-to-know.html 85% of employees in survey in 2015 reported at least some level of financial stress. 33% were assessed as having serious debt, such as student debt, medical bills and/or credit card debt. (7/20/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/federal-reserve-board-47-of-americans-struggle-to-pay-unexpected-400-bill.html  47% of Americans struggle to pay unexpected $400 bill (6/8/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/54.abstract For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships (1/2016)]&lt;br /&gt;
* [http://www.pwc.com/us/en/private-company-services/publications/financial-well-being-retirement-survey.html Survey shows 52% of employees stressed about their finances. 45% saying that financial matters cause the most stress, nearly as many as stress from job, health, or relationships combined. (2016 Employee Financial Wellness Survey)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/more-americans-struggle-healthcare-costs 46% of Americas described paying for care as a hardship rather than affordable (12/19/14)]&lt;br /&gt;
&lt;br /&gt;
Health Inequality &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2017/06/05/america-is-a-world-leader-in-health-inequality/?utm_term=.7c7983e42f5c People in households making less than $22,500 a year, 38% reported being in poor or fair health. That's more than three times the rate of health troubles faced by individuals in households making more than $47,700 a year. (6/5/17)]&lt;br /&gt;
* [http://www.hhnmag.com/articles/7416-look-to-income-inequality-to-help-explain-population-health Having less money is linked to poorer health regardless of personal habits. (7/5/16)]&lt;br /&gt;
* [https://www.brookings.edu/research/what-growing-life-expectancy-gaps-mean-for-the-promise-of-social-security/ Life expectancy is higher for the wealthiest. Among American men born in 1940, the wealthiest 10% are expected to live on average 12 years longer than the poorest 10%. (2/12/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/costs-deter-low-income-patients-from-participating-in-clinical-trials.html Costs deter low-income patients from participating in clinical trials (11/3/15)]&lt;br /&gt;
* [http://www.nytimes.com/2014/04/06/health/even-small-medical-advances-can-mean-big-jumps-in-bills.html?from=homepage&amp;amp;_r=0 New innovative treatments and technology is often out of the reach of low income patients. (4/5/14)]&lt;br /&gt;
&lt;br /&gt;
Medical Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/half-of-uninsured-people-face-problems-with-their-medical-bills-9-survey-findings.html Half of uninsured people face problems with their medical bills (8/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/61-of-patients-confused-by-medical-bills-survey-finds.html 61% of patients confused by medical bills, survey finds (7/14/16)]&lt;br /&gt;
* [http://www.cbsnews.com/news/cdc-one-in-five-americans-cant-pay-medical-bills/ CDC: One in five Americans can't pay medical bills (9/30/13)]&lt;br /&gt;
&lt;br /&gt;
Prescription Drugs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/sticker-shock-forces-thousands-of-cancer-patients-to-skip-drugs-skimp-on-treatment/amp/ Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (3/15/17)]&lt;br /&gt;
* [http://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/ Faced With Unaffordable Drug Prices, Tens Of Millions Buy Medicine Outside U.S. (12/20/16)]&lt;br /&gt;
&lt;br /&gt;
Price Shopping for Medical Services &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.marketwired.com/press-release/survey-finds-healthcare-providers-benefit-from-up-front-cost-estimates-yet-many-patients-nyse-tru-2192070.htm Survey found 43% said it was somewhat or very difficult to get information on costs, while another 21% of patients had never tried to get procedure cost information. (1/31/17)]&lt;br /&gt;
* [http://khn.org/news/consumer-choices-have-limited-impact-on-u-s-health-care-spending-study/ Less than 7% of total health care spending in 2011 was paid by consumers for “shoppable” services. (3/4/16)]&lt;br /&gt;
&lt;br /&gt;
====Food Insecurity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Food_Insecurity_Determinants Food Insecurity Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.hpoe.org/resources/ahahret-guides/3058 Social Determinants of Health Series: Food Insecurity(8/3/17)]&lt;br /&gt;
* [http://online.liebertpub.com/doi/abs/10.1089/pop.2015.0127 Study of food insecurity in patients with high rates of inpatient hospitalization (“super-utilizers”). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed. Using USDA definition of food insecurity, 30% were food insecure and 25% were marginally food secure. 40% responded that, in the past 30 days, they worried that their food would run out; 17.5% that they did not eat for a full day. 75% were unable to shop for food on their own and 58% were unable to prepare their own food. (12/1/16)]&lt;br /&gt;
* [http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html 42.2 million Americans lived in food insecure households in 2015 (29.1 million adults and 13.1 million children). (2016)]&lt;br /&gt;
* [http://pdf.aarpfoundation.org/i/455086-aarp-foundation-findings-on-nutrition-knowledge-and-food-insecurity-among-older-adults Nearly 9 million older adults in the United States experience food insecurity. (12/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1949.abstract Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1830.abstract Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. (11/2015)]&lt;br /&gt;
* [http://khn.org/news/in-sunlit-paradise-seniors-go-hungry/ In Sunlit Paradise, Seniors Go Hungry (5/26/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/03/food-insecurity-undiagnosed-medical-problem.html Food insecurity is an undiagnosed medical problem (3/6/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/1/116.abstract Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia (1/2014)]&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Insurance_Determinants Health Insurance Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [https://www.nytimes.com/2017/05/08/upshot/a-medicare-drug-incentive-that-leads-to-greater-hospitalizations.html For sicker Medicare beneficiaries, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits (5/8/17)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/09/16/494139538/studies-link-cancer-patients-survival-time-to-insurance-status Studies Link Cancer Patients' Survival Time To Insurance Status (9/16/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/958.abstract?=right Insurance is paying for more of the cost of treating mental health conditions (68%) but not for Substance Use Disorders (46%) (6/2016)]&lt;br /&gt;
* [http://khn.org/news/new-health-plans-offer-discounts-for-diabetes-care/ New health plans offer discounts and give gift cards to encourage patients to use diabetes care (11/17/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aca-health-plans-limit-access-to-specialists-7-findings.html ACA health plans limit access to specialists: 7 findings (10/28/15)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2015/09/21/insurance-healthy-behavior-key-reducing-cost-chronic-disease/72563266/ Study showed total cost for insured members with no chronic conditions was $3,024 a year ($2,204 out-of-pocket) and members with two or more chronic conditions was $11,940 a year ($3,500 out-of-pocket). (9/21/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/why-doctors-must-discuss-costly-treatment-before-patients-receive-bills Why doctors must discuss costly treatment before patients receive bills (10/18/13)]&lt;br /&gt;
&lt;br /&gt;
Denied Coverage &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/many-patients-chronic-illnesses-find-insurance-providers-deny-treatment-new-survey-says 'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says (8/16/17)]&lt;br /&gt;
Dual Eligible Patients (Qualify for Medicare and Medicaid) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://files.kff.org/attachment/Testimony-of-Gretchen-Jacobson-Ways-and-Means-Committee-Subcommittee-on-Health Low-income people on Medicare who receive assistance from Medicaid tend to have more chronic conditions, as well as cognitive and functional limitations, than others on Medicare: 61% vs. 33% need assistance with one or more activities of daily living, such as eating, bathing, and dressing; more than half, 58% vs. 29% have a mental condition or cognitive impairment; 37% vs. 27% have five or more chronic conditions; 18% vs 6% rate their health status as poor. (6/7/17)]&lt;br /&gt;
&lt;br /&gt;
Employer Sponsored Health Insurance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/interactives-and-data/maps-and-data/employer-health-insurance-premiums State-by-State Look at Employer Health Insurance Costs Finds Workers’ Premium Contributions and Deductibles Growing More Slowly But Eating Up Greater Share of Incomes (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/employer-family-plan-premiums-soar-above-18k-in-2016.html Employer family health plan premiums soar above $18k in 2016 (9/14/16)]&lt;br /&gt;
&lt;br /&gt;
High Deductable Health Plans (HDHPs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/10-things-to-know-about-2016-healthcare-consumer-payment-trends.html Consumers insured through high-deductible health plans increased from 10 million in 2010 to 75 million in 2016. The average deductible for individuals with employer-based coverage doubled from $735 in 2010 to $1,478 in 2016. Patient payments to providers increased 58% from 2013 to 2016. (6/13/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/cdc-nearly-40-of-us-adults-have-high-deductible-health-plans.html CDC: Nearly 40% of US adults have high-deductible health plans (6/7/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patients-with-chronic-illness-and-high-deductibles-more-likely-to-delay-care-study-finds.html Patients with chronic illness and high deductibles more likely to delay care, study finds. People with three or more chronic conditions were also nearly three times as likely to delay or avoid care as those without chronic conditions (25% compared to 9%) (11/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/given-the-choice-34-of-employees-choose-hdhps.html Given the choice, 34% of employees choose HDHPs (5/3/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly one-quarter of workers are enrolled in an High Deductable Health Plan, up from 4% in 2006. (2/4/16)]&lt;br /&gt;
&lt;br /&gt;
Medicaid &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://healthpayerintelligence.com/news/spike-in-late-stage-cancer-diagnosis-related-to-medicaid-cut Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut (7/5/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare Beneficiaries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/ Half of all Medicare beneficiaries had incomes below $26,200 in 2016 (4/21/17)]&lt;br /&gt;
Patient Out-of-Pocket Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medicare-cancer-patients-without-additional-coverage-hit-with-high-out-of-pocket-costs-4-things-to-know.html Medicare cancer patients without additional coverage hit with high out-of-pocket costs (11/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patient-payment-responsibility-spiked-13-in-2015.html Patient payment responsibility spiked 13% in 2015 (6/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/may/on-medicare-but-at-risk 16 percent of Medicare beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. (5/10/16)]&lt;br /&gt;
* [http://www.healthsystemtracker.org/insight/payments-for-cost-sharing-increasing-rapidly-over-time/?utm_campaign=KFF-2016-Peterson-Cost-Sharing-Analysis&amp;amp;utm_medium=email&amp;amp;_hsenc=p2ANqtz-_fzaJSkoJE-fetaUk0iwQOwPP__Fpq1BkKAV4WPcOHEuKp1Ww3jVG7Fl41gr19-i_hWcUPOy The average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. (4/12/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly half of workers are covered by an insurance plan with a general annual deductible of at least $1,000 for individual coverage. (2/4/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/high-out-pocket-expenses-narrow-insurance-networks-send-more-patients-to-ers High out-of-pocket expenses, narrow insurance networks send more patients to ERs (10/26/15)]&lt;br /&gt;
* [http://kff.org/report-section/ehbs-2015-summary-of-findings/ Workers with health insurance covered by their employers have an annual deductible amount for single coverage of $1,318. (9/22/15)]&lt;br /&gt;
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Surprise Out-of-Network Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/many-medicare-advantage-members-burned-by-out-of-network-bills.html Many Medicare Advantage members burned by out-of-network bills due to changes in network providers (11/28/16)]&lt;br /&gt;
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Uninsured &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/lists/2016/remaining-uninsured Why Do Millions of U.S. Adults Remain Uninsured? 1) The ACA excludes undocumented immigrants; 2) Nineteen states have not expanded Medicaid eligibility; 3) Many people still don’t know about the health insurance marketplaces; 4) Affordability is a concern; 5) Selecting a plan can be difficult: 6) Many aren’t getting the help they need. (10/21/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/federal-estimate-of-uninsured-falls-to-record-low-7-statistics.html Federal estimate of uninsured falls to record low 8.6% (9/7/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/who-are-the-remaining-uninsured Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? (8/18/16)]&lt;br /&gt;
* [http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf The percentage uninsured in 2015 was 10.5% (28.4 million) (5/2016)]&lt;br /&gt;
* [http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Uninsured nonelderly Americans in 2014 was 32 million. 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Over 5 in 10 of uninsured have family income below 200% of poverty. (10/5/15).]&lt;br /&gt;
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====Income &amp;amp; Work ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Income_.26_Work_Determinants Income &amp;amp; Work Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-working-night-shifts-furthers-health-disparities.html How working night shifts furthers health disparities (10/25/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3064755/work-smart/study-finds-work-life-balance-could-be-a-matter-of-life-and-death Study found that those who work in high-stress jobs with little control are more likely to die sooner than those who have more control over and balance in their work. (10/20/16)]&lt;br /&gt;
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* [http://healthcare-economist.com/2016/09/26/effect-of-job-loss-on-physical-and-mental-health/ Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results similar for mental health. (9/26/16)]&lt;br /&gt;
* [http://khn.org/news/low-income-patients-face-hurdles-to-care-at-public-hospital-in-miami/ Low-Income Patients Face Hurdles To Care At Public Hospital (8/28/14)]&lt;br /&gt;
* [http://www.nccp.org/topics/childpoverty.html More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level]&lt;br /&gt;
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Labor Force Participation &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2016-10-07/why-are-so-many-men-not-working-they-re-in-pain A large share of American men between the ages of 25 and 54 who aren’t in the labor force may suffer from serious health conditions that are “a barrier to work” and suffer physical pain, sadness, and stress in their daily lives. (10/7/16)]&lt;br /&gt;
Lack of Sick Leave &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.wbur.org/npr/484960907/hassle-of-being-a-patient-can-turn-into-a-crisis-without-sick-leave Hassle Of Being A Patient Can Turn Into A Crisis Without Sick Leave. Third of working Americans say their jobs don't offer paid sick days (7/11/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/3/520.abstract Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. 3.0 times more likely to forego medical care for themselves and 1.6 times more likely to forego care for family (3/2016)] &lt;br /&gt;
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Low Income Impact on Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/socioeconomic-hardships-hurt-dual-eligibles-health-outcomes Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid (4/2/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/03/screening-poverty-included-medical-curriculum.html Low socioeconomic status (SES) is a risk factor for a multitude of medical conditions including cardiovascular disease, respiratory disease, cancer, and mental illness. (3/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/employment-status-top-socioeconomic-factor-readmissions Employment status top socioeconomic factor in readmissions (12/11/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/08/29/exhibit-of-the-month-income-related-disparities-associated-with-negative-health-outcomes/ Income-Related Disparities Associated With Negative Health Outcomes (8/29/14)]&lt;br /&gt;
* [http://hin.com/Healthcare_Business_Weekly_Update/2014/06/06/data-dive-uncovers-socioeconomics-driving-er-visits-readmissions/ Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions (6/6/14)]&lt;br /&gt;
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Work environment &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/258.abstract?=right Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence (2/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1761.abstract Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups (10/2015)]&lt;br /&gt;
&lt;br /&gt;
====Legal ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Legal_Determinants Legal Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Jail Involved &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/05/499775644/helping-ex-inmates-stay-out-of-the-er-brings-multiple-benefits Early access to primary care for ex-inmates can bring down healthcare costs by keeping them out of the ER (12/5/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/443.abstract The Critical Link Between Health Care And Jails (3/2014)]&lt;br /&gt;
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===Environmental ''Insight''===&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Access &amp;amp; Logistics ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Access_.26_Logistics_Determinants Access &amp;amp; Logistics Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Disability &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.mentalhealthamerica.net/sites/default/files/Parity%20or%20Disparity%20Report%20FINAL.pdf There is only 1 mental health provider for every 790 individuals. One out of three adults with disability could not see a doctor because of costs. (2015)]&lt;br /&gt;
Rural or Remote Area &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/patients-lacking-pharmacy-access-likely-to-readmitted-to-hospital Patients in rural or remote communities with lack of access to a pharmacy may be more likely to end up back in the hospital (8/4/16)]&lt;br /&gt;
* [https://www.minnpost.com/health/2014/06/late-life-live-home-rural-seniors-need-food-socialization-support Late-in-life: To live at home, rural seniors need food, socialization, support (6/23/14)]&lt;br /&gt;
* [http://www.rand.org/pubs/research_reports/RR578.html Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care. (2015)]&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/ Transportation barriers to health care access are common, and greater for vulnerable populations. (12/2013)]&lt;br /&gt;
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====Communication ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Communication_Determinants Communication Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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====Community ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Community_Determinants Community Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://cdnfiles.americashealthrankings.org/SiteFiles/Reports/2015_Am_Health_Ranking.pdf America’s Health Rankings of Behaviors, Community &amp;amp; Environment, Policy, and Clinical Care determinants of health that directly influence health outcomes (2015 Edition)]&lt;br /&gt;
* [http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Apr/Community-Factors-and-Hospital-Readmission-Rates.aspx Community factors most strongly associated with lower hospital readmission rates include more general practitioners and fewer specialists per capita and the presence of high-quality nursing home care. (4/17/14)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html Time to Act: Investing in the Health of Our Children and Communities (1/13/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/29/3/503.long Children had a 20-60% higher likelihood of being obese or overweight if living in neighborhoods with unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers. (3/2010)]&lt;br /&gt;
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Clean Air &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html The surprising link between air pollution and Alzheimer’s disease (1/31/17)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/world/air-pollution-smog-who.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ More Than 9 in 10 People Breathe Bad Air, W.H.O. Study Says (9/28/16)]&lt;br /&gt;
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Clean Water &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/08/14/63-million-americans-exposed-unsafe-drinking-water/564278001/ 63 million Americans exposed to unsafe drinking water (8/14/17)]&lt;br /&gt;
* [http://www.reuters.com/investigates/special-report/usa-lead-testing/ Water testing for lead levels found almost 3,000 areas with poisoning rates far higher than in Flint Michigan. Yet many of these lead hotspots are receiving little attention or funding. (12/19/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/as-water-infrastructure-ages-cost-treating-infections-rise Researchers believe as much as $2 billion of healthcare costs each year is tied to the treatment of infections that lurk in water distribution systems. (9/19/16)]&lt;br /&gt;
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Community Related - Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1571 Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990–2013 (8/2017)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/05/08/u-s-life-expectancy-varies-by-more-than-20-years-from-county-to-county/ U.S. life expectancy varies by more than 20 years from county to county (5/8/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/tackling_life_expect.html A person born in Princeton, NJ can expect to live 87 years, his or her neighbor a dozen miles away in Trenton has a life expectancy of 73 years (11/9/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thetwo-way/2016/04/11/473749157/its-not-just-what-you-make-its-where-you-live-says-study-on-life-expectancy Life Expectancy Study: It's Not Just What You Make, It's Where You Live (4/11/16)]&lt;br /&gt;
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Countries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/when-it-comes-to-healthcare-u-s-once-again-ranks-last-quality-care-compared-to-other When it comes to healthcare, U.S. once again ranks last in quality care compared to other wealthy nations (7/14/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/global-study-700k-smartphone-users-shows-link-between-obesity-and-activity-inequality Global study of 700K smartphone users shows link between obesity and activity inequality within country (7/11/17)]&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.revealnews.org/blog/14-million-kids-could-be-exposed-to-toxic-pcbs-at-school/ 14 million US kids could be exposed to toxic PCBs at school (10/12/16)] &lt;br /&gt;
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Food Deserts &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0122 Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14 (8/2017)]&lt;br /&gt;
* [http://www.ers.usda.gov/amber-waves/2010-march/access-to-affordable,-nutritious-food-is-limited-in-%E2%80%9Cfood-deserts%E2%80%9D.aspx Some neighborhoods in US, mostly in low-income areas, have been dubbed “food deserts” because they don't have supermarkets or other food retailers that carry affordable and nutritious food. (3/1/2010)]&lt;br /&gt;
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Food Safety &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lead-detected-in-20-of-baby-food-samples-surprising-even-researchers/ Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers (6/15/17)]&lt;br /&gt;
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Low Income Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/999.abstract One’s neighborhood may drive or influence health disparities, which can be understood as disadvantages in health associated with one’s social, racial, economic, or physical environment, originate in childhood and persist across an individual’s life course. (6/2017)]&lt;br /&gt;
*[http://www.theatlantic.com/business/archive/2016/04/why-the-poor-die-young/477846/ A massive study of health and income found that smoking, obesity, and exercise are the most important determinants of longevity. Poor neighborhoods score worse in all of them. (4/12/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1383.abstract People who live in lower-income neighborhoods have a higher rate of diabetic lower-extremity amputations than those in more affluent areas (8/2014)]&lt;br /&gt;
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Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/06/13/well/live/noise-may-raise-blood-pressure-risk.html Noise May Raise Blood Pressure Risk based on a study of people who lived near Athens International Airport (6/13/17)]&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
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Walkable Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27218630 Higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012 (5/24/16)]&lt;br /&gt;
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====Home ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Home_Determinants Home Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.mhealthtalk.com/common-problems-solutions/ The most common problems as you age in your home. (8/7/16)]&lt;br /&gt;
&lt;br /&gt;
Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.miamiherald.com/opinion/op-ed/article113730634.html Affordable housing, quality healthcare can let seniors age in place (11/9/16)]&lt;br /&gt;
* [http://www.stltoday.com/lifestyles/health-med-fit/health/want-a-better-chance-to-stay-out-of-a-nursing/article_c1b66d15-7afd-5b85-8e95-d83cc13d8f16.html Want a better chance to stay out of a nursing home? Modify your home (11/6/16)]&lt;br /&gt;
* [http://www.nytimes.com/2015/06/23/health/at-home-many-seniors-are-imprisoned-by-their-independence.html?ref=health&amp;amp;_r=3 Many seniors living at home feel imprisoned by their independence] (6/19/15)&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2016/07/gas-leaks-mold-and-rats-millions-of-americans-live-in-hazardous-homes/492689/ Gas Leaks, Mold, and Rats: Millions of Americans Live in Hazardous Homes (7/25/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/01/important-lesson-personalized-patient-care.html Controlling environmental allergens can reduce sneezing and nasal congestion that trigger asthma (1/1/14)]&lt;br /&gt;
* [http://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet Scientists estimate that lung cancer deaths could be reduced by 2 to 4% by addressing the one in 15 homes the EPA believes has too much radon exposure]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/multi-faceted-home-ventilation-intervention-reduces-copd-readmissions-study-finds Multi-faceted home ventilation intervention reduces COPD readmissions, study finds (7/15/15)]&lt;br /&gt;
* [http://www.cdc.gov/nceh/lead/ At least 4 million households have children living in them that are being exposed to high levels of lead (1/29/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2009/07/improving-the-health-of-all-americans-through-safe-and-healthy-h.html Approximately 40% of the 6.7 million children with diagnosed asthma are believed to be attributable to residential exposures (7/2009)]&lt;br /&gt;
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Homelessness &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://academic.oup.com/jpubhealth/article-abstract/doi/10.1093/pubmed/fdx034/3074503/Lifetime-and-1-year-prevalence-of-homelessness-in?redirectedFrom=fulltext Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2% and 1.5%, respectively (3/18/17)]&lt;br /&gt;
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Home Injuries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commissiononhealth.org/PDF/e434bb61-64d3-4267-9dca-705b9d80ddaa/HousingFactSheetJun09.pdf An estimated 4 million emergency department visits and 70,000 hospital admissions were attributed to injuries at home. (6/2009)]&lt;br /&gt;
&lt;br /&gt;
Housing Instability &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/housing-instability-will-cost-healthcare-industry-111b-over-next-decade.html Housing instability will cost healthcare industry $111B over next decade (8/10/17)]&lt;br /&gt;
&lt;br /&gt;
Housing Quality &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.sciencedirect.com/science/article/pii/S1353829214001087 NYC heat-mortality rates are associated with poverty and poor housing quality. (11/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Security ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Security_Determinants Security Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
Neighborhood Violence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/chicagoans-rank-violence-as-top-concern-in-health-needs-assessment.html Injury and violence was ranked as top concerns among Chicago's South and West Side residents, along with diabetes, nutrition, physical activity and weight, substance abuse and tobacco use, according to a health needs survey. (6/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-link-between-neighborhood-violence-and-biological-stress-in-children.html Study finds link between neighborhood violence and biological stress in children (11/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Content_Determinants Digital Content &amp;amp; Technology Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Records_Determinants Medical Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [http://medcitynews.com/2014/01/trends-healthcare-giving-access-doctor-notes-can-stimulate-patient-engagement/ Giving access to doctor notes can stimulate patient engagement (1/6/14)]&lt;br /&gt;
* [https://www.healthit.gov/patients-families/blue-button/about-blue-button Medicare provides medical history on a mobile app (Blue Button) for patients and caregivers to share with doctors]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Determinants_Records Health Determinants Records] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Records_Determinants Health Interventions Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Outcomes_Records_Determinants Health Outcomes Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Technology_.26_Apps_Determinants Technology &amp;amp; Apps Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.chicagotribune.com/lifestyles/health/sc-devices-to-track-wandering-kids-with-autism-health-0517-20170508-story.html 96% of parents surveyed who said they were using an electronic tracking device for their child with autism claimed it improved their quality of life (5/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/may/mobile-health-and-patient-engagement-in-the-safety-net Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics (5/13/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Making and Condition Management&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/new-apps-aim-guide-men-through-treatment-symptom-management-prostate-cancer New apps aim to guide men through treatment, symptom management of prostate cancer (9/10/16)]&lt;br /&gt;
&lt;br /&gt;
Devices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-patients-often-misuse-wrist-blood-pressure-monitors-leading-inaccurate-readings Study finds patients often misuse wrist blood pressure monitors, leading to inaccurate readings (9/7/16)]&lt;br /&gt;
&lt;br /&gt;
Digital Health Apps &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.engadget.com/amp/2017/07/11/lumosity-does-not-improve-cognitive-skills/ Lumosity doesn’t actually improve your cognitive skills (7/11/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/internet-mobile-disease-interventions-seem-work-longterm-studies-are-lacking Internet, mobile disease interventions seem to work, but long term studies are lacking (9/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-health-apps-near-meaningless-for-low-income-patients-with-chronic-conditions.html Study: Health apps near meaningless for low-income patients with chronic conditions (7/20/16)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/03/rehab-app-shoulder-rotator-cuff/ Rehab App Aims to Improve Shoulder &amp;amp; Rotator Cuff Repair Rehabilitation (3/21/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/commonwealth-fund-reasonably-small-number-chronic-health-apps-are-useful Some 43 percent of iOS health apps and 27 percent of Android health apps are useful. (2/22/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/copd-management-apps/ 5 digital health tools that could improve COPD management (12/3/15)]&lt;br /&gt;
* [http://www.imedicalapps.com/2014/11/cardiosmart-explorer-great-tool-educating-patients-clinic/ CardioSmart Explorer is a great tool for educating patients with cardiac disease (11/21/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/oct/vision-digital-health-tech A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System (10/1/14)]&lt;br /&gt;
* A [http://mobihealthnews.com/23418/most-patients-want-their-doctors-to-prescribe-apps/ study] from Digitas Health found that 90 percent of chronic patients in the US would accept a mobile app prescription as opposed to only 66 percent willing to accept a prescription of medication. (7/1/13)&lt;br /&gt;
&lt;br /&gt;
Digital Health Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-technology-self-monitor-blood-glucose-levels-no-better-traditional-management JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/content/study-patients-are-more-compliant-alivecor-devices-traditional-event-monitors Patients are more compliant to  smartphone-connected heart monitor devices than traditional event monitors (5/5/16)]&lt;br /&gt;
* [http://journals.lww.com/neurologynow/Citation/2015/11040/Wearing_the_Detectives__Wristbands,_smartwatches,.23.aspx Wristbands, smartwatches, and other wearable devices allow for more real-time monitoring of seizures and other neurologic symptoms—and, possibly, more precise treatment. (8/2015)]&lt;br /&gt;
&lt;br /&gt;
Home Automation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/top-home-tech-for-seniors-infographic/ Top Home Tech for Seniors (7/28/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/home-automation-and-home-health-care/ Home automation and in-home care aid gives patients independence without sacrificing their health needs. (3/25/14)]&lt;br /&gt;
&lt;br /&gt;
Internet Access &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/a-growing-number-people-chronic-conditions-also-lack-internet-access A growing number of people with chronic conditions also lack internet access (6/9/17)]&lt;br /&gt;
* [http://www.huffingtonpost.com/jane-sarasohnkahn/broadband-connectivity-is_b_11059720.html Broadband Connectivity Is A Social Determinant Of Health (7/22/16)]&lt;br /&gt;
&lt;br /&gt;
Technology Efficacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/smart-pill-bottles-didn-t-improve-adherence-for-heart-attack-patients-but-researchers-say Smart pill bottles didn’t improve medication adherence for heart attack patients, but earlier intervention could help (6/26/17)]&lt;br /&gt;
&lt;br /&gt;
==Impacting People Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Physicians ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Disciplines_.26_Resources_Determinants Physician Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Primary Care Physicians &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/many-americans-don-t-have-a-primary-care-doctor Some 28% of U.S. men and 17% of women don’t have a personal doctor or healthcare provider, according to a government survey. (1/12/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Team Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_.26_Resources_Determinants Care Team &amp;amp; Resources Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
====Credentialed Care Specialists Insight====&lt;br /&gt;
Nurses &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/how-a-specialist-nurse-can-help-with-dementia/ How a Specialist Nurse can Help with Dementia (6/21/14)]&lt;br /&gt;
&lt;br /&gt;
====Credentialed Support Providers Insight====&lt;br /&gt;
&lt;br /&gt;
====Team-Based Approach====&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/04/526475132/to-bring-down-stubbornly-high-blood-pressure-it-helps-to-have-a-team To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team (5/4/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/team-based-care-can-have-negative-financial-impact-on-primary-care-in-ffs-environment.html Team-based care can have negative financial impact on primary care in FFS environment (8/10/16)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2016/06/15/the-team-sport-of-diagnosis-a-culture-shift-can-reduce-missed-diagnoses/ The Team Sport of Diagnosis: A Culture Shift Can Reduce Missed Diagnoses (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Insight''===&lt;br /&gt;
Caregiver &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170807.061390/full/ More than a million youngsters ages 8–18 are caregivers taking on challenging tasks to help a parent, grandparent, sibling, or other relative. (8/7//17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-70-percent-caregivers-say-tech-plays-no-role-or-minor-role-their-work Survey: 70 percent of caregivers say tech plays no role or a minor role in their work (6/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/new-pennsylvania-law-requires-hospitals-to-educate-caregivers-upon-patient-discharge.html  New Pennsylvania law requires hospitals to educate caregivers upon patient discharge (4/27/17)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family-caregiving-cost-survey-res-ltc.pdf Study: Many Caregivers Spend $7K Annually Out Of Pocket, which is 20% of their income (11/14/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3065403/the-future-of-work/the-hidden-caregiving-crisis-that-the-election-wont-solve The number of U.S. workers struggling to care for ill or aging loved ones is growing fast. But the support they need isn't. (11/8/16)]&lt;br /&gt;
* [http://khn.org/news/study-elderlys-family-caregivers-need-help-too/amp/ Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones (9/14/16)]&lt;br /&gt;
* [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers In Some States, a New Focus on Family Caregivers. Nearly half of family caregivers administer multiple medications, treat wounds or operate specialized medical equipment. (6/22/16)]&lt;br /&gt;
* [http://khn.org/news/who-are-americas-caregivers-nearly-a-quarter-are-millennials/ Who Are The 40 Million American Caregivers? Nearly A Quarter Are Millennials (12/3/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/15-things-to-know-about-caregivers.html 15 things to know about caregivers (11/3/15)]&lt;br /&gt;
* [http://mobihealthnews.com/48054/new-council-will-guide-family-caregivers-to-available-tools/ New council will guide family caregivers to available tools (10/28/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/caregiver-frustration/ Nearly one-third struggle in their caregiving role and want tools to help them and their family members. 64% feel stressed and overwhelmed; nearly half struggle with balancing personal needs and caregiving. (10/24/15)]&lt;br /&gt;
* [http://khn.org/news/dementia-also-takes-toll-on-unpaid-caregivers-study-shows/ Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia (10/16/2015)]&lt;br /&gt;
* [http://www.usnews.com/news/us/articles/2015/07/14/ap-norc-poll-many-californians-unaware-of-caregiver-program Many Californians unaware of caregiver program for low-income seniors, disabled (7/14/15)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-undeniable-progress.pdf In 2013, about 40 million family caregivers in the US provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013. (7/2015)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf An estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the 12 months period in 2014 and 2015. (6/2015)]&lt;br /&gt;
* [http://medcitynews.com/2015/04/care-caregiver/ How Do We Care for the Caregiver (4/23/15)]&lt;br /&gt;
* [https://www.caring.com/about/news-room/costs-of-caregiving-2014 Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs (9/15/14)]&lt;br /&gt;
&lt;br /&gt;
Home Care (Non-Credentialed) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/ Lots Of Responsibility For In-Home Care Providers — But No Training Required (1/6/15)]&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends Determinants] that can decisively affect a patient's overall health and well-being. &amp;lt;br&amp;gt;&lt;br /&gt;
Spouse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.asco.org/about-asco/press-center/news-releases/large-study-finds-association-between-marriage-and-cancer Large Study Finds Association Between Marriage and Cancer Outcomes (9/23/13)]&lt;br /&gt;
&lt;br /&gt;
===Support Team Insight===&lt;br /&gt;
&lt;br /&gt;
Community Health Workers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/ Hospitals Eye Community Health Workers To Cultivate Patients’ Successes (4/11/16)]&lt;br /&gt;
* [http://khn.org/news/in-l-a-community-health-workers-are-part-of-the-medical-team/ In L.A., Community Health Workers Are Part Of The Medical Team (10/26/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/16/how-community-health-workers-can-reinvent-health-care-delivery-in-the-us/ How Community Health Workers Can Reinvent Health Care Delivery In The US (1/16/15)]&lt;br /&gt;
&lt;br /&gt;
Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html How Social Spending Affects Health Outcomes (8/17/16)]&lt;br /&gt;
* [https://thehealthcaremarketer.wordpress.com/2016/08/11/the-health-impact-in-5-years-hi-5-initiative/ Centers for Disease Control and Prevention (CDC) launches new initiative – Health Impact in 5 Years (HI-5). Promotes list of proven non-clinical, community-wide interventions that improved health within five years and are cost-effective or have cost-saving over the lifetime of the population. (8/11/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/politics/2016/05/02/social-service-shortfalls-hinder-health-boost-medical-spending/83625264/ Social service shortfalls hinder health, boost medical spending (5/3/16)] &lt;br /&gt;
* [https://www.icsi.org/_asset/nsnyw1/sharingknowledgedata.pdf Sharing Knowledge and Data at the Community/System Level To Address Social Determinants (4/2015)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/14/to-lower-the-cost-of-health-care-invest-in-social-services/ To Lower The Cost Of Health Care, Low-tech social services also should be considered a key factor in our health care equation. (7/14/15)]&lt;br /&gt;
* [http://www.cdc.gov/chinav/ CDC launches Community Health Improvement Navigator (CHI Navigator) website (5/2015)] with tools and resources from [http://www.thecommunityguide.org/ The Guide to Community Preventive Services], the [http://whatworksforhealth.wisc.edu/ What Works for Health database (on the University of Wisconsin website)], the [https://innovations.ahrq.gov/ AHRQ Health Care Innovations Exchange], the [http://cdc.thehcn.net/index.php?module=promisepractice&amp;amp;controller=index&amp;amp;action=index Healthy Communities Institute Promising Practices] and the [http://healthyamericans.org/ New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/11/understanding-intersection-health-care-social-services.html Understanding the intersection of health care and social services (11/10/13)]&lt;br /&gt;
&lt;br /&gt;
===Organizations Insight===&lt;br /&gt;
====Healthcare Organizations Insight====&lt;br /&gt;
====Government Organizations Insight====&lt;br /&gt;
====Employer Insight====&lt;br /&gt;
====Community and Social Services Organizations Insight====&lt;br /&gt;
====Support Resources Organizations Insight====&lt;br /&gt;
===Other Contributors Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Healthy Lifestyle ''Insight''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1569 The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed (8/2017)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1605086#t=article A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor). Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle. (12/15/16)]&lt;br /&gt;
* [http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract Study finds 2.7% of U.S. adults meet criteria for ‘healthy lifestyle’ (4/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ Scientist assert Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Only 5–10% of all cancer cases were attributed to genetic defects, whereas the remaining 90–95% is lifestyle factors including tobacco (25–30%), diet (30–35% - fried foods, red meat), infections (15–20%) the remaining alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity. (7/15/2008)]&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Insight''===&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/06/26/teenagers-are-as-sedentary-as-60-year-olds-by-age-19/?utm_term=.127016b508d0 Teenagers are as sedentary as 60-year-olds by age 19 (6/26/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/15/why-being-a-weekend-warrior-is-still-good-for-your-health/#EQ6NSxU86kqy Researchers found that the weekend warriors who met physical activity guidelines were less likely to die during the nine-year study period, compared with people who didn't get any exercise. A total of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity over one or two days a week. (1/15/17)]&lt;br /&gt;
* [https://www.technologyreview.com/s/602706/pokemon-go-increased-us-activity-levels-by-144-billion-steps-in-just-30-days/ Pokemon Go Increased U.S. Activity Levels by 144 Billion Steps in Just 30 Days (10/21/16)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ Brain Benefits of Exercise Diminish After Short Rest (9/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-more-than-a-quarter-of-adults-over-50-get-no-exercise-outside-of-daily-life-activities.html CDC: More than a quarter of adults over 50 get no exercise outside of daily life activities (9/20/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/27/study-suggests-new-formula-for-physical-activity-8-hours-of-sitting-means-1-hour-of-exercise/ Study suggests 1 hour of activity per 8 hours of sitting (7/27/16)]&lt;br /&gt;
&lt;br /&gt;
* [https://medlineplus.gov/podcast/transcript071816.html Moderate exercise is associated with a reduced risk of 13 types of cancer (7/18/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html The percentage of adults over 18 who met the 2008 federal physical activity guidelines for aerobic activity increased from 41.4 percent in 2006 to 49.5 percent in 2012. That rate has remained stable through 2015. (5/26/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-common-fund-launches-physical-activity-research-program NIH Common Fund launches physical activity research program to identify biological molecules that change in response to exercise (6/11/15)]&lt;br /&gt;
* [http://www.reuters.com/article/us-sedentary-television-mortality-idUSKBN0F65BW20140701 Too much TV tied to premature death (7/1/14)]&lt;br /&gt;
Children Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/recruiting-insider/wp/2017/09/06/youth-sports-study-declining-participation-rising-costs-and-unqualified-coaches/?utm_term=.39fd187136e1 Youth sports study: Declining participation, rising costs and unqualified coaches (9/6/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/johns-hopkins-us-could-save-21b-in-healthcare-costs-if-kids-played-outside-every-day.html Johns Hopkins: US could save $21B in healthcare costs if kids played outside every day (5/15/17)]&lt;br /&gt;
* [https://www.usatoday.com/story/news/health/2017/05/06/kids-inactivity-rises-creating-health-care-time-bomb/101245982/ The percent of children aged six to 12 who were physically active three or more times a week had its biggest drop in five years and is now under 25% (5/6/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/03/well/move/childs-play-is-good-for-all-of-us.html If all of the children who currently are sedentary started exercising every day in the United States alone, we could expect to save more than $120 billion every year in health care and associated expenses. (5/3/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/902 Modeling The Economic And Health Impact Of Increasing Children’s Physical Activity In The United States (5/2017)]&lt;br /&gt;
&lt;br /&gt;
Sitting &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/09/04/547580952/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later Study of sitting and walking ability over 8 to 10 years, those who sit the most and move the least had more than three times the risk of difficulty walking by the end of the study (9/4/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/sitting-can-be-bad-especially-if-you-do-it-for-more-than-10-hours-a-day/2016/07/22/43f7f228-4f77-11e6-aa14-e0c1087f7583_story.html Sitting can be bad, especially if you do it for more than 10 hours a day (7/24/16)]&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities Insight===&lt;br /&gt;
===Nutrition ''Insight''===&lt;br /&gt;
* [http://fortune.com/2017/07/17/artificial-sweeteners-weight-loss-study/ Artificial Sweeteners Won't Help You Lose Weight, According to a Sad but Important New Study (7/17/17)]&lt;br /&gt;
* [http://ajcn.nutrition.org/content/early/2017/06/07/ajcn.117.154872.abstract?papeto The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. (6/7/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1 Pediatricians Advise No Fruit Juice Until Kids Are 1 (5/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/15/well/eat/red-meat-increases-risk-of-dying-from-8-diseases.html Red meat increase risk of dying from 8 diseases (5/15/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/26/well/diet-sodas-tied-to-dementia-and-stroke.html Diet soda tied to dementia and stroke (4/26/17)] &lt;br /&gt;
* [https://www.statnews.com/2017/01/26/soda-sugary-drinks/ The number of calories per day that children and adults have been getting from soda and other sugar-sweetened beverages has been dropping for steadily for nearly 20 years, but new data show that since 2009 that number has plateaued. (1/26/17)] &lt;br /&gt;
* [http://www.alzheimersanddementia.com/article/S1552-5260(17)30050-X/fulltext Excess sugar consumption has been linked with Alzheimer's disease (AD) pathology in animal models. (1/24/17)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2529628 Dietary Intake Among US Adults, 1999-2012 Improved. The American Heart Association (AHA) primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). (6/21/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2016/03/more-than-half-of-what-americans-eat-is-ultra-processed/472791/ More Than Half of What Americans Eat Is 'Ultra-Processed'. And those foods account for 90 percent of U.S. added sugar intake, new research says.(3/10/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1916.abstract Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; Overall Diet Remains Poor (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1940.abstract Foods with the largest positive associations with three-year excess weight gain (among children and adolescents) were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages (11/2015)]&lt;br /&gt;
* [http://now.tufts.edu/news-releases/sugary-drinks-linked-high-death-tolls-worldwide Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year (6/29/15)]&lt;br /&gt;
* [http://openheart.bmj.com/content/2/1/e000196.full US and UK governments dietary guidelines introduced in 1977 and 1983 to reduce coronary heart disease (CHD) by reducing fat intake didn't have studies to support it. (2/9/15)]&lt;br /&gt;
&lt;br /&gt;
===Functional Activities Insight===&lt;br /&gt;
&lt;br /&gt;
Digital Health Usage &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-21-percent-americans-have-used-virtual-healthcare-78-percent-are-interested Survey: 21 percent of Americans have used virtual healthcare, 78 percent are interested (2/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/senior-citizens-rarely-use-digital-health-resources-5-study-findings.html Seniors rarely use digital health resources: 5 study findings (8/3/16)]&lt;br /&gt;
* [http://mobihealthnews.com/39189/parks-41-percent-of-caregivers-use-a-digital-health-device 41 percent of caregivers use a digital health device (12/18/14)]&lt;br /&gt;
* [http://mobihealthnews.com/38904/kaiser-members-who-use-app-are-more-adherent-satisfied-and-loyal/ Kaiser now has 70% of its 9 million members as active users of its online and mobile offerings, patients are more adherent, satisfied, and loyal (12/10/14)]&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Insight''===&lt;br /&gt;
* [https://www.alz.org/aaic/releases_2017/AAIC17-Tues-Briefing-Sleep.asp Interrupted sleep may lead to Alzheimer’s. Research found significant associations between sleep disordered breathing (SDB) and the accumulation of biomarkers for Alzheimer's disease. (7/18/18)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/06/504448639/drivers-beware-crash-rate-spikes-with-every-hour-of-lost-sleep Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep (12/6/16)]&lt;br /&gt;
* [http://mashable.com/2016/11/30/sleep-deprivation-economic-cost.amp In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death (11/30/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/08/24/432764792/snooze-alert-a-sleep-disorder-may-be-harming-your-body-and-brain Snooze Alert: A Sleep Disorder May Be Harming Your Body And Brain A Sleep Disorder May Be Harming Your Body And Brain. More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea. (8/24/15)]&lt;br /&gt;
* [http://articles.latimes.com/2013/aug/29/science/la-sci-sn-sleeping-pill-use-cdc-20130830 One in 25 American adults takes sleeping pills to help them fall asleep and stay asleep at night (8/29/13)]&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-things-to-know-about-america-s-unhealthy-behaviors.html More than 70 percent of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. (4/5/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-overweight-heart-uspstf-idUSKBN0GP1XA20140825 Overweight patients with risk factors for heart disease need &amp;quot;intensive behavioral counseling&amp;quot; about '''diet''' or '''exercise''', according to USPSTF. (8/25/14)]&lt;br /&gt;
* [https://georgevanantwerp.com/2013/12/30/8-risks-drive-15-conditions-and-80-of-healthcare-costs/ 8 Behavior Risks Drive 15 Conditions And 80% Of Healthcare Costs (12/30/13)]&lt;br /&gt;
&lt;br /&gt;
Alcohol &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/28793133 One in eight Americans abuses alcohol, a new study finds, a 50 percent increase since the start of the century (9/1/17)]&lt;br /&gt;
* [https://www.bloomberg.com/news/articles/2017-08-09/america-s-drinking-problem-is-much-worse-this-century The number of adults who binge drink at least once a week could be as high as 30 million, according to a study published on Wednesday in JAMA Psychiatry. (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 32% of Americans had a minimum of one heavy drinking day in the last year. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. (5/27/16)]&lt;br /&gt;
* Alcohol Consumption - [https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ The top 10% of American drinkers consume, on average, 74 alcoholic drinks per week. (9/25/14)]&lt;br /&gt;
&lt;br /&gt;
Falls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-elderly-patients-treated-for-falls-may-be-more-likely-to-suffer-later-adverse Elderly patients treated for falls may be more likely to suffer later adverse events, study finds (7/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/among-the-elderly-an-epidemic-of-falling.html The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. (9/21/16)] &lt;br /&gt;
* [http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/ The use of 4 or more medications was associated with increased risk of falling and the risk of recurrent falls (9/27/13)]&lt;br /&gt;
&lt;br /&gt;
Risky Behaviors &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/05/29/health/car-accidents-child-deaths-seat-belts.html Car Accidents Remain a Top Child Killer, and Belts a Reliable Savior (5/29/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-high-risk-behaviors-often-persist-even-after-cancer-diagnoses.html Study finds high-risk behaviors often persist after cancer diagnoses. 19.8% of women cancer survivors smoked, compared with 15.8% of women without cancer. No differences existed for fruit and vegetable consumption or body mass index. (9/6/16)]&lt;br /&gt;
&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/01/10/smoking-costs-the-world-economy-1-trillion-per-year-world-health-organization-says/?utm_term=.378ab21f3e8c Smoking costs the world economy $1 trillion per year, World Health Organization says (1/10/17)]&lt;br /&gt;
* [https://directorsblog.nih.gov/2016/12/13/study-finds-no-safe-level-of-smoking/ New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. (12/13/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall Centers for Disease Control and Prevention says smoking rates have fallen from 21% of the adult population in 2005 to 15% in 2015 (11/10/16)]&lt;br /&gt;
* [http://www.sanger.ac.uk/news/view/smoking-pack-day-year-causes-150-mutations-lung-cells Smoking a pack a day for a year causes 150 mutations in lung cells (11/3/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cigarettes-linked-to-nearly-30-of-cancer-deaths-6-things-to-know.html Cigarettes linked to nearly 30% of cancer deaths: 6 things to know (10/24/16)]&lt;br /&gt;
* [http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002020 A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. (5/10/16)]&lt;br /&gt;
* [https://www.boston.com/news/health/2016/05/24/kicking-habit-adult-smoking-rate-us-falling-fast CDC reports smoking rate among adults in the U.S. fell to 15% in 2015, down two percentage points from 2014. (5/24/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/04/19/opioid-addiction-relapse-science/ How drug use changes the brain — and makes relapse all too common (4/19/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://health.usnews.com/health-care/articles/2017-04-19/many-heart-attack-patients-fail-to-stick-with-statins Many Heart Attack Patients Fail to Stick With Statins (4/19/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/25/more-than-half-of-adults-misuse-medications-study-finds/ More than half of adults and 44% of children drug-tested by a national clinical laboratory last year misused their prescription medications, either taking too much, too little or none of their medications. 45 percent of adults were taking drugs (including illicit drugs) that were not prescribed. (7/25/16)]&lt;br /&gt;
* [http://www.mcolblog.com/kcblog/2016/7/12/factors-attributed-to-medication-non-adherence.html 30% of prescriptions are never filled. 69% of nonadherence is due to behavioral issues, such as forgetfulness or procrastination, 16% was due to cost, and 15% say it was medication side effects (7/12/16)]&lt;br /&gt;
*  [http://www.imshealth.com/en/about-us/news/ims-health-study:-low-levels-of-adherence-and-persistence-remain-barriers-to-reducing-the-costs-of-diabetes-complications The U.S. could save $4 billion a year if more seniors with type 2 diabetes followed their doctor’s orders, according to a report by the IMS (7/12/16)]&lt;br /&gt;
* [http://www.hindawi.com/journals/ijfm/2013/901845/ Study found that only 6.5% of patients (only 46 in study) adhered completely to the discharge medication list after average hospital stay of 4.3 days. The average patient age was 76, prescription medications was 10 and number of chronic diseases was 7. (2/24/13)] &lt;br /&gt;
* [http://medcitynews.com/2014/11/study-medication-adherence-prompts/ Study: Medication adherence improved with proper prompts (11/17/14)]&lt;br /&gt;
* [http://well.blogs.nytimes.com/2012/11/15/when-the-patient-is-noncompliant/ When the patient is non-compliant (11/15/12)]&lt;br /&gt;
* [http://healthcare-economist.com/2015/05/31/patient-adherence-to-antipsychotic-medications/ About 40% of patients with schizophrenia are adhering to antipsychotic medications (5/31/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Activation Levels &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/mar/patient-self-management-capability In 2012, ED costs were 37% lower for those at highest activation level versus the lowest ($1,126 vs. $711). In 2014, the difference was 28% (3/8/16)]&lt;br /&gt;
* [http://hpr.weill.cornell.edu/divisions/biostatistics/pdf/Gerber-Research_Seminar_Talk-5-10-07.pdf Effect of the Patient Activation Measure (PAM) on Chronic Care: Baseline Findings from a Cluster Randomized Study (5/10/07)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/3/431 When Patient Activation Levels Change, Health Outcomes And Costs Change, Too (3/2015)]&lt;br /&gt;
&lt;br /&gt;
Prevention &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.ajc.com/news/local/study-finds-percent-sunscreens-don-even-work-how-find-one-that-does/ergzPOJyVv0nM7ZG88yBHK/ Study finds 73 percent of sunscreens don’t even work — how to find one that does (5/26/17)]&lt;br /&gt;
&lt;br /&gt;
Preventive Screening and Vaccinations&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentages of adults who received an influenza vaccination in 2015 was 65.8% for adults aged 65 and over, 46% for ages 50 to 64 and 31.2% for those aged 18 to 49. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentage of adults over 65 years old vaccinated for pneumonia increased rapidly from 42.4% in 1997 to 53.1% in 2000. In 2015, the percentage rose to 63.5% (5/26/16)]&lt;br /&gt;
&lt;br /&gt;
Self Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.reuters.com/article/us-pressure-management-study-idUSKBN0GR2C220140827 Self management may reduce blood pressure (8/27/14)]&lt;br /&gt;
&lt;br /&gt;
Treatment Delays &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://go.americanwell.com/rs/335-QLG-882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf 67% of consumers say they have delayed seeking care for a health problem. They delay because: It costs too much (23%), It takes too long to get in to see a doctor or nurse (23%), They thought the problem would go away on its own (36%), They are too busy (13%) (1/2017)]&lt;br /&gt;
&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-fewer-americans-diet-20170308-story.html American adults either overweight or obese rose from about 53% a generation ago to roughly 66% more recently. 56% of overweight or obese adults reported in 1988 to 1994 they had tried to lose weight in the last year, it has declined to 49% in 2009 to 2014. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Wellness Programs&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/279396/will-every-human-be-health-reward-program-when-it-comes-health-rewards-it-seems 74 percent of employers use health reward program (12/1/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/193551/amount-reward-consumer-health-behavior What Size Reward Drives a Consumer to Take a Desired Health Behavior? (9/9/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/25/workplace-wellness-produces-no-savings/ Workplace Wellness Produces No Savings (11/25/14)]&lt;br /&gt;
&lt;br /&gt;
===Care Planning Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/05/10/addressing-triggers-of-decline-in-older-adults-physical-cognitive-or-mental-health/ “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/07/02/family-caregiving-and-palliative-care-closing-the-policy-gap/ Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)]&lt;br /&gt;
&lt;br /&gt;
Care Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/02/implementing-a-care-planning-system-how-to-fix-the-most-pervasive-errors-in-health-care/ Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/630.abstract Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)] &lt;br /&gt;
* [http://familiesusa.org/press-release/2016/proven-best-choices-guides-health-care-options-launched-icer-and-families-usa Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)]&lt;br /&gt;
* [https://decisionaid.ohri.ca/odsf.html The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/october-november/in-focus Helping Patients Make Better Treatment With Decision Aids (10/2012)]&lt;br /&gt;
&lt;br /&gt;
Evidence-Based Practice &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/primary-care-docs-may-struggle-to-find-high-quality-evidence-to-support-clinical Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/22/credibility-of-evidence-a-reconsideration-of-the-logic-and-strength-of-our-healthcare-decisions/ Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)]&lt;br /&gt;
&lt;br /&gt;
Medical Advocates &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/medical-advocates-can-help-guide-patients-on-difficult-care-choices/ Medical Advocates Can Help Guide Patients On Difficult Care Choices  (1/27/16)]&lt;br /&gt;
&lt;br /&gt;
Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/partners-expands-second-opinion-service-health-advocate-partnership Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/88-of-second-opinions-from-mayo-physicians-result-in-different-diagnosis-study-finds.html 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)]&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/patients-with-more-say-in-treatment-have-fewer-side.html Patients with more say in treatment have fewer side effects (7/13/16)]&lt;br /&gt;
*  [http://khn.org/news/inviting-patients-to-help-decide-their-own-treatment/ Inviting Patients To Help Decide Their Own Treatment (3/16/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/17/shared-decision-making-and-the-use-of-patient-decision-aids/ Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/doctors-patients-critically-medical-decisions.html How should doctors and patients look critically at medical decisions?] (8/16/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/medical-interventions-5050-informs-patient.html Many medical interventions are 50/50: Who informs the patient? (8/13/2013)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management - Communications Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Communicating Instructions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/most-patients-don-t-understand-post-discharge-care-plans-study-finds Most patients don't understand post-discharge care plans, study finds (1/6/2016)]&lt;br /&gt;
&lt;br /&gt;
Difficult Dialog &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/03/377569539/even-some-doctors-fear-these-10-questions The difficulty of asking questions about &amp;quot;adverse childhood experiences&amp;quot; that identifies health risks (3/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/24/394927484/many-doctors-who-diagnose-alzheimers-fail-to-tell-the-patient Many Doctors Who Diagnose Alzheimer's Fail To Tell The Patient (3/24/15)]&lt;br /&gt;
&lt;br /&gt;
Digital Communications &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cio.com/article/3195891/cio-role/kaiser-cio-shares-it-lessons-for-the-future-of-healthcare.html Kaiser Permanente crossed an important threshold last year when 52 percent of its patient interactions were digital. (5/10/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/mhealth-monitor-patients-physicians/ 58% of people in the U.S. with a smartphone shared information with a medical professional using a mobile or wearable device. And 25% used email or text to send a photo of a medical issue to their doctor. (11/15/16)]&lt;br /&gt;
* [http://www.huffingtonpost.com/2015/06/29/doctors-facebook-telehealth_n_7662774.html Communicating With Your Doctor On Facebook May Be The Future Of Healthcare (6/29/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/07/healthcrowd-pilot-finds-mobile-engagement-medicaid-patients-cost-effective/ Pilot project finds mobile engagement with Medicaid patients ‘most cost-effective’ (7/29/14)]&lt;br /&gt;
* [http://mobihealthnews.com/35160/nearly-half-of-kaiser-permanentes-members-use-my-health-manager/ Nearly half of Kaiser Permanente's members use online health management platform (7/25/14)]&lt;br /&gt;
* Electronic Communication - [http://link.springer.com/article/10.1007%2Fs11606-012-2329-5 71% of vulnerable patient populations want to use electronic communication with health care providers.] (2/20/13)&lt;br /&gt;
&lt;br /&gt;
Doctor Patient Discussions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/language-doctors-use-to-talk-to-diabetes-patients-makes-a-difference The language doctors use to talk to diabetes patients makes a difference to success (6/14/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/prudent-antibiotic-prescribing-lowers-patient-satisfaction.html How prudent antibiotic prescribing lowers patient satisfaction (9/13/16)]&lt;br /&gt;
* [http://khn.org/news/attending-to-the-human-element-is-key-to-keeping-patients-healthy/amp/ Study recommends improving communication with racial minorities and lower-income patients, such as better bedside manner (so patients trust their doctors), communication that is easily understood by everyday people and willingness to discuss how price fits into consumers’ health decisions. (9/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/physicians-spend-twice-as-much-time-on-ehr-desk-work-than-with-patients.html Physicians spend twice as much time on EHR, desk work than with patients (9/6/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/06/costs_of_care_getti.html Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. (6/15/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/get-10-minutes-doctor-2/ Why Do I Only Get 10 Minutes With My Doctor? (9/18/14)]&lt;br /&gt;
* [http://khn.org/news/15-minute-doctor-visits/ 15-Minute Visits Take A Toll On The Doctor-Patient Relationship (4/21/14)]&lt;br /&gt;
&lt;br /&gt;
Patient Portals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/ehr/despite-federal-push-to-offer-ehr-access-patient-engagement-low Just 15% of hospital patients electronically accessed their medical records despite 88% of hospitals offering access. Nearly one-third of patients accessed EHRs offered by physician practices. (3/16/17)]&lt;br /&gt;
&lt;br /&gt;
Patient Provided Data&lt;br /&gt;
* [http://www.fiercehealthcare.com/analytics/how-university-rochester-medical-center-uses-patient-generated-data-to-set-expectations University of Rochester Medical Center (URMC) collects patient-reported outcomes by using a Patient-Reported Outcomes Measurement Information System (PROMIS), which requires patients to answer five to seven questions on a tablet. (7/6/17)] &lt;br /&gt;
* [http://www.annfammed.org/content/15/2/158.abstract Patients Typing Their Own Visit Agendas Into an Electronic Medical Record. Patients and clinicians agreed that the agendas improved patient-clinician communication. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Remote Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2488923#Results Study finds readmissions nearly the same for heart failure patients using remote patient monitoring (3/2016)]&lt;br /&gt;
* [http://mobihealthnews.com/content/scripps-wired-health-study-results-show-no-clinical-or-economic-benefit-digital-health Scripps Wired for Health study shows no clinical or economic benefit from digital health monitoring (1/19/16)]&lt;br /&gt;
* [http://khn.org/news/making-the-human-condition-computable/ Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to enable doctors to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails. (12/11/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/can-fall-monitoring-technology-keep-elders-safe/ Can Fall Monitoring Technology Keep Elders Safe? (4/7/14)]&lt;br /&gt;
* [http://www.mddionline.com/article/digital-health-dominates-ces-2014-%E2%80%93-3-trends-watch-3 Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. (1/9/14)]&lt;br /&gt;
&lt;br /&gt;
Screenings &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/doctors-should-screen-patients-for-social-isolation-to-address-loneliness-epidemic Doctors must screen patients for social isolation to address 'loneliness epidemic' (8/8/17)]&lt;br /&gt;
* [https://nam.edu/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool/ Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool. (5/30/17)] [https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf See PDF] &lt;br /&gt;
&lt;br /&gt;
Text Messaging &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/despite-privacy-hoops-text-messaging-offers-unprecedented-convenience Despite privacy hoops, text messaging offers ‘unprecedented convenience’ (5/11/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management - Operational Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/474.abstract Breaking Down Silos Between Health Care And Criminal Justice (3/2014)]&lt;br /&gt;
&lt;br /&gt;
Behavioral Health Integration&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/10/1808.abstract Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care (10/2014)]&lt;br /&gt;
* [http://docs.house.gov/meetings/IF/IF02/20150211/102944/HHRG-114-IF02-Wstate-KohnL-20150211.pdf About 10 million—or 4.2%—of adults in the United States suffered from a serious mental illness in 2013 were supported by 112 different federal programs (2/11/15)]&lt;br /&gt;
&lt;br /&gt;
Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-acute-care-needs-to-be-coordinated-but-it-often-not Only 30% of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7% reported they were fully coordinated. (11/131/6)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/07/20/peds.2015-4182 Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. (7/2016)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/09/difficult-transition-hospital-nursing-home.html The difficult transition between the hospital and nursing home (9/5/13)]&lt;br /&gt;
* [http://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/ One of the most dangerous junctures in medical care: patients leaving the hospital. Nearly a quarter had inadequately reviewed or tracked medications, sometimes even causing fatal events. (5/2/16)] &lt;br /&gt;
* [https://psnet.ahrq.gov/primers/primer/11 Nearly 20% of patients experience adverse events within 3 weeks of hospital discharge, nearly three-quarters of which could have been prevented or ameliorated. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-discharge-risks-persist-for-elderly-patients The transition from hospital to home poses significant risks to patients, especially the elderly, and gaps persist in care during this crucial time. (7/11/16)]&lt;br /&gt;
&lt;br /&gt;
Coordinated Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/nov/healthcare-fragmentation-frequency-diagnostic-tests Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, linked to high rates of hospitalization and emergency department visits as well as lower satisfaction. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients. (11/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/on-lok Program of All-Inclusive Care for the Elderly (PACE) cares for frail elders in the community (8/12/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/12/poor-interoperability-affects-patients.html How poor interoperability affects patients. It often requires duplicate testing that is not only costly (e.g., CT scans), but also invasive and not without risk to the patient (e.g., bronchoscopy, biopsies). (12/17/15)]&lt;br /&gt;
* [http://www.jhsph.edu/news/news-releases/2015/four-in-ten-older-adults-burdened-by-demands-of-health-care-system.html Four in Ten Older Adults Burdened by Demands of Health Care System] (10/14/15)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2014/nov/international-survey-of-older-adults International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care (11/19/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/special-report/5-pieces-care-coordination-puzzle 5 pieces of the care coordination puzzle (6/11/14)]&lt;br /&gt;
* [http://www.healthcare-informatics.com/news-item/lack-coordinated-care-problem-older-patients-survey-says Lack of Coordinated Care is a Problem for Older Patients, Survey Says (4/3/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/10/coordinated-care-critical-reducing-u-s-health-spending/ Coordinated care critical for reducing U.S. health spending  (10/8/13)]&lt;br /&gt;
&lt;br /&gt;
Managing [http://www.patientdeterminants.org/index.php?title=Health_Insight#High_Need.2C_High_Cost_Patients_Insight High Cost High Need Patients] &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? (8/7/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/care-high-need-high-cost-patients Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis (10/29/15)] &lt;br /&gt;
&lt;br /&gt;
Palliative Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/44.abstract Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities (1/2016)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/29/the-challenge-of-financing-sustainable-community-based-palliative-care-programs/ The Challenge Of Financing Sustainable Community-Based Palliative Care Programs (12/29/14)]&lt;br /&gt;
&lt;br /&gt;
Partnering With Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/what-organizations-do-hospitals-partner-with-for-population-health.html What Organizations do Hospitals Partner With for Population Health? (12/5/13)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2014/12/28/the-trouble-with-home-health-care-care-coordination/ The Trouble with Home Health Care &amp;amp; Care Coordination (12/28/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2104.abstract Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Coordinating care and communicating with specialists, hospitals, home care and social service providers. (12/2015)]&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Determinants Health Strategy Activities Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Interventions Activities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Interventions_Determinants Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being. [[Medical Interventions]] Activities are impacted by:&lt;br /&gt;
&lt;br /&gt;
* [[Medical Intervention Access|Access]]&lt;br /&gt;
* [[Medical Intervention Diagnosis|Diagnosis]]&lt;br /&gt;
* [[Medical Intervention Efficacy|Efficacy]]&lt;br /&gt;
* Testing&lt;br /&gt;
* [[Medical Intervention Treatments|Treatments]]&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions Activity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Non-Medical_Interventions_Determinants Non-Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Cardiac Rehabilitation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/cardiac-rehab-improves-health-but-cost-and-access-issues-complicate-success/amp/ Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (8/31/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/07/18/485871530/cardiac-rehab-works-great-so-why-don-t-people-do-it Despite research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer; fewer than a third do. (7/18/16)]&lt;br /&gt;
&lt;br /&gt;
Employee Wellness Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/ Large firms (at least 200 employees) are more likely to offer Employee Wellness Programs than smaller firms (81% vs. 49%) in an effort to promote employee health and productivity and reduce health related cost (5/19/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/71.abstract Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study (1/2016)]&lt;br /&gt;
&lt;br /&gt;
Fall Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-step-up-to-help-seniors-avoid-falls/ Hospitals Step Up To Help Seniors Avoid Falls (1/12/16)]&lt;br /&gt;
&lt;br /&gt;
Health Coaching &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/the-underrated-value-of-coaching-in-healthcare-4-thoughts-from-population-health-expert-dr-william-appelgate.html The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William Appelgate (1/25/17)]&lt;br /&gt;
&lt;br /&gt;
Legal Counseling &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/legal-regulatory-issues/ku-kansas-hospital-to-offer-free-legal-counsel-to-low-income-patients.html Kansas hospital offers free legal counsel to low-income patients (8/18/16)]&lt;br /&gt;
&lt;br /&gt;
Obesity Counseling &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://khn.org/news/few-seniors-benefitting-from-medicare-obesity-counseling/ Few Seniors Benefiting From Medicare Obesity Counseling (2/23/15)]&lt;br /&gt;
* [http://khn.org/news/seniors-obesity-counseling-benefit-goes-largely-unused/ Seniors’ Obesity-Counseling Benefit Goes Largely Unused (11/20/14)]&lt;br /&gt;
&lt;br /&gt;
Opioid Alternative&lt;br /&gt;
* [http://www.denverpost.com/2016/11/30/battling-opioid-epidemic/ How a Colorado health care provider is battling the opioid epidemic with non-pill pain treatments (11/30/16)]&lt;br /&gt;
&lt;br /&gt;
Virtual Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fastcompany.com/3047894/the-future-of-work/how-to-turn-your-smartphone-into-your-personal-therapist Smartphone As A Personal Therapist. Could the technology that causes so much of our stress and anxiety also be the cure? (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence Insight====&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Patient_Stories</id>
		<title>Patient Stories</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Patient_Stories"/>
				<updated>2019-07-16T21:18:33Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;To truly understand '''managing health''', we need to hear first hand from patients to relate, emphathize and learn how to improve. &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
'''Addressing Non-Medical Determinants'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/social-determinants-matter-persons-health-heres-one-story.html A Physician tells a story of how social determinants drive patient outcomes in two men in their late 30s that live across the street from one another, both in good health with no family history of major illness (8/7/16)]&lt;br /&gt;
* [http://khn.org/news/using-data-to-help-home-health-workers-manage-patients-conditions/ 39-year-old woman that is nearly blind and unable to walk more than a step or two, struggles to raise three sons while dealing with a daunting array of health conditions from diabetes to pain from bulging spinal disks. A non medical health worker offers to help. (3/9/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/05/educating-community-health-conscious-physicians.html Mr. Jones had congestive heart failure, COPD, and a barrage of other chronic health problems. A visit to his home provided insight into why he was going to the ER each week (5/21/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/05/treating-physical-pain-address-emotional.html 78-year-old businessman with physical pain needed to address emotional needs first (5/17/14)] &lt;br /&gt;
&lt;br /&gt;
'''Aging In Place'''&lt;br /&gt;
* [http://www.philly.com/philly/health/aging_parents_living_alone.html 87-year-old Mary staying in a family home can become a strain for both the elderly and their adult children like her daughter Linda. (10/2/16)]&lt;br /&gt;
&lt;br /&gt;
'''Alcoholism'''&lt;br /&gt;
* [http://blog.acphospitalist.org/2016/08/love-of-my-life.html A man, sober for one year, struggles with his life and love for alcohol (8/24/16)] &lt;br /&gt;
&lt;br /&gt;
'''Behavior Impact on Health'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/07/limits-careful-physician-can.html A physician frustrated by his limits describes the tale of two patients. A 61-year-old man with elevated blood sugar. 52-year-old man with an elevated red blood count caused by smoking, sleep apnea from obesity, early lung disease and two cardiac stents. The 61-year old lost weight and lowered his blod sugar. The 52-year-old didn't make any lifestyle changes and health deteriorated. (7/15/16)]&lt;br /&gt;
&lt;br /&gt;
'''Breaking The Stigma'''&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1615974 Dr. Adam Hill is a husband, father, and pediatric palliative care physician. He decribes how he fought through the stigma of depression, alcoholism and suicidal through treamenta and recovery. (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
'''Caregivers'''&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/caring-for-a-loved-one-care-for-yourself-too/amp/ Michael Sloss and his brother care for both parents, ages 83 and 85, whose personalities have been transformed by the decline in their mental and physical health. The brothers wrestle with their parents’ memory loss, anger and delusions. (6/2/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/01/coordinates-patient-care-maybe-no-one.html Bonnie Friedman describes her frustration coordinating her husband's care over many hospitalizations for serious, sometimes life-threatening, illnesses. (1/20/17)]&lt;br /&gt;
* [http://khn.org/news/caring-for-a-loved-one-at-home-can-have-a-steep-learning-curve/amp/ How the family of 87-year old Ruth Perez's with dementia learned how to take care of their mom (12/12/16)]&lt;br /&gt;
* [http://www.mhealthtalk.com/what-caregiving-looks-like/ Six short videos, each just 3 minutes or less, show what caregiving looks like. (1/2/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/11/the-stress-of-being-a-caregiver-to-an-elderly-parent.html A son must decide between caring for his elderly mother or being able to retire one day (11/22/15)] &lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1689.abstract?rss=1 When a family caregiver becomes injured, she learns the difficulties—and costs—of caring for herself and her chronically ill husband at the same time. (9/2014)]&lt;br /&gt;
&lt;br /&gt;
'''Community Health Worker''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2017/apr/april-3-2017/high-need-feature-tanya 46-year-old Tanya never went to the doctors until she had no choice. She was diagnosed with hypertension, cirrhosis, asthma, and high blood pressure. Her doctor referred her to community health worker that has really helped Tanya (4/3/17)]&lt;br /&gt;
&lt;br /&gt;
'''Depression and Suicide''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fastcompany.com/40451951/learning-to-cope-with-clinical-depression-has-made-me-a-better-manager Learning To Cope With Clinical Depression Has Made Me A Better Manager. I’ve gone to great lengths to hide it for most of my career, but eventually I realized I didn’t need to. (8/11/17)]&lt;br /&gt;
* [http://www.miamiherald.com/opinion/op-ed/article158742984.html I lost two great personal and professional friends to depression and, ultimately, suicide — Raul Valdes-Fauli and Ervin Gonzalez. Both seemed to have the world in the palms of their hands: loving families, financial security, and professional success as a banker and lawyer, respectively. (6/28/17)]&lt;br /&gt;
&lt;br /&gt;
'''Disability from Stroke''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hidden-stroke-victims-the-young/amp/ 32-year-old Jamie Hancock, mother of children ages 1 and 3 had to adjust to a new life (8/24/16)]&lt;br /&gt;
&lt;br /&gt;
'''End of Life''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/owe-father-argue-death-dignity.html Active 68-year-old man had to suffer through several months of pain before dying. His physician daughter became a proponent for dignity in dying (9/16/16)] &lt;br /&gt;
* [http://content.healthaffairs.org/content/34/5/871.abstract A hospital CEO learns that the standard of care isn't always appropriate when her 94 mother sustained a fall (5/2015)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/02/diagnosed-brain-cancer-insurer-adds-nightmare.html A patient dying of cancer] was denied home treatment that would have improved her quality of life over her last few days and saved tens of thousands of dollars. (2/11/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/03/broken-hip-unfixed-surgeon-fails-communicate.html A frail, 94-year old women with with advanced Alzheimer’s] has hip fracture surgery during her dying days due to poor communications (3/10/13)&lt;br /&gt;
&lt;br /&gt;
'''Fragmented Healthcare System''' &amp;lt;br&amp;gt;&lt;br /&gt;
Lack of a coordinated, patient centered approach&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/10/patients-story-illustrates-barriers-health-care.html Katelyn Anderson is 28 years-old with communications degree was diagnosed with a disease while in graduate school. The fragmented, disjointed healthcare system makes it nearly impossible to manage her health and treatments. (10/29/16)]&lt;br /&gt;
&lt;br /&gt;
'''Geriatricians'''&lt;br /&gt;
* [http://khn.org/news/geriatricians-can-help-aging-patients-navigate-multiple-ailments/ 88-year-old patient with metastasized prostate cancer on 26 medications was troubled by profound fatigue, which dissipated after his Geriatrician took him off all but one medication. (2/23/17)]&lt;br /&gt;
'''Health Insurance Issues''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/01/convoluted-health-care-payment-system.html Corey Michael is a physician that was diagnosed with sleep apnea. He finds it may be easier to buy the continuous positive airway pressure (CPAP) device without insurance than going through the extra steps required by his health plan (1/25/17)] &lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/06/people-going-broke-cant-afford-care-needs-end.html A young professional woman a few years out of graduate school in late twenties with a good job and health insurance unable to maintain her health due to cost and coverage. (6/29/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/12/fragmentation-is-behind-health-cares-biggest-problems.html A man suffers for a week in agony with kidney stones because of insurance access issues to physicians and services (12/11/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/02/medicare-cover-infusion-services-patients-homes.html Medicare would only pay for an 84-year-old man's infusion therapy at a nursing home ($15,000) rather than at his home ($1,200).  (2/23/14)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2013/02/23/how-much-are-misaligned-incentives-in-health-care-costing-tax-payers/ A patient suffering from an infected artificial shoulder] couldn't afford intravenous antibiotics three times a day for six weeks in home. Medicare spent an unnecessary $30,000 on hospitalization and care rather than reimbursing for home care. (2/23/13)&lt;br /&gt;
&lt;br /&gt;
'''Happiness''' &lt;br /&gt;
* [https://khn.org/news/the-secret-to-chronic-happiness-as-you-age/ The Secret To Chronic Happiness As You Age (9/5/17)]&lt;br /&gt;
&lt;br /&gt;
'''Health Care Professionals As Patients'''&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/a-doctor-with-a-bad-knee-runs-into-one-size-fits-all-medicine/2016/12/02/d5ba55c0-a6a2-11e6-ba59-a7d93165c6d4_story.html?utm_term=.53c4ad6b9b20 A doctor with a bad knee. &amp;quot;It took me three months of physical torture before I diagnosed my problem: I was suffering from one-size-fits-all medicine.&amp;quot; (12/4/16)]&lt;br /&gt;
* [https://herecomesthesun927.com/ Young Oncology nurse turned cancer patient. &amp;quot;Dear every cancer patient I ever took care of, I’m sorry. I didn’t get it.&amp;quot; (11/14/16)]&lt;br /&gt;
&lt;br /&gt;
'''Health Literacy'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/necessary-reminder-health-literacy.html 65-year-old publicly-insured male doesn't understand procedure prep instructions causing him to reschedule and begin the process again. (8/21/16)]&lt;br /&gt;
&lt;br /&gt;
'''High-Deductible Health Plans'''&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/with-a-high-deductible-even-a-doctor-can-shortchange-his-health/2017/02/07/3c975fd2-ed79-11e6-9973-c5efb7ccfb0d_story.html?utm_term=.ea2b8a005245 With A High Deductible, Even A Doctor Can Shortchange His Health (2/7/17)]&lt;br /&gt;
&lt;br /&gt;
'''High-Need, High-Cost Patients'''&lt;br /&gt;
* [http://khn.org/news/emergency-room-frequent-flyers/ Forty-year-old Jeremie Seals] was assigned a care manager and a regular physician that helped reduced his 15 ER visits and 11 hospitals stays to 4 ER visits and 4 hospitals stays the following year. (7/10/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/03/patient-reflection-healthcare-system.html Virginia Hunt's] story illustrates the effectiveness and ineffectiveness of our healthcare system that addresses conditions and often lacks capability to treat the overall patient. (3/3/13)&lt;br /&gt;
* [http://www.pbs.org/remakingamericanmedicine/bryson.html Rebecca Bryson] has 10 different medical conditions and depends on 13 health care providers. Her life improved when a program funded a Clinical Care Specialist and the creation of a Shared Care Plan. (2006)&lt;br /&gt;
&lt;br /&gt;
'''Incrementalism in Managing Health'''&lt;br /&gt;
* [http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care Bill Haynes was fifty-seven years old, and he suffered from severe migraines for almost four decades. How an incremental approach improved his life from physician author Atul Gawande. (1/23/17)]  &lt;br /&gt;
&lt;br /&gt;
'''Living Conditions'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/can-patients-get-better-live-homes-tailor-made-disease.html How can patients get better if they live in homes tailor-made for disease? (9/17/16)]&lt;br /&gt;
&lt;br /&gt;
'''Living With Cancer''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/06/lets-stop-calling-cancer-war.html Mary had recurrent ovarian cancer struggled to come to terms with living with cancer that treatments were keeping in check rather than focusing on beating it. (6/8/17)]&lt;br /&gt;
&lt;br /&gt;
'''Living With Chronic Pain'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/mother-isnt-drug-seeking-patient-shes-pain.html 49-year-old women engineer for an aeronautics lab developed chronic pancreatitis from a rare birth defect and was treated as drug seeking addict when she needed medication to manage her pain (3/15/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/12/day-life-chronic-illness.html Toni Bernhard was a law professor. She shared what it is like living one day with chronic pain (12/17/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/subtle-arrogance-good-health.html Angelika Byczkowski was a hard working, high achiever in her 40's had to redefine what is important in her 50's when overcome by pain and diagnosed with Ehlers-Danlos syndrome (9/4/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/07/live-life-pain-plays-constant-role.html The frustrations of 70 year old woman going from a vibrant lifestyle to be consumed by pain with no solutions other than suffering and addicting opioids. (7/3/16)]&lt;br /&gt;
&lt;br /&gt;
'''Medical Decisions - Quality of Life vs. Aggressive Interventions'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/09/cost-benefit-analysis-case-conservative-management-wins.html 70-year-old male with deteriorating congestive heart failure. Costly, aggressive route, could have caused more harm than good, comprising quality of life. (9/20/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/06/cured-result-unacceptable.html Vibrant 68-year-old woman from Haiti. She was always impeccably dressed, loved to talk, and had an incredibly infectious laugh. While the condition was cured, she was not. (6/6/16)] &lt;br /&gt;
&lt;br /&gt;
'''Medical Debt'''&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/08/10/542589232/widowed-early-a-cancer-doctor-writes-about-the-harm-of-medical-debt Widowed Early, A Cancer Doctor Writes About The Harm Of Medical Debt (8/10/17)]&lt;br /&gt;
&lt;br /&gt;
'''Loneliness''' &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/01/01/506724900/easing-old-peoples-loneliness-can-help-keep-them-healthy Emil Girardi is 83-year-old was active until he didn't want to leave his home after a stroke. (1/1/17)]&lt;br /&gt;
&lt;br /&gt;
'''Mental Health Treatment''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/05/31/were-failing-adolescents-and-families-coping-with-behavioral-health-issues/ 16-year-old Joe's mom Amy, struggles to get services for her son (5/31/16)]&lt;br /&gt;
* [http://khn.org/news/saving-amanda-one-familys-struggle-to-deal-with-a-daughters-mental-illness/ Pam and Doug struggle to find care for their young daughter Amanda who is eventually diagnosed with bipolar. Finding available psychiatrist, psychiatric  hospital beds and programs were difficult. (3/14/16).]&lt;br /&gt;
&lt;br /&gt;
'''Opioid Addiction''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert/ A Long And Winding Road of Kicking Heroin In An Opioid ‘Treatment Desert’ (8/11/17)]&lt;br /&gt;
* [https://www.statnews.com/2017/03/16/opioid-overdose-west-virginia-taylor-wilson/ Taylor Wilson’s parents fought for 41 days to get their daughter treatment. They couldn’t stop another overdose (3/16/17)]&lt;br /&gt;
&lt;br /&gt;
'''Paying For High Cost Treatments''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/tackling-the-financial-toll-of-cancer-one-patient-at-a-time/2016/04/09/c8a85dd8-fb16-11e5-9140-e61d062438bb_story.html Scott Steiner is 46-year-old father of six kids that had to struggle to afford high cost cancer treatments. (4/9/16)]  &lt;br /&gt;
&lt;br /&gt;
'''Paying For Medicine''' &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/many-copd-patients-struggle-to-pay-for-each-medicinal-breath/amp/ After a lifetime of smoking, 67-year-old Juanita Milton needs help breathing. She’s tethered to an oxygen tank 24/7 and uses two drug inhalers a day, including Spiriva, which she called “the really expensive one.” (6/5/17)]&lt;br /&gt;
&lt;br /&gt;
'''Patient Dialog'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/new-generation-physicians-will-reconcile-patient-provider-relationship.html 60 year old Sally should not have had to go to the emergency department for severe gastrointestinal pain if she and her physician communicated better. (3/25/17)]&lt;br /&gt;
&lt;br /&gt;
'''Patient Goals'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/10/didnt-save-life-saved-lifestyle.html Jack was as a leader in trademark licensing for UCLA. He had been playing golf and running a business prior to admission. His doctor was determined to focus on Jack's quality of life. (10/26/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/08/patients-become-people-through-the-social-history.html Patients become people through their social history (8/26/15)]&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/how-i-discovered-an-important-question-a-doctor-should-ask-a-patient/2015/03/09/ca350634-bb9c-11e4-bdfa-b8e8f594e6ee_story.html A doctor discovers an important question patients should be asked. “What are their goals?” (3/9/15)]&lt;br /&gt;
&lt;br /&gt;
'''Primary Care Physicians - Managing Health'''&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/03/primary-care-importance-doctor.html Patient went to Urgent Care rather than Primary Care Physician that knows her, costing almost $10,000 that was unnecessary (3/14/14)]&lt;br /&gt;
&lt;br /&gt;
'''Social Concerns'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/dilemmas-faced-chronically-ill.html Toni Bernhard was a law professor. Now she wonders what to share and how to act on how she feels. (8/8/16)]&lt;br /&gt;
&lt;br /&gt;
'''Shared Decision Making'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/10/patients-often-victims-medication-creep.html Martha recently retired after 40 years as a business consultant. She has received care from many providers. Her primary care physicians discovers she is on 5 blood pressure medications. (10/24/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/10/evidence-not-used-enforce-mandates.html It is a good thing the patient did not accept evidence-based recommendations after ovarian cancer treatments. It may have saved her life. (10/5/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/03/shared-decision-making-still-exception-not-rule.html Joe is a healthy 85-year-old on just one medicine. His doctors office ordered an unnecessary medicine without a discussion. (3/25/16)]&lt;br /&gt;
&lt;br /&gt;
'''Stress Of Monitoring After Cancer Treatments'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/12/please-dear-doctor-give-results-life-hold.html 40 some year old woman with metastatic breast cancer requires scan every three months. She describes the stress the day before, the scan experience and the days of waiting for the results. (12/8/16)]&lt;br /&gt;
&lt;br /&gt;
'''Support System Beyond Spouse and Family'''&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/11/patients-without-partners-doctors-stereotype-us.html It was assumed a healthy 64 year old single woman living alone would be unable to handle the treatment most likely to keep her alive. (11/21/16)]&lt;br /&gt;
&lt;br /&gt;
'''Videos - In Their Own Words'''&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/jun/high-need-patients-personas-videos Annie is living with major chronic conditions, including Type 2 Diabetes, COPD, congestive heart failure, and high blood pressure. She often feels limited in what she can yet avoids asking for help for fear of burdening her family. (6/15/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/jun/high-need-patients-personas-videos Joshua has cerebral palsy and shares a number of the challenges faced by other high-need patients who are under age 65 and living with a disability. Joshua relies on aides for assistance with daily living, yet his parents must miss work to help when the aide is out sick. (6/15/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/jun/high-need-patients-personas-videos A frail elder, Jeanne is over age 65 and has functional limitations that cause major difficulty performing tasks such as preparing meals or getting across the room. Jeanne reflects on her loss of control over her own life because of her health conditions (6/15/17)]&lt;br /&gt;
'''Widespread Hype Gives False Hope To Many Cancer Patients'''&lt;br /&gt;
* [http://khn.org/news/widespread-hype-gives-false-hope-to-many-cancer-patients/amp/ For Michael Uvanni, hope gave way to crushing disappointment when his brother Jim’s health declined and he died from metastatic melanoma in 2014. (4/27/17)]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Insight</id>
		<title>Health Insight</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Insight"/>
				<updated>2019-07-16T21:15:19Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Adverse Behaviors Insight */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday there is new insight into our understanding of [[Health Determinants]] and [[barriers]] that impact patient outcomes. This page will curate new insight. While health care is likely the most important determinant of health when a patient has an acute condition, studies show it represents only a part of an overall health outcomes:&lt;br /&gt;
&lt;br /&gt;
[[Health Determinants Insight]]&lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Mission (Health Goals) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Personal Goals Insight===&lt;br /&gt;
===Health Goals (Care Goals) Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Mission_.26_Care_Goals_Determinants Health Goals (Care Goals) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Advanced Directives &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/1-3-u-s-adults-have-completed-advance-directive-study-finds 2 out of 3 adults fail to complete an advance directive (7/6/17)]&lt;br /&gt;
* [http://www.cbsnews.com/news/being-prepared-for-the-final-days/ Being prepared for the final days (4/27/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/lack-advance-directives-leads-to-unwanted-care Lack of advance directives leads to unwanted care (11/2/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/national-healthcare-decisions-day-11-statistics-on-end-of-life-decision-making.html Only 20% of Americans have an advanced directive documenting their wishes for end-of-life medical care. (4/16/15)]&lt;br /&gt;
&lt;br /&gt;
Care Goals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/12/defining-patients-goals-care.html Defining the patient’s goals of care (12/11/13)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1113631#t=article Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)]&lt;br /&gt;
&lt;br /&gt;
End of Life Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/end-life-care-planning-fails-patients End-of-life care, planning fails patients (2/5/15)]&lt;br /&gt;
* [https://www.minnpost.com/second-opinion/2014/06/few-doctors-discuss-end-life-planning-heart-failure-patients-mayo-study-finds Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)]&lt;br /&gt;
* [http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx ''Dying in America'' - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)]&lt;br /&gt;
* [http://khn.org/news/too-many-people-die-in-hospital-instead-of-home-heres-why/ Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)]&lt;br /&gt;
&lt;br /&gt;
Health Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/28/what-outcomes-matter-to-patients-with-rheumatoid-arthritis/ What outcomes matter to patients with Rheumatoid Arthritis? (8/28/17)]&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Strategy (Health Plan) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) Insight===&lt;br /&gt;
====Medical Interventions Insight====&lt;br /&gt;
====Non-Medical Interventions Insight====&lt;br /&gt;
====Intervention Changes Insight====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures===&lt;br /&gt;
===Strategy - Impacting People Insight===&lt;br /&gt;
===Strategy - Impacting Realities Insight===&lt;br /&gt;
===Strategy - Impacting Activities Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Health Conditions ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Physical Conditions ''Insight''==== &lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Physical_Conditions_Determinants Physical Conditions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.cbsnews.com/news/more-u-s-kids-have-chronic-health-problems-study The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest (5/2/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/jan/analysis-of-death-rates-for-middle-aged-whites A lack of progress since 1999 against common illnesses such as heart disease, diabetes, and respiratory disease was largely responsible for higher-than-expected death rates for middle-aged (45–54) white adults in 2014. (1/29/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/07/study-on-aging/ Don’t judge a person on their chronological age; their biological age might be a lot older than you think, aging study says (7/7/15)]&lt;br /&gt;
&lt;br /&gt;
Arthritis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/stateline-states-asthma/ Nationwide, one in 10 children has asthma. (4/16/14)]&lt;br /&gt;
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Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/science/archive/2017/03/no-cancer-isnt-mostly-bad-luck/521049/ Scientists don't agree 66% of cancer is due to bad luck (3/28/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521219318/cancer-is-partly-caused-by-bad-luck-study-finds Study: Causes of cancer, 66% from random mutations during cell division (bad luck), about 29% from environment and remaining 5% due to heredity. (3/23/17)]&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-cancer-drop-20170105-story.html Death rate from cancer now 25% lower than it was 25 years ago, report says (1/5/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-brain-cancer-now-killing-more-children-than-leukemia.html CDC: Brain cancer now killing more children than leukemia (9/16/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cancer-overtakes-heart-disease-as-leading-cause-of-death-in-22-states-3-things-to-know.html Cancer overtakes heart disease as leading cause of death in 22 states (8/25/16)]&lt;br /&gt;
* [https://www.sciencedaily.com/releases/2015/01/150101142318.htm Study shows two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes, while the remaining third are due to environmental factors and inherited genes. (1/1/15)]&lt;br /&gt;
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Chronic Pain &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/4-things-to-know-about-the-rising-rates-of-chronic-pain-in-the-us.html Number of Americans in their 60s reporting chronic pain increased from 10% in 1998 to 37% in 2010. (3/16/17)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain Estimated 25.3 million adults (11.2%) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6%) experience severe levels of pain. (8/11/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/04/chronic-pain-effect-patients-families.html Chronic pain and the effect on patients’ families (4/17/14)]&lt;br /&gt;
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COPD &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/copd/index.html Chronic lower respiratory disease, primarily COPD, is the third leading cause of death in the United States (3/12/15)]&lt;br /&gt;
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Cystic Fibrosis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/03/13/cystic-fibrosis-canadians-americans/ Canadians with cystic fibrosis outlive Americans by a decade (3/13/17)]&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-more-deadly-than-previously-thought-researchers-say.html Diabetes causes 12 percent of deaths in the United States, making it the third-leading cause of death in the country, according to a new study (1/26/17)] &lt;br /&gt;
* [http://khn.org/news/health-claims-on-the-rise-for-kids-with-type-2-diabetes-obesity-related-conditions/amp/ Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions (1/2/17)]&lt;br /&gt;
* [http://khn.org/news/diabetes-linked-to-risk-of-mental-health-hospitalization-in-young-adults-study/amp/ Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease (7/22/16)]&lt;br /&gt;
* [http://khn.org/news/as-childhood-diabetes-rates-rise-so-do-costs-and-families-feel-the-pinch-study/amp/ Childhood diabetes rates are on the rise. The spent $2,173 per capita in out-of-pocket health care costs in 2014. Nearly five times higher than that of kids without the illness. (6/20/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/americans-diabetes-reach-21-million Americans with diabetes reach 21 million (4/15/14)]&lt;br /&gt;
* [http://www.latimes.com/science/la-sci-sn-diabetes-study-20150908-story.html About half of all Americans have either diabetes or pre-diabetes. (9/8/15)]&lt;br /&gt;
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Heart Attack Risk &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/depression-among-heart-attack-survivors-can-be-deadly-yet-is-often-ignored/ Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (7/20/17)]&lt;br /&gt;
* [http://www.wsj.com/articles/heart-attacks-are-linked-to-what-patients-were-doing-feeling-1477923373 Performing heavy physical activity in a highly emotional state sharply raised the risk of a heart attack. (10/31/16)]&lt;br /&gt;
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High Blood Pressure &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cdc.gov/bloodpressure/facts.htm About 70 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults. (6/16/16)]&lt;br /&gt;
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Life Expectancies &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/death-rates-for-americans-in-prime-years-rise-after-century-of-decline.html The death rate for Americans between the ages of 25 and 44 rose by 8% between 2010 and 2015 after a century of decline. (6/14/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair The mortality rate for white Americans, ages 45 to 54, increased by a half percent each year from 1999 to 2013, attributed to increase in suicide, drugs and alcohol. (3/23/17)]&lt;br /&gt;
Non-Communicable Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-diseases-that-kill-16m-people-cost-the-world-economy-2-35t-annually.html Five non-communicable diseases that kill 16 million people around the world each year, cost the world economy $2.35T annually. 1) Cardiovascular disease, 2) Mental illness, 3) Cancer, 4) Chronic respiratory disease, 5) Diabetes. (2/28/17)]&lt;br /&gt;
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Obesity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/30/506433671/the-wrong-eating-habits-can-hurt-your-brain-not-just-your-waistline Being overweight can raise your blood pressure, cholesterol and risk for developing diabetes. It could be bad for your brain, too. (12/30/16)]&lt;br /&gt;
* [http://www.onemednews.com/2016/12/18/nyt-obesity/ Researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, are many. (12/12/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2016/12/01/nearly-half-of-americas-overweight-people-dont-realize-theyre-overweight/?utm_term=.2963e8177870 Nearly half of America’s overweight people don’t realize they’re overweight (12/1/16)]&lt;br /&gt;
* [http://khn.org/news/another-reason-to-diet-experts-find-additional-evidence-of-obesity-cancer-link/amp/ Experts Find Additional Evidence Of Obesity-Cancer Link (8/24/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/obesity-rates-up-in-us-women-stable-in-men.html Obesity rates up in US women, stable in men. Obesity was 35 percent among men and 40 percent among women in 2013-14 (6/7/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html American obesity rate continues consistent trend upward in 2015 with estimated 30.4% of Americans over 20 years of age obese, more than a 10% increase from 1997 (5/26/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1923.abstract Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013 (11/2015)]&lt;br /&gt;
&lt;br /&gt;
Sepsis &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/sepsis-causes-more-readmissions-than-copd-heart-failure-heart-attack-and-pneumonia.html Sepsis causes more hospital readmissions than COPD, heart failure, heart attack and pneumonia. (1/23/17)]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Mental_Health_Conditions_Determinants Mental Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
Childhood Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/06/01/disruptive-behavior-disorders-children/ Childhood disruptive behavior disorders increases risk for substance use, violent behaviors, victimization, incarceration, and even premature death. An estimated 50 to 75% of youths who move through the juvenile justice system could be diagnosed with a mental health disorder. (6/1/17)]&lt;br /&gt;
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Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/who-depression-leading-cause-of-illness-disability-worldwide.html Depression is the leading cause of illness, disability worldwide according to the World Health Organization (3/31/17)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878#T1 The prevalence of major depressive episodes (MDEs) in adolescents (age 12-17) has increased from 13.1% for girls and 4.5% for boys in 2005 to 17.3% for girls and 5.7% for boys in 2014 (11/2016)]  &lt;br /&gt;
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Dementia &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/16/536935957/stress-and-poverty-may-explain-high-rates-of-dementia-in-african-americans Stress And Poverty May Explain High Rates Of Dementia In African-Americans (7/16/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-alzheimer-s-deaths-up-by-more-than-50.html In 1999, the rate of Alzheimer's deaths was 16.5 per 100,000 individuals. By 2014, this rate had increased to 25.4 deaths per 100,000, marking a 54.5% increase. (5/26/17)]&lt;br /&gt;
* [http://www.alz.org/documents_custom/2017-facts-and-figures.pdf Estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. By 2025, Alzheimer’s dementia is estimated to reach 7.1 million. By 2050, the number of people with Alzheimer’s dementia may nearly triple to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure Alzheimer’s disease. (3/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587084 Dementia prevalence among US adults 65 years or older declined significantly, from 11.6% in 2000 to 8.8% in 2012. (11/21/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/10-alzheimer-s-patients-had-preventable-hospital-stays One in 10 Alzheimer’s patients have preventable hospital stays (7/27/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/30/472295791/big-financial-costs-are-part-of-alzheimers-toll-on-families Big Financial Costs Are Part Of Alzheimer's Toll On Families (3/30/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2016/02/10/study-finds-dementia-rates-decline/80016390/ Rates of dementia dropped 44% from the late 1970s to the early 2010s. (2/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-dementia-drives-er-visits-admissions-and-mortality-rates How dementia drives ER visits, admissions and mortality rates (11/16/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1642.abstract Dementia has a disproportionate impact on family and unpaid caregiving to older adults] (10/2015)&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1637.abstract Adults with probable dementia received 171 hours of monthly informal care, versus 89 hours for cognitively impaired adults without dementia and 66 hours for cognitively normal adults 10/2015)]&lt;br /&gt;
&lt;br /&gt;
Emotions &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Mental Health Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1024.abstract Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. Innovative federal, state, and local programs have combined social services with mental health interventions to try addressing this. (6/2017)] &lt;br /&gt;
* [http://healthaffairs.org/blog/2016/07/25/patients-with-severe-schizophrenia-arent-getting-the-help-they-need/ Patients With Severe Schizophrenia Aren’t Getting The Help They Need (7/25/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/mind-and-mood/the-prevalence-and-treatment-of-mental-illness-today An estimated 26% of American adults live with a mental disorder in any given year, and 46% will have a mental disorder in their lifetime.] (11/2005)&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html 18% of adults in the U.S. have a mental, behavioral or emotional disorder. Most common are specific phobias (8.7%), such as those related to heights, spiders or flying, social phobia (6.8%) and major depression (6.6%) (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Impact on Health Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.businessinsurance.com/article/20170306/NEWS08/912312232/Detecting-mental-health-issues-can-cut-workers-comp-claims-costs Detecting mental health issues can cut workers comp claims costs. Hartford Financial Services Group analyzed its workers comp claim data from 2002 to 2015 and found that 10% of claims featured at least one psychosocial issue, and that those claims account for 60% of claims costs. (3/6/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/nov/behavioral-health-high-need-adults High-need adults—defined as those with three or more chronic conditions and a functional limitation—who have a diagnosed behavioral health condition among their multiple chronic conditions make greater use of some health care services than their counterparts without a behavioral health condition (11/22/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/36.abstract Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients (1/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/most-readmissions-aren-t-linked-to-suboptimal-care-study-finds.html A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness. (6/15/16)]&lt;br /&gt;
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Opioid Addiction &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/ Patients With Mental Disorders Get Half Of All Opioid Prescriptions (6/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/ahrq-report-us-hospitals-see-sharp-rise-in-opioid-related-inpatient-stays-ed-visits.html Between 2005 and 2014, opioid-related emergency department visits nearly doubled and opioid-related inpatient stays increased 64% (6/20/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/cdc-likelihood-of-opioid-addiction-spikes-after-a-few-days-of-use.html CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days (3/17/17)]&lt;br /&gt;
* [http://khn.org/news/study-health-spending-related-to-opioid-treatment-rose-more-than-1300-percent/amp/ Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent In Four Year Period (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/prior-authorization-a-hurdle-for-patients-overcoming-opioid-dependency Insurer rules a hurdle for patients overcoming opioid dependency (8/5/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/15/patient-centered-research-can-improve-chronic-pain-care-and-address-opioid-abuse/ Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse (5/15/15)]&lt;br /&gt;
&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf Americans reporting at least one symptom of stress over the past month rose from 71% in August 2016 to 80% in January 2017. This includes headache (34%), feeling overwhelmed (33%), feeling nervous or anxious (33%), or feeling depressed or sad (32%). (2/15/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/12/chronic-stress-heart-attacks-study.amp Emotional stress has long been considered a major risk factor for heart disease. A new study suggests that heightened activity in the amygdala (the brain's fear and stress region) is associated with a greater risk of heart disease and stroke. (1/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/09/27/494922257/chill-out-stress-can-override-benefits-of-healthy-eating Stress Can Override Benefits Of Healthful Eating (9/27/16)]&lt;br /&gt;
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Substance Use Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.technologyreview.com/s/603073/big-pharma-and-distracted-driving-are-killing-americans-early/amp/ Accidental poisoning increased 13%. 97% percent of accidental poisoning was from drug overdoses and alcohol (12/9/16)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin,methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
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Suicide &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/suicide-rates-for-teen-girls-hits-40-year-high.html Suicide rates for teen girls hits 40-year high (8/8/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-machine-learning-shows-promise-toward-accurately-identifying-suicidal-behavior Study found machine learning is 93% accurate in correctly identifying a suicidal person, and 85% accurate in determining differential diagnosis of mental illness (11/8/16)]&lt;br /&gt;
* [http://www.npr.org/sections/ed/2016/11/04/500659746/middle-school-suicides-reach-an-all-time-high Middle School Suicides Reach An All-Time High (11/4/16)]&lt;br /&gt;
&lt;br /&gt;
Treating Mental Health &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2016/05/13/hlthaff.2015.1659.abstract Mental Disorders top the list of the most costly conditions in the United States: $201 Billion] (5/2016)&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
* [http://hrsonline.isr.umich.edu/ Health and Retirement Study (HRS) surveys 20,000 people in America about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and health care expenditures. (3/2007)]&lt;br /&gt;
&lt;br /&gt;
Chronic Diesease &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/21/the-association-between-observed-mobility-and-quality-of-life-in-the-near-elderly/ Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life. (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Daily Activities Assistance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 6.9% of adults in 2015 over the age of 65 required assistance with personal care. (5/26/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/howardgleckman/2014/10/08/nearly-half-of-all-seniors-need-help-with-daily-activities-far-more-than-we-thought/ Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought] (10/8/14)&lt;br /&gt;
&lt;br /&gt;
Disabilities &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/4/626.abstract If all five risk factors were eliminated, 53% of disability could be prevented nationally if five risk factors were eliminated. The largest were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). (4/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/18/challenges-for-people-with-disabilities-within-the-health-care-safety-net/ Challenges For People With Disabilities Within The Health Care Safety Net. Nearly 57 million Americans had disabilities in 2010. (11/18/14)]&lt;br /&gt;
&lt;br /&gt;
Functional Independence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patients-functional-independence-may-predict-readmissions Patients' functional independence may predict readmissions (5/6/14)]&lt;br /&gt;
&lt;br /&gt;
Healthcare Costs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 The average healthcare cost for adults in the United States (2009-2011) was $4,845, for adults with 3 or more chronic conditions and no functional limitations was $7,526, for adults with 3 or more chronic conditions and functional limitation was $21,021 (8/29/16)]&lt;br /&gt;
&lt;br /&gt;
Homebound &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/26010119 An estimated 1.9 million U.S. adults age 65 or older are completely or mostly homebound, while another 5.3 million have functional limitations that make it hard to  leave their homes. (7/2015)]&lt;br /&gt;
* Homebound - [http://content.healthaffairs.org/content/34/1/21.abstract Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care.] (1/2015)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/q-and-a/2015/jan/invisible-homebound Treating the “Invisible Homebound”: Setting Standards for Health Care Provided at Home (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
Impairments &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. 44% of people with arthritis report activity limitations of everyday tasks, such as walking or lifting bags. (3/7/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/09/hearing-loss-linked-to-increased-risk-of-death/ Adults ages 70 years or older with moderate or more severe hearing impairment have a 54% increased risk of all causes of death (9/25/15)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Usual Activities&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 39.7 million persons (12%) were limited in their usual activities due to one or more chronic health conditions (12/2013)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/books/NBK92521/ About 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis limiting their functional status and adversely impacting their quality of life. The total financial cost of pain to society (health care and productivity estimates) ranges from $560 to $635 billion (2011 Study)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Work&lt;br /&gt;
* [https://www.theatlantic.com/business/archive/2017/03/mortality-of-american-men-and-the-labor-force/520329/ 43% of men in America ages 25 to 54 who are out of the labor force report their health as fair or poor, compared with 12% of employed men and 16% of unemployed men. (3/22/17)]&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 13.8 million adults aged 18–69 (6%) were unable to work due to health problems, and 6.7 million (3%) were limited in the kind or amount of work they could do because of their health (12/2013)]&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Genomic_Profiles_Determinants Genomic Profiles Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [https://www.ted.com/talks/moshe_szyf_how_early_life_experience_is_written_into_dna Epigenetics research suggests living things reprogram their genome in response to social factors like stress and lack of food. The biochemical signals passed from mothers to offspring tell the child what kind of world they're going to live in, changing the expression of genes. (7/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877678/ Scientists believe most, if not all, diseases arise from interactions between the genome, the epigenome (controls gene expression), and the environment (broadly defined to include social, behavioral, and physical agents). (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====High Need, High Cost Patients ''Insight''====&lt;br /&gt;
High-Need, High-Cost Patients &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-superusers-pennsylvania-ring-up-1-25b-tab-0 Superusers represent 3% of hospitalized patients in Pennsylvania consumed $1.25 billion in health care costs. (6/21/17)]&lt;br /&gt;
* [https://www.theatlantic.com/theplatinumpatients/ Each year, 1 in every 20 Americans racks up just as much in medical bills as another 19 combined. (6/15/17)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% did not have good access to services that could help them manage their daily living activities. 58% did not have good access to an informed and up-to-date care coordinator. (12/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 1.2% of employees are high cost claimants who comprise 31% of total health care spending according to a report on 26 large employers. (9/15/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1608511 Caring for High-Need, High-Cost Patients — An Urgent Priority (9/8/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps2 Health care spending for high-need adults exceeded $21,000 per person, nearly three times the average for adults with multiple chronic diseases only ($7,526) and more than four times that of all adults ($4,845). (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/aug/high-need-high-cost-meps Report Profiles The 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs (8/25/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/jun/listening-to-those-living-with-chronic-conditions Top concerns of high-need patients include: Paying for Care, Accessing Care, Insurance Frustrations,  Technology Can Be Helpful, Getting Help at Home (6/16/16)]  &lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2015/dec/primary-care-physicians-in-ten-countries Nearly 25% of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84% say they are not well prepared to manage patients with serious mental illness (12/7/15)]&lt;br /&gt;
* [http://features.commonwealthfund.org/improving-care-for-those-who-need-it-most Researchers are focusing on high-need, high-cost patients—both because they need the most help and because they have the biggest impact on national health spending. 5 percent of the U.S. population accounts for 50 percent of the nation’s health care costs. (11/11/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/8/1312.abstract?=right For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary. Only 28% of super-utilizers remained on top of the list at the end of a year. (8/2015)]&lt;br /&gt;
* [https://hcttf.org/wp-content/uploads/2018/01/WhitePaper-ProactivelyIdentifyingtheHighCostPopulation.pdf Proactively	Identifying the	High Cost Population - White Paper Insights from Health Care Transforamtion Task Force 5/14/15)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1315568?query=TOC&amp;amp; Hospital-dependent patient's medical problems cannot be managed outside the hospital. (2/20/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/challenge-frequent-fliers-20-er-visits-per-year-progress/ The challenge of frequent fliers: 20 ER visits per year is progress (11/11/13)]&lt;br /&gt;
* [http://khn.org/news/one-percent-of-costliest-patients/ Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending (10/7/13)]&lt;br /&gt;
* [http://berkeleyhealthcareforum.berkeley.edu/report/executive-summary/ 53% of California's healthcare expenditures are spent by just 5% of the population (2/2013)]&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Competencies_Determinants Competencies Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Literacy_Determinants Health Literacy Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.georgiahealthnews.com/2016/10/health-literacy-life-or-death-matter/ Health literacy can be a life-or-death matter. 1 out of 3 adult Georgians is functionally illiterate. Without a clear understanding of their health condition, these adults are more likely to skip necessary medical tests and have a harder time with diabetes management or high blood pressure numbers. (10/31/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/guide-surviving-chronic-disease.html A guide to surviving chronic disease (8/3/16)]&lt;br /&gt;
* Education - A [http://www.reuters.com/article/2013/06/26/us-cancer-cure-idUSBRE95P15320130626 survey] of patients with terminal lung cancer found nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. (6/26/13)&lt;br /&gt;
* [http://www.imedicalapps.com/2014/09/knee-guide-app-educates-engages-patients-total-knee-arthroplasty-care/ My Knee Guide App Educates and Engages Patients in Total Knee Arthroplasty Care (9/25/14)]&lt;br /&gt;
* [http://medcitynews.com/2015/05/video-replay-patient-education/ Surgeon entrepreneur develops video replay for specialist appointments to boost patient education (5/28/15)]&lt;br /&gt;
* [https://health.gov/communication/literacy/issuebrief/ 77 Million Adults Have Basic or Below Basic Health Literacy (2003)]&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Education &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/07/patients-need-education-role-care.html Patients need education about their role in care (7/3/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 39% patients admit they’re only somewhat knowledgeable, at best, about how to effectively manage their chronic condition. (7/2017)] from [http://www.jonespr.net/strengthening-chronic-care-download West] Study.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-addressing-alzheimer-s-risk-factors-could-lead-to-medicare-medicaid-savings.html Preventing and effectively managing obesity, diabetes, hypertension and cardiovascular disease can reduce onset and duration of dementia and reduce healthcare costs. (4/11/14)]&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/12/536519077/took-the-wrong-medicine-by-mistake-study-finds-such-errors-are-on-the-rise More People Are Making Mistakes With Medicines At Home (7/12/17)]&lt;br /&gt;
* [http://www.reuters.com/article/us-medication-errors-health-literacy-idUSKBN0FN1SK20140718 More than half of heart patients made mistakes taking their medications or misunderstood instructions (7/18/14)]&lt;br /&gt;
* [http://www.bbc.com/news/health-30556329 Only 7% of asthma sufferers were found to use asthma inhalers in the right way (12/20/14)]&lt;br /&gt;
&lt;br /&gt;
Physician Office Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/can-help-doctor-diagnose.html How a patient can help their physician diagnose them. 3/19/17)]&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Functional Competencies Determinants] that can decisively affect a patient's overall health and well-being. &lt;br /&gt;
&lt;br /&gt;
Literacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.kevinmd.com/blog/2017/08/literacy-health-care-problem-no-one-talks.html It is estimated that there are 23 million adults in the U.S. with limited literacy, defined as below basic literacy or non-literate. (8/18/17)]&lt;br /&gt;
&lt;br /&gt;
====Education ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Education_Determinants Education Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Social ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Patient_.28About_.26_History.29_Determinants Patient (About &amp;amp; History) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-death-rate-rises-for-first-time-in-decade-7-things-to-know.html American death rate rises for first time in decade. Rises in death rates from: Alzheimer's disease, heart diseases, suicide and unintentional injuries (auto accidents and drug overdoses) (6/1/16)]&lt;br /&gt;
* [http://www.pnas.org/content/112/49/15078.full.pdf Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (9/17/15)]&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Events_Determinants Adverse Events Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Adverse Childhood Events (ACEs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/09/29/444451363/childhood-stress-may-prime-pump-for-chronic-disease-later Childhood Stress May Prime Pump For Chronic Disease Later (9/29/15)]&lt;br /&gt;
* [http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime How childhood trauma affects health across a lifetime (9/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/12/2106.abstract Adverse Childhood Events (ACEs) on attributed to higher rates of chronic disease among children (12/2014)]&lt;br /&gt;
&lt;br /&gt;
Elder Abuse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf A study found an elder abuse incidence rate in New York State was nearly 24 times greater than the number of cases referred to social service, law enforcement or legal authorities. (see Page 2) (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Beliefs_Determinants Beliefs Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/aug/improving-population-health-management Patients who don't feel they can manage their health or navigate the health care system are more likely to develop a chronic disease over a three-year period than “activated” patients with good self-management skills. Low patient-activation levels are linked to significantly more hospitalizations and emergency department (ED) use. (8/23/16)]&lt;br /&gt;
&lt;br /&gt;
====Determination ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Determination_Determinants Determination Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Insight''====&lt;br /&gt;
* See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight People]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Resilience_Determinants_-_.28Psychological_Fitness.29 Resilience Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Optimism &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/07/504709736/a-brighter-outlook-could-translate-to-a-longer-life A Brighter Outlook Could Translate To A Longer Life (12/7/16)]&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/490841/ Psychological resilience plays a role in the molecular impact of traumatic experiences. Promoting resilience may have benefits for physical and mental health (7/12/16)]&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2015/10/stressful-jobs-makes-life-shorter/412951/ Study: Stressful Jobs Make Life Shorter. Researchers found that unhealthy workplaces can affect mortality. (10/29/15)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/10/how-stress-makes-you-sick/412699/ How Stress Makes You Sick. Feeling overwhelmed affects everything from digestion to stroke risk. (10/28/15)]&lt;br /&gt;
* [http://www.nature.com/news/bacteria-implicated-in-stress-related-heart-attacks-1.15396 Emotional or physical stress can trigger heart attacks may now have a scientific explanation (6/10/14)]&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Responsibilities_Determinants Responsibilities Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://mobile.reuters.com/article/idUSKCN0VO21Q Family caregivers may be sacrificing their own health to help loved ones (2/15/16)]&lt;br /&gt;
* [http://www.mhealthtalk.com/a-guide-for-the-older-caregiver/?utm_source=rss&amp;amp;utm_medium=rss&amp;amp;utm_campaign=a-guide-for-the-older-caregiver A caregiving spouse who is between the ages of 66 and 96 and under excessive mental or emotional strain has a 63% greater risk of dying compared to those who are not tasked with caregiving. (1/17/14)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282240/ Quality of life: impact of chronic illness on the partner (11/2001)]&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Well-Being_Determinants Social Well-Being Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Defining Well-Being &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2330497 Most medical research focuses on disease rather than wellness. The diverse and interconnected dimensions of physical, emotional and social well-being. It includes achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. (7/14/15)]&lt;br /&gt;
* [http://voxeu.org/article/origins-happiness Depression and Anxiety explains the largest variance in life satisfaction. Study shows eliminating Depression and Anxiety would have 4 times the impact of eliminating poverty in improving life satisfaction. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Competence &amp;amp; Control &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/11/30/independence-its-what-older-people-want/ Independence—It’s What Older People Want (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Loneliness &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/08/07/loneliness-public-health/ Why Loneliness Is a Public Health Threat. People with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles. (8/7/17)] &lt;br /&gt;
* [http://khn.org/news/social-isolation-may-worsen-breast-cancer-prospects/amp/ Social Isolation May Worsen Breast Cancer Prospects. Women with fewer social ties — to friends, family, community and religious groups, as well as spouses or romantic partners — were 43% more likely to see their breast cancer return, 64% more likely to die from breast cancer and 69% more likely to die from any cause (12/13/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors) 37% felt socially isolated and lacked companionship compared to 15% of other adults. (12/9/12)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/loneliness-a-bigger-risk-factor-for-death-than-obesity.html Loneliness a bigger risk factor for death than obesity (9/6/16)]&lt;br /&gt;
* [http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=137534&amp;amp;WT.mc_id=USNSF_51&amp;amp;WT.mc_ev=click The profound power of loneliness can depression and other serious health problems (2/3/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/12/loneliness-social-isolation-and-health/418395/ How Loneliness Wears on the Body. New research supports the idea that social isolation is detrimental to physical health—and that companionship may improve it. (12/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems Loneliness May Warp Our Genes, And Our Immune Systems (11/29/15)]&lt;br /&gt;
* [http://time.com/3747784/loneliness-mortality/ Loneliness increases risk of death by 26%. Social isolation — or lacking social connection — and living alone were found to be even more devastating to a person’s health than feeling lonely, respectively increasing mortality risk by 29% and 32% (3/18/15)]&lt;br /&gt;
* [http://www.pnas.org/content/110/15/5797.full Social isolation and loneliness are associated with increased mortality (9/12/12)]&lt;br /&gt;
&lt;br /&gt;
Love &amp;amp; Connection &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2014/05/isolation-and-death/362063/ Stressful relationships might be significantly shortening your life, are you better off alone? (5/13/14)]&lt;br /&gt;
&lt;br /&gt;
Purpose &amp;amp; Meaning &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/soul-purpose-seniors-with-strong-reasons-to-live-often-live-stronger/ Soul Purpose: Seniors With Strong Reasons To Live Often Live Stronger (8/31/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/28/479751942/could-thinking-positively-about-aging-be-the-secret-of-health People with a sense of purpose and having positive view about aging in late middle age lived about 7 and half years longer than the people who saw aging in a negative light. (5/28/16)]&lt;br /&gt;
&lt;br /&gt;
Social Influence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.time.com/time/health/article/0,8599,1646997,00.html If a friend is obese, there is a 57% greater chance of becoming obese. (7/25/07)]&lt;br /&gt;
&lt;br /&gt;
Social Via Smartphones &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/08/07/542016165/how-smartphones-are-making-kids-unhappy How Smartphones Are Making Kids Unhappy. Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. (8/7/17)]&lt;br /&gt;
&lt;br /&gt;
====Support ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Determinants Support Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Asking For Help &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/alone-and-aging-creating-a-safety-net-for-isolated-seniors/amp/ A growing number of seniors who find themselves alone just when aging and end-of-life care becomes real. They don’t know how to approach a casual acquaintance to ask for help when they need it most. (11/28/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/population-health-means-asking-about-basic-needs-are-your-providers-ready-for-that.html Population Health Means Asking About Basic Needs: Are Your Providers Ready for That? (11/20/13)]&lt;br /&gt;
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Addressing Social Determinants&lt;br /&gt;
* [http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/ Improving population health will require broader approaches that address social, economic, and environmental factors that influence health. (11/4/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/21/with-the-aca-secure-its-time-to-focus-on-social-determinants/ Literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral, and environmental factors. It’s Time To Focus On Social Determinants. (7/21/15)] &lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/05/why-its-time-to-improve-the-social-determinants-of-health.html Why it’s time to improve the social determinants of health (5/1/15)]&lt;br /&gt;
* [https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf Going Beyond Clinical Walls to address the other 80% of determinants that are often challenging to address in clinical visits. (10/2014)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/may/addressing-patients-social-needs Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment (5/29/14)]&lt;br /&gt;
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Managing Chronic Conditions &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 70 percent of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease. (7/2017)]&lt;br /&gt;
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Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://morningconsult.com/opinions/importance-nonemergency-medical-transportation-vulnerable-patients/ The Importance of Nonemergency Medical Transportation for Vulnerable Patients. One patient has to take two bus rides and walk a mile just to get herself and two young children to the doctor. (1/25/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/antifraud/fierce-exclusive-beneath-patient-transportation-arrangements-a-subtle-layer-fraud Unreliable or inaccessible transportation has emerged as a significant patient care issue. Legal experts say healthcare systems providing rides to patients raises concerns that they could be violating the Anti-Kickback Statute or providing a beneficiary inducement. (8/31/16)]&lt;br /&gt;
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===Socioeconomic ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Socioeconomic_Determinants Socioeconomic Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
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*[https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/ If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. (8/17/17)]&lt;br /&gt;
====Can't Afford Treatments ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Can.27t_Afford_Treatments_Determinants Can't Afford Treatments Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Delay Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-half-of-millennials-have-delayed-medical-care-because-of-cost.html Half of millennials have delayed medical care because of cost (1/1/16)]&lt;br /&gt;
* [http://www.gallup.com/poll/187190/cost-delays-healthcare-one-three.aspx 31% Americans say that they or a family member have put off any sort of medical treatment in the past year because of the cost (11/30/15)]&lt;br /&gt;
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Reduce Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-half-of-aca-exchange-customers-skimp-on-healthcare-to-reduce-costs.html Half of ACA exchange customers skimp on healthcare to reduce costs (10/28/16)]&lt;br /&gt;
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Skip Medical Care &amp;lt;Br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-1-in-3-older-millennials-skips-medical-care-because-of-costs.html Survey: 1 in 3 older millennials skips medical care because of costs (6/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/nov/international-survey-release About one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. (11/16/16)]&lt;br /&gt;
* [http://archpedi.jamanetwork.com/article.aspx?articleid=1872780 Financial Barriers to Care Among Low-Income Children With Asthma (7/2014)]* [http://money.cnn.com/2013/04/26/news/economy/health-care-cost/ 80 million people (43% of America's working-age adults) didn't go to the doctor or access other medical services last year because of the cost (4/26/13)]&lt;br /&gt;
&lt;br /&gt;
====Financial ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Financial_Determinants Financial Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Annual Healthcare Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2016/05/24/annual-healthcare-cost-for-family-of-four-now-at-25826/#33aa77f75226 Healthcare Costs in 2016 for a Family of Four Will Be $25,826 (5/24/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2015/05/19/annual-healthcare-cost-for-family-of-four-now-at-24671/#29d013444dfb Annual Healthcare Cost For Family Of Four Now At $24,671 (5/19/15)]&lt;br /&gt;
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Fear of Healthcare Costs&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/53-of-americans-equate-unaffordable-medical-bills-to-being-diagnosed-with-a-serious-illness.html 53% of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness (3/21/17)]&lt;br /&gt;
* [http://www.healthpopuli.com/2017/02/08/health-care-worries-top-terrorism-far-americans-minds/ Health Care Worries Top Terrorism, By Far, In Americans’ Minds (2/8/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/healthcare-finances-a-source-of-fear-for-75-of-consumers.html Healthcare finances a source of fear for 75% of consumers (2/7/17)]&lt;br /&gt;
* [http://www.businesswire.com/news/home/20141006006149/en/Cigna-Consumer-Survey-%E2%80%98Health-Costs-Derail-Financial#.VDg8PvldXng 75% fear health costs could ruin prospects for secure retirement (10/6/14)]&lt;br /&gt;
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Financial Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthpopuli.com/2017/04/26/financial-stress-health-risk-factor-impacts-americans/ Financial Stress As A Health Risk Factor Impacts More Americans (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% of high-need said they experience stress about their ability to afford housing, utilities or nutritious meals compared to 32% of other adults. (12/9/16)]  &lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-bills-lead-to-serious-debt-for-some-americans-6-things-to-know.html 85% of employees in survey in 2015 reported at least some level of financial stress. 33% were assessed as having serious debt, such as student debt, medical bills and/or credit card debt. (7/20/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/federal-reserve-board-47-of-americans-struggle-to-pay-unexpected-400-bill.html  47% of Americans struggle to pay unexpected $400 bill (6/8/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/54.abstract For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships (1/2016)]&lt;br /&gt;
* [http://www.pwc.com/us/en/private-company-services/publications/financial-well-being-retirement-survey.html Survey shows 52% of employees stressed about their finances. 45% saying that financial matters cause the most stress, nearly as many as stress from job, health, or relationships combined. (2016 Employee Financial Wellness Survey)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/more-americans-struggle-healthcare-costs 46% of Americas described paying for care as a hardship rather than affordable (12/19/14)]&lt;br /&gt;
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Health Inequality &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2017/06/05/america-is-a-world-leader-in-health-inequality/?utm_term=.7c7983e42f5c People in households making less than $22,500 a year, 38% reported being in poor or fair health. That's more than three times the rate of health troubles faced by individuals in households making more than $47,700 a year. (6/5/17)]&lt;br /&gt;
* [http://www.hhnmag.com/articles/7416-look-to-income-inequality-to-help-explain-population-health Having less money is linked to poorer health regardless of personal habits. (7/5/16)]&lt;br /&gt;
* [https://www.brookings.edu/research/what-growing-life-expectancy-gaps-mean-for-the-promise-of-social-security/ Life expectancy is higher for the wealthiest. Among American men born in 1940, the wealthiest 10% are expected to live on average 12 years longer than the poorest 10%. (2/12/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/costs-deter-low-income-patients-from-participating-in-clinical-trials.html Costs deter low-income patients from participating in clinical trials (11/3/15)]&lt;br /&gt;
* [http://www.nytimes.com/2014/04/06/health/even-small-medical-advances-can-mean-big-jumps-in-bills.html?from=homepage&amp;amp;_r=0 New innovative treatments and technology is often out of the reach of low income patients. (4/5/14)]&lt;br /&gt;
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Medical Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/half-of-uninsured-people-face-problems-with-their-medical-bills-9-survey-findings.html Half of uninsured people face problems with their medical bills (8/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/61-of-patients-confused-by-medical-bills-survey-finds.html 61% of patients confused by medical bills, survey finds (7/14/16)]&lt;br /&gt;
* [http://www.cbsnews.com/news/cdc-one-in-five-americans-cant-pay-medical-bills/ CDC: One in five Americans can't pay medical bills (9/30/13)]&lt;br /&gt;
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Prescription Drugs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/sticker-shock-forces-thousands-of-cancer-patients-to-skip-drugs-skimp-on-treatment/amp/ Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (3/15/17)]&lt;br /&gt;
* [http://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/ Faced With Unaffordable Drug Prices, Tens Of Millions Buy Medicine Outside U.S. (12/20/16)]&lt;br /&gt;
&lt;br /&gt;
Price Shopping for Medical Services &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.marketwired.com/press-release/survey-finds-healthcare-providers-benefit-from-up-front-cost-estimates-yet-many-patients-nyse-tru-2192070.htm Survey found 43% said it was somewhat or very difficult to get information on costs, while another 21% of patients had never tried to get procedure cost information. (1/31/17)]&lt;br /&gt;
* [http://khn.org/news/consumer-choices-have-limited-impact-on-u-s-health-care-spending-study/ Less than 7% of total health care spending in 2011 was paid by consumers for “shoppable” services. (3/4/16)]&lt;br /&gt;
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====Food Insecurity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Food_Insecurity_Determinants Food Insecurity Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.hpoe.org/resources/ahahret-guides/3058 Social Determinants of Health Series: Food Insecurity(8/3/17)]&lt;br /&gt;
* [http://online.liebertpub.com/doi/abs/10.1089/pop.2015.0127 Study of food insecurity in patients with high rates of inpatient hospitalization (“super-utilizers”). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed. Using USDA definition of food insecurity, 30% were food insecure and 25% were marginally food secure. 40% responded that, in the past 30 days, they worried that their food would run out; 17.5% that they did not eat for a full day. 75% were unable to shop for food on their own and 58% were unable to prepare their own food. (12/1/16)]&lt;br /&gt;
* [http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html 42.2 million Americans lived in food insecure households in 2015 (29.1 million adults and 13.1 million children). (2016)]&lt;br /&gt;
* [http://pdf.aarpfoundation.org/i/455086-aarp-foundation-findings-on-nutrition-knowledge-and-food-insecurity-among-older-adults Nearly 9 million older adults in the United States experience food insecurity. (12/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1949.abstract Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1830.abstract Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. (11/2015)]&lt;br /&gt;
* [http://khn.org/news/in-sunlit-paradise-seniors-go-hungry/ In Sunlit Paradise, Seniors Go Hungry (5/26/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/03/food-insecurity-undiagnosed-medical-problem.html Food insecurity is an undiagnosed medical problem (3/6/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/1/116.abstract Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia (1/2014)]&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Insurance_Determinants Health Insurance Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [https://www.nytimes.com/2017/05/08/upshot/a-medicare-drug-incentive-that-leads-to-greater-hospitalizations.html For sicker Medicare beneficiaries, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits (5/8/17)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/09/16/494139538/studies-link-cancer-patients-survival-time-to-insurance-status Studies Link Cancer Patients' Survival Time To Insurance Status (9/16/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/958.abstract?=right Insurance is paying for more of the cost of treating mental health conditions (68%) but not for Substance Use Disorders (46%) (6/2016)]&lt;br /&gt;
* [http://khn.org/news/new-health-plans-offer-discounts-for-diabetes-care/ New health plans offer discounts and give gift cards to encourage patients to use diabetes care (11/17/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aca-health-plans-limit-access-to-specialists-7-findings.html ACA health plans limit access to specialists: 7 findings (10/28/15)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2015/09/21/insurance-healthy-behavior-key-reducing-cost-chronic-disease/72563266/ Study showed total cost for insured members with no chronic conditions was $3,024 a year ($2,204 out-of-pocket) and members with two or more chronic conditions was $11,940 a year ($3,500 out-of-pocket). (9/21/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/why-doctors-must-discuss-costly-treatment-before-patients-receive-bills Why doctors must discuss costly treatment before patients receive bills (10/18/13)]&lt;br /&gt;
&lt;br /&gt;
Denied Coverage &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/many-patients-chronic-illnesses-find-insurance-providers-deny-treatment-new-survey-says 'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says (8/16/17)]&lt;br /&gt;
Dual Eligible Patients (Qualify for Medicare and Medicaid) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://files.kff.org/attachment/Testimony-of-Gretchen-Jacobson-Ways-and-Means-Committee-Subcommittee-on-Health Low-income people on Medicare who receive assistance from Medicaid tend to have more chronic conditions, as well as cognitive and functional limitations, than others on Medicare: 61% vs. 33% need assistance with one or more activities of daily living, such as eating, bathing, and dressing; more than half, 58% vs. 29% have a mental condition or cognitive impairment; 37% vs. 27% have five or more chronic conditions; 18% vs 6% rate their health status as poor. (6/7/17)]&lt;br /&gt;
&lt;br /&gt;
Employer Sponsored Health Insurance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/interactives-and-data/maps-and-data/employer-health-insurance-premiums State-by-State Look at Employer Health Insurance Costs Finds Workers’ Premium Contributions and Deductibles Growing More Slowly But Eating Up Greater Share of Incomes (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/employer-family-plan-premiums-soar-above-18k-in-2016.html Employer family health plan premiums soar above $18k in 2016 (9/14/16)]&lt;br /&gt;
&lt;br /&gt;
High Deductable Health Plans (HDHPs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/10-things-to-know-about-2016-healthcare-consumer-payment-trends.html Consumers insured through high-deductible health plans increased from 10 million in 2010 to 75 million in 2016. The average deductible for individuals with employer-based coverage doubled from $735 in 2010 to $1,478 in 2016. Patient payments to providers increased 58% from 2013 to 2016. (6/13/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/cdc-nearly-40-of-us-adults-have-high-deductible-health-plans.html CDC: Nearly 40% of US adults have high-deductible health plans (6/7/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patients-with-chronic-illness-and-high-deductibles-more-likely-to-delay-care-study-finds.html Patients with chronic illness and high deductibles more likely to delay care, study finds. People with three or more chronic conditions were also nearly three times as likely to delay or avoid care as those without chronic conditions (25% compared to 9%) (11/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/given-the-choice-34-of-employees-choose-hdhps.html Given the choice, 34% of employees choose HDHPs (5/3/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly one-quarter of workers are enrolled in an High Deductable Health Plan, up from 4% in 2006. (2/4/16)]&lt;br /&gt;
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Medicaid &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://healthpayerintelligence.com/news/spike-in-late-stage-cancer-diagnosis-related-to-medicaid-cut Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut (7/5/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare Beneficiaries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/ Half of all Medicare beneficiaries had incomes below $26,200 in 2016 (4/21/17)]&lt;br /&gt;
Patient Out-of-Pocket Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medicare-cancer-patients-without-additional-coverage-hit-with-high-out-of-pocket-costs-4-things-to-know.html Medicare cancer patients without additional coverage hit with high out-of-pocket costs (11/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patient-payment-responsibility-spiked-13-in-2015.html Patient payment responsibility spiked 13% in 2015 (6/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/may/on-medicare-but-at-risk 16 percent of Medicare beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. (5/10/16)]&lt;br /&gt;
* [http://www.healthsystemtracker.org/insight/payments-for-cost-sharing-increasing-rapidly-over-time/?utm_campaign=KFF-2016-Peterson-Cost-Sharing-Analysis&amp;amp;utm_medium=email&amp;amp;_hsenc=p2ANqtz-_fzaJSkoJE-fetaUk0iwQOwPP__Fpq1BkKAV4WPcOHEuKp1Ww3jVG7Fl41gr19-i_hWcUPOy The average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. (4/12/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly half of workers are covered by an insurance plan with a general annual deductible of at least $1,000 for individual coverage. (2/4/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/high-out-pocket-expenses-narrow-insurance-networks-send-more-patients-to-ers High out-of-pocket expenses, narrow insurance networks send more patients to ERs (10/26/15)]&lt;br /&gt;
* [http://kff.org/report-section/ehbs-2015-summary-of-findings/ Workers with health insurance covered by their employers have an annual deductible amount for single coverage of $1,318. (9/22/15)]&lt;br /&gt;
&lt;br /&gt;
Surprise Out-of-Network Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/many-medicare-advantage-members-burned-by-out-of-network-bills.html Many Medicare Advantage members burned by out-of-network bills due to changes in network providers (11/28/16)]&lt;br /&gt;
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Uninsured &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/lists/2016/remaining-uninsured Why Do Millions of U.S. Adults Remain Uninsured? 1) The ACA excludes undocumented immigrants; 2) Nineteen states have not expanded Medicaid eligibility; 3) Many people still don’t know about the health insurance marketplaces; 4) Affordability is a concern; 5) Selecting a plan can be difficult: 6) Many aren’t getting the help they need. (10/21/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/federal-estimate-of-uninsured-falls-to-record-low-7-statistics.html Federal estimate of uninsured falls to record low 8.6% (9/7/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/who-are-the-remaining-uninsured Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? (8/18/16)]&lt;br /&gt;
* [http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf The percentage uninsured in 2015 was 10.5% (28.4 million) (5/2016)]&lt;br /&gt;
* [http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Uninsured nonelderly Americans in 2014 was 32 million. 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Over 5 in 10 of uninsured have family income below 200% of poverty. (10/5/15).]&lt;br /&gt;
&lt;br /&gt;
====Income &amp;amp; Work ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Income_.26_Work_Determinants Income &amp;amp; Work Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-working-night-shifts-furthers-health-disparities.html How working night shifts furthers health disparities (10/25/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3064755/work-smart/study-finds-work-life-balance-could-be-a-matter-of-life-and-death Study found that those who work in high-stress jobs with little control are more likely to die sooner than those who have more control over and balance in their work. (10/20/16)]&lt;br /&gt;
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* [http://healthcare-economist.com/2016/09/26/effect-of-job-loss-on-physical-and-mental-health/ Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results similar for mental health. (9/26/16)]&lt;br /&gt;
* [http://khn.org/news/low-income-patients-face-hurdles-to-care-at-public-hospital-in-miami/ Low-Income Patients Face Hurdles To Care At Public Hospital (8/28/14)]&lt;br /&gt;
* [http://www.nccp.org/topics/childpoverty.html More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level]&lt;br /&gt;
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Labor Force Participation &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2016-10-07/why-are-so-many-men-not-working-they-re-in-pain A large share of American men between the ages of 25 and 54 who aren’t in the labor force may suffer from serious health conditions that are “a barrier to work” and suffer physical pain, sadness, and stress in their daily lives. (10/7/16)]&lt;br /&gt;
Lack of Sick Leave &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.wbur.org/npr/484960907/hassle-of-being-a-patient-can-turn-into-a-crisis-without-sick-leave Hassle Of Being A Patient Can Turn Into A Crisis Without Sick Leave. Third of working Americans say their jobs don't offer paid sick days (7/11/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/3/520.abstract Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. 3.0 times more likely to forego medical care for themselves and 1.6 times more likely to forego care for family (3/2016)] &lt;br /&gt;
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Low Income Impact on Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/socioeconomic-hardships-hurt-dual-eligibles-health-outcomes Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid (4/2/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/03/screening-poverty-included-medical-curriculum.html Low socioeconomic status (SES) is a risk factor for a multitude of medical conditions including cardiovascular disease, respiratory disease, cancer, and mental illness. (3/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/employment-status-top-socioeconomic-factor-readmissions Employment status top socioeconomic factor in readmissions (12/11/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/08/29/exhibit-of-the-month-income-related-disparities-associated-with-negative-health-outcomes/ Income-Related Disparities Associated With Negative Health Outcomes (8/29/14)]&lt;br /&gt;
* [http://hin.com/Healthcare_Business_Weekly_Update/2014/06/06/data-dive-uncovers-socioeconomics-driving-er-visits-readmissions/ Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions (6/6/14)]&lt;br /&gt;
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Work environment &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/258.abstract?=right Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence (2/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1761.abstract Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups (10/2015)]&lt;br /&gt;
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====Legal ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Legal_Determinants Legal Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Jail Involved &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/05/499775644/helping-ex-inmates-stay-out-of-the-er-brings-multiple-benefits Early access to primary care for ex-inmates can bring down healthcare costs by keeping them out of the ER (12/5/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/443.abstract The Critical Link Between Health Care And Jails (3/2014)]&lt;br /&gt;
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===Environmental ''Insight''===&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Access &amp;amp; Logistics ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Access_.26_Logistics_Determinants Access &amp;amp; Logistics Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Disability &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.mentalhealthamerica.net/sites/default/files/Parity%20or%20Disparity%20Report%20FINAL.pdf There is only 1 mental health provider for every 790 individuals. One out of three adults with disability could not see a doctor because of costs. (2015)]&lt;br /&gt;
Rural or Remote Area &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/patients-lacking-pharmacy-access-likely-to-readmitted-to-hospital Patients in rural or remote communities with lack of access to a pharmacy may be more likely to end up back in the hospital (8/4/16)]&lt;br /&gt;
* [https://www.minnpost.com/health/2014/06/late-life-live-home-rural-seniors-need-food-socialization-support Late-in-life: To live at home, rural seniors need food, socialization, support (6/23/14)]&lt;br /&gt;
* [http://www.rand.org/pubs/research_reports/RR578.html Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care. (2015)]&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/ Transportation barriers to health care access are common, and greater for vulnerable populations. (12/2013)]&lt;br /&gt;
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====Communication ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Communication_Determinants Communication Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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====Community ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Community_Determinants Community Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://cdnfiles.americashealthrankings.org/SiteFiles/Reports/2015_Am_Health_Ranking.pdf America’s Health Rankings of Behaviors, Community &amp;amp; Environment, Policy, and Clinical Care determinants of health that directly influence health outcomes (2015 Edition)]&lt;br /&gt;
* [http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Apr/Community-Factors-and-Hospital-Readmission-Rates.aspx Community factors most strongly associated with lower hospital readmission rates include more general practitioners and fewer specialists per capita and the presence of high-quality nursing home care. (4/17/14)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html Time to Act: Investing in the Health of Our Children and Communities (1/13/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/29/3/503.long Children had a 20-60% higher likelihood of being obese or overweight if living in neighborhoods with unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers. (3/2010)]&lt;br /&gt;
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Clean Air &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html The surprising link between air pollution and Alzheimer’s disease (1/31/17)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/world/air-pollution-smog-who.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ More Than 9 in 10 People Breathe Bad Air, W.H.O. Study Says (9/28/16)]&lt;br /&gt;
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Clean Water &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/08/14/63-million-americans-exposed-unsafe-drinking-water/564278001/ 63 million Americans exposed to unsafe drinking water (8/14/17)]&lt;br /&gt;
* [http://www.reuters.com/investigates/special-report/usa-lead-testing/ Water testing for lead levels found almost 3,000 areas with poisoning rates far higher than in Flint Michigan. Yet many of these lead hotspots are receiving little attention or funding. (12/19/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/as-water-infrastructure-ages-cost-treating-infections-rise Researchers believe as much as $2 billion of healthcare costs each year is tied to the treatment of infections that lurk in water distribution systems. (9/19/16)]&lt;br /&gt;
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Community Related - Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1571 Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990–2013 (8/2017)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/05/08/u-s-life-expectancy-varies-by-more-than-20-years-from-county-to-county/ U.S. life expectancy varies by more than 20 years from county to county (5/8/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/tackling_life_expect.html A person born in Princeton, NJ can expect to live 87 years, his or her neighbor a dozen miles away in Trenton has a life expectancy of 73 years (11/9/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thetwo-way/2016/04/11/473749157/its-not-just-what-you-make-its-where-you-live-says-study-on-life-expectancy Life Expectancy Study: It's Not Just What You Make, It's Where You Live (4/11/16)]&lt;br /&gt;
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Countries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/when-it-comes-to-healthcare-u-s-once-again-ranks-last-quality-care-compared-to-other When it comes to healthcare, U.S. once again ranks last in quality care compared to other wealthy nations (7/14/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/global-study-700k-smartphone-users-shows-link-between-obesity-and-activity-inequality Global study of 700K smartphone users shows link between obesity and activity inequality within country (7/11/17)]&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.revealnews.org/blog/14-million-kids-could-be-exposed-to-toxic-pcbs-at-school/ 14 million US kids could be exposed to toxic PCBs at school (10/12/16)] &lt;br /&gt;
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Food Deserts &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0122 Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14 (8/2017)]&lt;br /&gt;
* [http://www.ers.usda.gov/amber-waves/2010-march/access-to-affordable,-nutritious-food-is-limited-in-%E2%80%9Cfood-deserts%E2%80%9D.aspx Some neighborhoods in US, mostly in low-income areas, have been dubbed “food deserts” because they don't have supermarkets or other food retailers that carry affordable and nutritious food. (3/1/2010)]&lt;br /&gt;
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Food Safety &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lead-detected-in-20-of-baby-food-samples-surprising-even-researchers/ Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers (6/15/17)]&lt;br /&gt;
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Low Income Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/999.abstract One’s neighborhood may drive or influence health disparities, which can be understood as disadvantages in health associated with one’s social, racial, economic, or physical environment, originate in childhood and persist across an individual’s life course. (6/2017)]&lt;br /&gt;
*[http://www.theatlantic.com/business/archive/2016/04/why-the-poor-die-young/477846/ A massive study of health and income found that smoking, obesity, and exercise are the most important determinants of longevity. Poor neighborhoods score worse in all of them. (4/12/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1383.abstract People who live in lower-income neighborhoods have a higher rate of diabetic lower-extremity amputations than those in more affluent areas (8/2014)]&lt;br /&gt;
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Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/06/13/well/live/noise-may-raise-blood-pressure-risk.html Noise May Raise Blood Pressure Risk based on a study of people who lived near Athens International Airport (6/13/17)]&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
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Walkable Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27218630 Higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012 (5/24/16)]&lt;br /&gt;
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====Home ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Home_Determinants Home Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.mhealthtalk.com/common-problems-solutions/ The most common problems as you age in your home. (8/7/16)]&lt;br /&gt;
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Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.miamiherald.com/opinion/op-ed/article113730634.html Affordable housing, quality healthcare can let seniors age in place (11/9/16)]&lt;br /&gt;
* [http://www.stltoday.com/lifestyles/health-med-fit/health/want-a-better-chance-to-stay-out-of-a-nursing/article_c1b66d15-7afd-5b85-8e95-d83cc13d8f16.html Want a better chance to stay out of a nursing home? Modify your home (11/6/16)]&lt;br /&gt;
* [http://www.nytimes.com/2015/06/23/health/at-home-many-seniors-are-imprisoned-by-their-independence.html?ref=health&amp;amp;_r=3 Many seniors living at home feel imprisoned by their independence] (6/19/15)&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2016/07/gas-leaks-mold-and-rats-millions-of-americans-live-in-hazardous-homes/492689/ Gas Leaks, Mold, and Rats: Millions of Americans Live in Hazardous Homes (7/25/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/01/important-lesson-personalized-patient-care.html Controlling environmental allergens can reduce sneezing and nasal congestion that trigger asthma (1/1/14)]&lt;br /&gt;
* [http://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet Scientists estimate that lung cancer deaths could be reduced by 2 to 4% by addressing the one in 15 homes the EPA believes has too much radon exposure]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/multi-faceted-home-ventilation-intervention-reduces-copd-readmissions-study-finds Multi-faceted home ventilation intervention reduces COPD readmissions, study finds (7/15/15)]&lt;br /&gt;
* [http://www.cdc.gov/nceh/lead/ At least 4 million households have children living in them that are being exposed to high levels of lead (1/29/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2009/07/improving-the-health-of-all-americans-through-safe-and-healthy-h.html Approximately 40% of the 6.7 million children with diagnosed asthma are believed to be attributable to residential exposures (7/2009)]&lt;br /&gt;
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Homelessness &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://academic.oup.com/jpubhealth/article-abstract/doi/10.1093/pubmed/fdx034/3074503/Lifetime-and-1-year-prevalence-of-homelessness-in?redirectedFrom=fulltext Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2% and 1.5%, respectively (3/18/17)]&lt;br /&gt;
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Home Injuries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commissiononhealth.org/PDF/e434bb61-64d3-4267-9dca-705b9d80ddaa/HousingFactSheetJun09.pdf An estimated 4 million emergency department visits and 70,000 hospital admissions were attributed to injuries at home. (6/2009)]&lt;br /&gt;
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Housing Instability &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/housing-instability-will-cost-healthcare-industry-111b-over-next-decade.html Housing instability will cost healthcare industry $111B over next decade (8/10/17)]&lt;br /&gt;
&lt;br /&gt;
Housing Quality &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.sciencedirect.com/science/article/pii/S1353829214001087 NYC heat-mortality rates are associated with poverty and poor housing quality. (11/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Security ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Security_Determinants Security Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
Neighborhood Violence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/chicagoans-rank-violence-as-top-concern-in-health-needs-assessment.html Injury and violence was ranked as top concerns among Chicago's South and West Side residents, along with diabetes, nutrition, physical activity and weight, substance abuse and tobacco use, according to a health needs survey. (6/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-link-between-neighborhood-violence-and-biological-stress-in-children.html Study finds link between neighborhood violence and biological stress in children (11/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Content_Determinants Digital Content &amp;amp; Technology Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Records_Determinants Medical Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [http://medcitynews.com/2014/01/trends-healthcare-giving-access-doctor-notes-can-stimulate-patient-engagement/ Giving access to doctor notes can stimulate patient engagement (1/6/14)]&lt;br /&gt;
* [https://www.healthit.gov/patients-families/blue-button/about-blue-button Medicare provides medical history on a mobile app (Blue Button) for patients and caregivers to share with doctors]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Determinants_Records Health Determinants Records] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Records_Determinants Health Interventions Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Outcomes_Records_Determinants Health Outcomes Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Technology_.26_Apps_Determinants Technology &amp;amp; Apps Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.chicagotribune.com/lifestyles/health/sc-devices-to-track-wandering-kids-with-autism-health-0517-20170508-story.html 96% of parents surveyed who said they were using an electronic tracking device for their child with autism claimed it improved their quality of life (5/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/may/mobile-health-and-patient-engagement-in-the-safety-net Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics (5/13/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Making and Condition Management&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/new-apps-aim-guide-men-through-treatment-symptom-management-prostate-cancer New apps aim to guide men through treatment, symptom management of prostate cancer (9/10/16)]&lt;br /&gt;
&lt;br /&gt;
Devices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-patients-often-misuse-wrist-blood-pressure-monitors-leading-inaccurate-readings Study finds patients often misuse wrist blood pressure monitors, leading to inaccurate readings (9/7/16)]&lt;br /&gt;
&lt;br /&gt;
Digital Health Apps &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.engadget.com/amp/2017/07/11/lumosity-does-not-improve-cognitive-skills/ Lumosity doesn’t actually improve your cognitive skills (7/11/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/internet-mobile-disease-interventions-seem-work-longterm-studies-are-lacking Internet, mobile disease interventions seem to work, but long term studies are lacking (9/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-health-apps-near-meaningless-for-low-income-patients-with-chronic-conditions.html Study: Health apps near meaningless for low-income patients with chronic conditions (7/20/16)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/03/rehab-app-shoulder-rotator-cuff/ Rehab App Aims to Improve Shoulder &amp;amp; Rotator Cuff Repair Rehabilitation (3/21/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/commonwealth-fund-reasonably-small-number-chronic-health-apps-are-useful Some 43 percent of iOS health apps and 27 percent of Android health apps are useful. (2/22/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/copd-management-apps/ 5 digital health tools that could improve COPD management (12/3/15)]&lt;br /&gt;
* [http://www.imedicalapps.com/2014/11/cardiosmart-explorer-great-tool-educating-patients-clinic/ CardioSmart Explorer is a great tool for educating patients with cardiac disease (11/21/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/oct/vision-digital-health-tech A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System (10/1/14)]&lt;br /&gt;
* A [http://mobihealthnews.com/23418/most-patients-want-their-doctors-to-prescribe-apps/ study] from Digitas Health found that 90 percent of chronic patients in the US would accept a mobile app prescription as opposed to only 66 percent willing to accept a prescription of medication. (7/1/13)&lt;br /&gt;
&lt;br /&gt;
Digital Health Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-technology-self-monitor-blood-glucose-levels-no-better-traditional-management JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/content/study-patients-are-more-compliant-alivecor-devices-traditional-event-monitors Patients are more compliant to  smartphone-connected heart monitor devices than traditional event monitors (5/5/16)]&lt;br /&gt;
* [http://journals.lww.com/neurologynow/Citation/2015/11040/Wearing_the_Detectives__Wristbands,_smartwatches,.23.aspx Wristbands, smartwatches, and other wearable devices allow for more real-time monitoring of seizures and other neurologic symptoms—and, possibly, more precise treatment. (8/2015)]&lt;br /&gt;
&lt;br /&gt;
Home Automation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/top-home-tech-for-seniors-infographic/ Top Home Tech for Seniors (7/28/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/home-automation-and-home-health-care/ Home automation and in-home care aid gives patients independence without sacrificing their health needs. (3/25/14)]&lt;br /&gt;
&lt;br /&gt;
Internet Access &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/a-growing-number-people-chronic-conditions-also-lack-internet-access A growing number of people with chronic conditions also lack internet access (6/9/17)]&lt;br /&gt;
* [http://www.huffingtonpost.com/jane-sarasohnkahn/broadband-connectivity-is_b_11059720.html Broadband Connectivity Is A Social Determinant Of Health (7/22/16)]&lt;br /&gt;
&lt;br /&gt;
Technology Efficacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/smart-pill-bottles-didn-t-improve-adherence-for-heart-attack-patients-but-researchers-say Smart pill bottles didn’t improve medication adherence for heart attack patients, but earlier intervention could help (6/26/17)]&lt;br /&gt;
&lt;br /&gt;
==Impacting People Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Physicians ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Disciplines_.26_Resources_Determinants Physician Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Primary Care Physicians &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/many-americans-don-t-have-a-primary-care-doctor Some 28% of U.S. men and 17% of women don’t have a personal doctor or healthcare provider, according to a government survey. (1/12/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Team Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_.26_Resources_Determinants Care Team &amp;amp; Resources Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
====Credentialed Care Specialists Insight====&lt;br /&gt;
Nurses &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/how-a-specialist-nurse-can-help-with-dementia/ How a Specialist Nurse can Help with Dementia (6/21/14)]&lt;br /&gt;
&lt;br /&gt;
====Credentialed Support Providers Insight====&lt;br /&gt;
&lt;br /&gt;
====Team-Based Approach====&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/04/526475132/to-bring-down-stubbornly-high-blood-pressure-it-helps-to-have-a-team To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team (5/4/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/team-based-care-can-have-negative-financial-impact-on-primary-care-in-ffs-environment.html Team-based care can have negative financial impact on primary care in FFS environment (8/10/16)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2016/06/15/the-team-sport-of-diagnosis-a-culture-shift-can-reduce-missed-diagnoses/ The Team Sport of Diagnosis: A Culture Shift Can Reduce Missed Diagnoses (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Insight''===&lt;br /&gt;
Caregiver &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170807.061390/full/ More than a million youngsters ages 8–18 are caregivers taking on challenging tasks to help a parent, grandparent, sibling, or other relative. (8/7//17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-70-percent-caregivers-say-tech-plays-no-role-or-minor-role-their-work Survey: 70 percent of caregivers say tech plays no role or a minor role in their work (6/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/new-pennsylvania-law-requires-hospitals-to-educate-caregivers-upon-patient-discharge.html  New Pennsylvania law requires hospitals to educate caregivers upon patient discharge (4/27/17)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family-caregiving-cost-survey-res-ltc.pdf Study: Many Caregivers Spend $7K Annually Out Of Pocket, which is 20% of their income (11/14/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3065403/the-future-of-work/the-hidden-caregiving-crisis-that-the-election-wont-solve The number of U.S. workers struggling to care for ill or aging loved ones is growing fast. But the support they need isn't. (11/8/16)]&lt;br /&gt;
* [http://khn.org/news/study-elderlys-family-caregivers-need-help-too/amp/ Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones (9/14/16)]&lt;br /&gt;
* [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers In Some States, a New Focus on Family Caregivers. Nearly half of family caregivers administer multiple medications, treat wounds or operate specialized medical equipment. (6/22/16)]&lt;br /&gt;
* [http://khn.org/news/who-are-americas-caregivers-nearly-a-quarter-are-millennials/ Who Are The 40 Million American Caregivers? Nearly A Quarter Are Millennials (12/3/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/15-things-to-know-about-caregivers.html 15 things to know about caregivers (11/3/15)]&lt;br /&gt;
* [http://mobihealthnews.com/48054/new-council-will-guide-family-caregivers-to-available-tools/ New council will guide family caregivers to available tools (10/28/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/caregiver-frustration/ Nearly one-third struggle in their caregiving role and want tools to help them and their family members. 64% feel stressed and overwhelmed; nearly half struggle with balancing personal needs and caregiving. (10/24/15)]&lt;br /&gt;
* [http://khn.org/news/dementia-also-takes-toll-on-unpaid-caregivers-study-shows/ Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia (10/16/2015)]&lt;br /&gt;
* [http://www.usnews.com/news/us/articles/2015/07/14/ap-norc-poll-many-californians-unaware-of-caregiver-program Many Californians unaware of caregiver program for low-income seniors, disabled (7/14/15)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-undeniable-progress.pdf In 2013, about 40 million family caregivers in the US provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013. (7/2015)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf An estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the 12 months period in 2014 and 2015. (6/2015)]&lt;br /&gt;
* [http://medcitynews.com/2015/04/care-caregiver/ How Do We Care for the Caregiver (4/23/15)]&lt;br /&gt;
* [https://www.caring.com/about/news-room/costs-of-caregiving-2014 Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs (9/15/14)]&lt;br /&gt;
&lt;br /&gt;
Home Care (Non-Credentialed) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/ Lots Of Responsibility For In-Home Care Providers — But No Training Required (1/6/15)]&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends Determinants] that can decisively affect a patient's overall health and well-being. &amp;lt;br&amp;gt;&lt;br /&gt;
Spouse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.asco.org/about-asco/press-center/news-releases/large-study-finds-association-between-marriage-and-cancer Large Study Finds Association Between Marriage and Cancer Outcomes (9/23/13)]&lt;br /&gt;
&lt;br /&gt;
===Support Team Insight===&lt;br /&gt;
&lt;br /&gt;
Community Health Workers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/ Hospitals Eye Community Health Workers To Cultivate Patients’ Successes (4/11/16)]&lt;br /&gt;
* [http://khn.org/news/in-l-a-community-health-workers-are-part-of-the-medical-team/ In L.A., Community Health Workers Are Part Of The Medical Team (10/26/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/16/how-community-health-workers-can-reinvent-health-care-delivery-in-the-us/ How Community Health Workers Can Reinvent Health Care Delivery In The US (1/16/15)]&lt;br /&gt;
&lt;br /&gt;
Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html How Social Spending Affects Health Outcomes (8/17/16)]&lt;br /&gt;
* [https://thehealthcaremarketer.wordpress.com/2016/08/11/the-health-impact-in-5-years-hi-5-initiative/ Centers for Disease Control and Prevention (CDC) launches new initiative – Health Impact in 5 Years (HI-5). Promotes list of proven non-clinical, community-wide interventions that improved health within five years and are cost-effective or have cost-saving over the lifetime of the population. (8/11/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/politics/2016/05/02/social-service-shortfalls-hinder-health-boost-medical-spending/83625264/ Social service shortfalls hinder health, boost medical spending (5/3/16)] &lt;br /&gt;
* [https://www.icsi.org/_asset/nsnyw1/sharingknowledgedata.pdf Sharing Knowledge and Data at the Community/System Level To Address Social Determinants (4/2015)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/14/to-lower-the-cost-of-health-care-invest-in-social-services/ To Lower The Cost Of Health Care, Low-tech social services also should be considered a key factor in our health care equation. (7/14/15)]&lt;br /&gt;
* [http://www.cdc.gov/chinav/ CDC launches Community Health Improvement Navigator (CHI Navigator) website (5/2015)] with tools and resources from [http://www.thecommunityguide.org/ The Guide to Community Preventive Services], the [http://whatworksforhealth.wisc.edu/ What Works for Health database (on the University of Wisconsin website)], the [https://innovations.ahrq.gov/ AHRQ Health Care Innovations Exchange], the [http://cdc.thehcn.net/index.php?module=promisepractice&amp;amp;controller=index&amp;amp;action=index Healthy Communities Institute Promising Practices] and the [http://healthyamericans.org/ New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/11/understanding-intersection-health-care-social-services.html Understanding the intersection of health care and social services (11/10/13)]&lt;br /&gt;
&lt;br /&gt;
===Organizations Insight===&lt;br /&gt;
====Healthcare Organizations Insight====&lt;br /&gt;
====Government Organizations Insight====&lt;br /&gt;
====Employer Insight====&lt;br /&gt;
====Community and Social Services Organizations Insight====&lt;br /&gt;
====Support Resources Organizations Insight====&lt;br /&gt;
===Other Contributors Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Healthy Lifestyle ''Insight''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1569 The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed (8/2017)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1605086#t=article A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor). Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle. (12/15/16)]&lt;br /&gt;
* [http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract Study finds 2.7% of U.S. adults meet criteria for ‘healthy lifestyle’ (4/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ Scientist assert Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Only 5–10% of all cancer cases were attributed to genetic defects, whereas the remaining 90–95% is lifestyle factors including tobacco (25–30%), diet (30–35% - fried foods, red meat), infections (15–20%) the remaining alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity. (7/15/2008)]&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Insight''===&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/06/26/teenagers-are-as-sedentary-as-60-year-olds-by-age-19/?utm_term=.127016b508d0 Teenagers are as sedentary as 60-year-olds by age 19 (6/26/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/15/why-being-a-weekend-warrior-is-still-good-for-your-health/#EQ6NSxU86kqy Researchers found that the weekend warriors who met physical activity guidelines were less likely to die during the nine-year study period, compared with people who didn't get any exercise. A total of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity over one or two days a week. (1/15/17)]&lt;br /&gt;
* [https://www.technologyreview.com/s/602706/pokemon-go-increased-us-activity-levels-by-144-billion-steps-in-just-30-days/ Pokemon Go Increased U.S. Activity Levels by 144 Billion Steps in Just 30 Days (10/21/16)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ Brain Benefits of Exercise Diminish After Short Rest (9/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-more-than-a-quarter-of-adults-over-50-get-no-exercise-outside-of-daily-life-activities.html CDC: More than a quarter of adults over 50 get no exercise outside of daily life activities (9/20/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/27/study-suggests-new-formula-for-physical-activity-8-hours-of-sitting-means-1-hour-of-exercise/ Study suggests 1 hour of activity per 8 hours of sitting (7/27/16)]&lt;br /&gt;
&lt;br /&gt;
* [https://medlineplus.gov/podcast/transcript071816.html Moderate exercise is associated with a reduced risk of 13 types of cancer (7/18/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html The percentage of adults over 18 who met the 2008 federal physical activity guidelines for aerobic activity increased from 41.4 percent in 2006 to 49.5 percent in 2012. That rate has remained stable through 2015. (5/26/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-common-fund-launches-physical-activity-research-program NIH Common Fund launches physical activity research program to identify biological molecules that change in response to exercise (6/11/15)]&lt;br /&gt;
* [http://www.reuters.com/article/us-sedentary-television-mortality-idUSKBN0F65BW20140701 Too much TV tied to premature death (7/1/14)]&lt;br /&gt;
Children Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/johns-hopkins-us-could-save-21b-in-healthcare-costs-if-kids-played-outside-every-day.html Johns Hopkins: US could save $21B in healthcare costs if kids played outside every day (5/15/17)]&lt;br /&gt;
* [https://www.usatoday.com/story/news/health/2017/05/06/kids-inactivity-rises-creating-health-care-time-bomb/101245982/ The percent of children aged six to 12 who were physically active three or more times a week had its biggest drop in five years and is now under 25% (5/6/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/03/well/move/childs-play-is-good-for-all-of-us.html If all of the children who currently are sedentary started exercising every day in the United States alone, we could expect to save more than $120 billion every year in health care and associated expenses. (5/3/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/902 Modeling The Economic And Health Impact Of Increasing Children’s Physical Activity In The United States (5/2017)]&lt;br /&gt;
&lt;br /&gt;
Sitting &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/09/04/547580952/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later Study of sitting and walking ability over 8 to 10 years, those who sit the most and move the least had more than three times the risk of difficulty walking by the end of the study (9/4/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/sitting-can-be-bad-especially-if-you-do-it-for-more-than-10-hours-a-day/2016/07/22/43f7f228-4f77-11e6-aa14-e0c1087f7583_story.html Sitting can be bad, especially if you do it for more than 10 hours a day (7/24/16)]&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities Insight===&lt;br /&gt;
===Nutrition ''Insight''===&lt;br /&gt;
* [http://fortune.com/2017/07/17/artificial-sweeteners-weight-loss-study/ Artificial Sweeteners Won't Help You Lose Weight, According to a Sad but Important New Study (7/17/17)]&lt;br /&gt;
* [http://ajcn.nutrition.org/content/early/2017/06/07/ajcn.117.154872.abstract?papeto The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. (6/7/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1 Pediatricians Advise No Fruit Juice Until Kids Are 1 (5/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/15/well/eat/red-meat-increases-risk-of-dying-from-8-diseases.html Red meat increase risk of dying from 8 diseases (5/15/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/26/well/diet-sodas-tied-to-dementia-and-stroke.html Diet soda tied to dementia and stroke (4/26/17)] &lt;br /&gt;
* [https://www.statnews.com/2017/01/26/soda-sugary-drinks/ The number of calories per day that children and adults have been getting from soda and other sugar-sweetened beverages has been dropping for steadily for nearly 20 years, but new data show that since 2009 that number has plateaued. (1/26/17)] &lt;br /&gt;
* [http://www.alzheimersanddementia.com/article/S1552-5260(17)30050-X/fulltext Excess sugar consumption has been linked with Alzheimer's disease (AD) pathology in animal models. (1/24/17)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2529628 Dietary Intake Among US Adults, 1999-2012 Improved. The American Heart Association (AHA) primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). (6/21/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2016/03/more-than-half-of-what-americans-eat-is-ultra-processed/472791/ More Than Half of What Americans Eat Is 'Ultra-Processed'. And those foods account for 90 percent of U.S. added sugar intake, new research says.(3/10/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1916.abstract Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; Overall Diet Remains Poor (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1940.abstract Foods with the largest positive associations with three-year excess weight gain (among children and adolescents) were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages (11/2015)]&lt;br /&gt;
* [http://now.tufts.edu/news-releases/sugary-drinks-linked-high-death-tolls-worldwide Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year (6/29/15)]&lt;br /&gt;
* [http://openheart.bmj.com/content/2/1/e000196.full US and UK governments dietary guidelines introduced in 1977 and 1983 to reduce coronary heart disease (CHD) by reducing fat intake didn't have studies to support it. (2/9/15)]&lt;br /&gt;
&lt;br /&gt;
===Functional Activities Insight===&lt;br /&gt;
&lt;br /&gt;
Digital Health Usage &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-21-percent-americans-have-used-virtual-healthcare-78-percent-are-interested Survey: 21 percent of Americans have used virtual healthcare, 78 percent are interested (2/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/senior-citizens-rarely-use-digital-health-resources-5-study-findings.html Seniors rarely use digital health resources: 5 study findings (8/3/16)]&lt;br /&gt;
* [http://mobihealthnews.com/39189/parks-41-percent-of-caregivers-use-a-digital-health-device 41 percent of caregivers use a digital health device (12/18/14)]&lt;br /&gt;
* [http://mobihealthnews.com/38904/kaiser-members-who-use-app-are-more-adherent-satisfied-and-loyal/ Kaiser now has 70% of its 9 million members as active users of its online and mobile offerings, patients are more adherent, satisfied, and loyal (12/10/14)]&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Insight''===&lt;br /&gt;
* [https://www.alz.org/aaic/releases_2017/AAIC17-Tues-Briefing-Sleep.asp Interrupted sleep may lead to Alzheimer’s. Research found significant associations between sleep disordered breathing (SDB) and the accumulation of biomarkers for Alzheimer's disease. (7/18/18)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/06/504448639/drivers-beware-crash-rate-spikes-with-every-hour-of-lost-sleep Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep (12/6/16)]&lt;br /&gt;
* [http://mashable.com/2016/11/30/sleep-deprivation-economic-cost.amp In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death (11/30/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/08/24/432764792/snooze-alert-a-sleep-disorder-may-be-harming-your-body-and-brain Snooze Alert: A Sleep Disorder May Be Harming Your Body And Brain A Sleep Disorder May Be Harming Your Body And Brain. More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea. (8/24/15)]&lt;br /&gt;
* [http://articles.latimes.com/2013/aug/29/science/la-sci-sn-sleeping-pill-use-cdc-20130830 One in 25 American adults takes sleeping pills to help them fall asleep and stay asleep at night (8/29/13)]&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-things-to-know-about-america-s-unhealthy-behaviors.html More than 70 percent of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. (4/5/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-overweight-heart-uspstf-idUSKBN0GP1XA20140825 Overweight patients with risk factors for heart disease need &amp;quot;intensive behavioral counseling&amp;quot; about '''diet''' or '''exercise''', according to USPSTF. (8/25/14)]&lt;br /&gt;
* [https://georgevanantwerp.com/2013/12/30/8-risks-drive-15-conditions-and-80-of-healthcare-costs/ 8 Behavior Risks Drive 15 Conditions And 80% Of Healthcare Costs (12/30/13)]&lt;br /&gt;
&lt;br /&gt;
Alcohol &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/28793133 One in eight Americans abuses alcohol, a new study finds, a 50 percent increase since the start of the century (9/1/17)]&lt;br /&gt;
* [https://www.bloomberg.com/news/articles/2017-08-09/america-s-drinking-problem-is-much-worse-this-century The number of adults who binge drink at least once a week could be as high as 30 million, according to a study published on Wednesday in JAMA Psychiatry. (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 32% of Americans had a minimum of one heavy drinking day in the last year. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. (5/27/16)]&lt;br /&gt;
* Alcohol Consumption - [https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ The top 10% of American drinkers consume, on average, 74 alcoholic drinks per week. (9/25/14)]&lt;br /&gt;
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Falls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-elderly-patients-treated-for-falls-may-be-more-likely-to-suffer-later-adverse Elderly patients treated for falls may be more likely to suffer later adverse events, study finds (7/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/among-the-elderly-an-epidemic-of-falling.html The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. (9/21/16)] &lt;br /&gt;
* [http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/ The use of 4 or more medications was associated with increased risk of falling and the risk of recurrent falls (9/27/13)]&lt;br /&gt;
&lt;br /&gt;
Risky Behaviors &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/05/29/health/car-accidents-child-deaths-seat-belts.html Car Accidents Remain a Top Child Killer, and Belts a Reliable Savior (5/29/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-high-risk-behaviors-often-persist-even-after-cancer-diagnoses.html Study finds high-risk behaviors often persist after cancer diagnoses. 19.8% of women cancer survivors smoked, compared with 15.8% of women without cancer. No differences existed for fruit and vegetable consumption or body mass index. (9/6/16)]&lt;br /&gt;
&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/01/10/smoking-costs-the-world-economy-1-trillion-per-year-world-health-organization-says/?utm_term=.378ab21f3e8c Smoking costs the world economy $1 trillion per year, World Health Organization says (1/10/17)]&lt;br /&gt;
* [https://directorsblog.nih.gov/2016/12/13/study-finds-no-safe-level-of-smoking/ New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. (12/13/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall Centers for Disease Control and Prevention says smoking rates have fallen from 21% of the adult population in 2005 to 15% in 2015 (11/10/16)]&lt;br /&gt;
* [http://www.sanger.ac.uk/news/view/smoking-pack-day-year-causes-150-mutations-lung-cells Smoking a pack a day for a year causes 150 mutations in lung cells (11/3/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cigarettes-linked-to-nearly-30-of-cancer-deaths-6-things-to-know.html Cigarettes linked to nearly 30% of cancer deaths: 6 things to know (10/24/16)]&lt;br /&gt;
* [http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002020 A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. (5/10/16)]&lt;br /&gt;
* [https://www.boston.com/news/health/2016/05/24/kicking-habit-adult-smoking-rate-us-falling-fast CDC reports smoking rate among adults in the U.S. fell to 15% in 2015, down two percentage points from 2014. (5/24/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/04/19/opioid-addiction-relapse-science/ How drug use changes the brain — and makes relapse all too common (4/19/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://health.usnews.com/health-care/articles/2017-04-19/many-heart-attack-patients-fail-to-stick-with-statins Many Heart Attack Patients Fail to Stick With Statins (4/19/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/25/more-than-half-of-adults-misuse-medications-study-finds/ More than half of adults and 44% of children drug-tested by a national clinical laboratory last year misused their prescription medications, either taking too much, too little or none of their medications. 45 percent of adults were taking drugs (including illicit drugs) that were not prescribed. (7/25/16)]&lt;br /&gt;
* [http://www.mcolblog.com/kcblog/2016/7/12/factors-attributed-to-medication-non-adherence.html 30% of prescriptions are never filled. 69% of nonadherence is due to behavioral issues, such as forgetfulness or procrastination, 16% was due to cost, and 15% say it was medication side effects (7/12/16)]&lt;br /&gt;
*  [http://www.imshealth.com/en/about-us/news/ims-health-study:-low-levels-of-adherence-and-persistence-remain-barriers-to-reducing-the-costs-of-diabetes-complications The U.S. could save $4 billion a year if more seniors with type 2 diabetes followed their doctor’s orders, according to a report by the IMS (7/12/16)]&lt;br /&gt;
* [http://www.hindawi.com/journals/ijfm/2013/901845/ Study found that only 6.5% of patients (only 46 in study) adhered completely to the discharge medication list after average hospital stay of 4.3 days. The average patient age was 76, prescription medications was 10 and number of chronic diseases was 7. (2/24/13)] &lt;br /&gt;
* [http://medcitynews.com/2014/11/study-medication-adherence-prompts/ Study: Medication adherence improved with proper prompts (11/17/14)]&lt;br /&gt;
* [http://well.blogs.nytimes.com/2012/11/15/when-the-patient-is-noncompliant/ When the patient is non-compliant (11/15/12)]&lt;br /&gt;
* [http://healthcare-economist.com/2015/05/31/patient-adherence-to-antipsychotic-medications/ About 40% of patients with schizophrenia are adhering to antipsychotic medications (5/31/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Activation Levels &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/mar/patient-self-management-capability In 2012, ED costs were 37% lower for those at highest activation level versus the lowest ($1,126 vs. $711). In 2014, the difference was 28% (3/8/16)]&lt;br /&gt;
* [http://hpr.weill.cornell.edu/divisions/biostatistics/pdf/Gerber-Research_Seminar_Talk-5-10-07.pdf Effect of the Patient Activation Measure (PAM) on Chronic Care: Baseline Findings from a Cluster Randomized Study (5/10/07)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/3/431 When Patient Activation Levels Change, Health Outcomes And Costs Change, Too (3/2015)]&lt;br /&gt;
&lt;br /&gt;
Prevention &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.ajc.com/news/local/study-finds-percent-sunscreens-don-even-work-how-find-one-that-does/ergzPOJyVv0nM7ZG88yBHK/ Study finds 73 percent of sunscreens don’t even work — how to find one that does (5/26/17)]&lt;br /&gt;
&lt;br /&gt;
Preventive Screening and Vaccinations&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentages of adults who received an influenza vaccination in 2015 was 65.8% for adults aged 65 and over, 46% for ages 50 to 64 and 31.2% for those aged 18 to 49. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentage of adults over 65 years old vaccinated for pneumonia increased rapidly from 42.4% in 1997 to 53.1% in 2000. In 2015, the percentage rose to 63.5% (5/26/16)]&lt;br /&gt;
&lt;br /&gt;
Self Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.reuters.com/article/us-pressure-management-study-idUSKBN0GR2C220140827 Self management may reduce blood pressure (8/27/14)]&lt;br /&gt;
&lt;br /&gt;
Treatment Delays &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://go.americanwell.com/rs/335-QLG-882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf 67% of consumers say they have delayed seeking care for a health problem. They delay because: It costs too much (23%), It takes too long to get in to see a doctor or nurse (23%), They thought the problem would go away on its own (36%), They are too busy (13%) (1/2017)]&lt;br /&gt;
&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-fewer-americans-diet-20170308-story.html American adults either overweight or obese rose from about 53% a generation ago to roughly 66% more recently. 56% of overweight or obese adults reported in 1988 to 1994 they had tried to lose weight in the last year, it has declined to 49% in 2009 to 2014. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Wellness Programs&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/279396/will-every-human-be-health-reward-program-when-it-comes-health-rewards-it-seems 74 percent of employers use health reward program (12/1/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/193551/amount-reward-consumer-health-behavior What Size Reward Drives a Consumer to Take a Desired Health Behavior? (9/9/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/25/workplace-wellness-produces-no-savings/ Workplace Wellness Produces No Savings (11/25/14)]&lt;br /&gt;
&lt;br /&gt;
===Care Planning Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/05/10/addressing-triggers-of-decline-in-older-adults-physical-cognitive-or-mental-health/ “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/07/02/family-caregiving-and-palliative-care-closing-the-policy-gap/ Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)]&lt;br /&gt;
&lt;br /&gt;
Care Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/02/implementing-a-care-planning-system-how-to-fix-the-most-pervasive-errors-in-health-care/ Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/630.abstract Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)] &lt;br /&gt;
* [http://familiesusa.org/press-release/2016/proven-best-choices-guides-health-care-options-launched-icer-and-families-usa Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)]&lt;br /&gt;
* [https://decisionaid.ohri.ca/odsf.html The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/october-november/in-focus Helping Patients Make Better Treatment With Decision Aids (10/2012)]&lt;br /&gt;
&lt;br /&gt;
Evidence-Based Practice &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/primary-care-docs-may-struggle-to-find-high-quality-evidence-to-support-clinical Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/22/credibility-of-evidence-a-reconsideration-of-the-logic-and-strength-of-our-healthcare-decisions/ Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)]&lt;br /&gt;
&lt;br /&gt;
Medical Advocates &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/medical-advocates-can-help-guide-patients-on-difficult-care-choices/ Medical Advocates Can Help Guide Patients On Difficult Care Choices  (1/27/16)]&lt;br /&gt;
&lt;br /&gt;
Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/partners-expands-second-opinion-service-health-advocate-partnership Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/88-of-second-opinions-from-mayo-physicians-result-in-different-diagnosis-study-finds.html 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)]&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/patients-with-more-say-in-treatment-have-fewer-side.html Patients with more say in treatment have fewer side effects (7/13/16)]&lt;br /&gt;
*  [http://khn.org/news/inviting-patients-to-help-decide-their-own-treatment/ Inviting Patients To Help Decide Their Own Treatment (3/16/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/17/shared-decision-making-and-the-use-of-patient-decision-aids/ Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/doctors-patients-critically-medical-decisions.html How should doctors and patients look critically at medical decisions?] (8/16/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/medical-interventions-5050-informs-patient.html Many medical interventions are 50/50: Who informs the patient? (8/13/2013)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management - Communications Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Communicating Instructions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/most-patients-don-t-understand-post-discharge-care-plans-study-finds Most patients don't understand post-discharge care plans, study finds (1/6/2016)]&lt;br /&gt;
&lt;br /&gt;
Difficult Dialog &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/03/377569539/even-some-doctors-fear-these-10-questions The difficulty of asking questions about &amp;quot;adverse childhood experiences&amp;quot; that identifies health risks (3/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/24/394927484/many-doctors-who-diagnose-alzheimers-fail-to-tell-the-patient Many Doctors Who Diagnose Alzheimer's Fail To Tell The Patient (3/24/15)]&lt;br /&gt;
&lt;br /&gt;
Digital Communications &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cio.com/article/3195891/cio-role/kaiser-cio-shares-it-lessons-for-the-future-of-healthcare.html Kaiser Permanente crossed an important threshold last year when 52 percent of its patient interactions were digital. (5/10/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/mhealth-monitor-patients-physicians/ 58% of people in the U.S. with a smartphone shared information with a medical professional using a mobile or wearable device. And 25% used email or text to send a photo of a medical issue to their doctor. (11/15/16)]&lt;br /&gt;
* [http://www.huffingtonpost.com/2015/06/29/doctors-facebook-telehealth_n_7662774.html Communicating With Your Doctor On Facebook May Be The Future Of Healthcare (6/29/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/07/healthcrowd-pilot-finds-mobile-engagement-medicaid-patients-cost-effective/ Pilot project finds mobile engagement with Medicaid patients ‘most cost-effective’ (7/29/14)]&lt;br /&gt;
* [http://mobihealthnews.com/35160/nearly-half-of-kaiser-permanentes-members-use-my-health-manager/ Nearly half of Kaiser Permanente's members use online health management platform (7/25/14)]&lt;br /&gt;
* Electronic Communication - [http://link.springer.com/article/10.1007%2Fs11606-012-2329-5 71% of vulnerable patient populations want to use electronic communication with health care providers.] (2/20/13)&lt;br /&gt;
&lt;br /&gt;
Doctor Patient Discussions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/language-doctors-use-to-talk-to-diabetes-patients-makes-a-difference The language doctors use to talk to diabetes patients makes a difference to success (6/14/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/prudent-antibiotic-prescribing-lowers-patient-satisfaction.html How prudent antibiotic prescribing lowers patient satisfaction (9/13/16)]&lt;br /&gt;
* [http://khn.org/news/attending-to-the-human-element-is-key-to-keeping-patients-healthy/amp/ Study recommends improving communication with racial minorities and lower-income patients, such as better bedside manner (so patients trust their doctors), communication that is easily understood by everyday people and willingness to discuss how price fits into consumers’ health decisions. (9/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/physicians-spend-twice-as-much-time-on-ehr-desk-work-than-with-patients.html Physicians spend twice as much time on EHR, desk work than with patients (9/6/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/06/costs_of_care_getti.html Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. (6/15/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/get-10-minutes-doctor-2/ Why Do I Only Get 10 Minutes With My Doctor? (9/18/14)]&lt;br /&gt;
* [http://khn.org/news/15-minute-doctor-visits/ 15-Minute Visits Take A Toll On The Doctor-Patient Relationship (4/21/14)]&lt;br /&gt;
&lt;br /&gt;
Patient Portals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/ehr/despite-federal-push-to-offer-ehr-access-patient-engagement-low Just 15% of hospital patients electronically accessed their medical records despite 88% of hospitals offering access. Nearly one-third of patients accessed EHRs offered by physician practices. (3/16/17)]&lt;br /&gt;
&lt;br /&gt;
Patient Provided Data&lt;br /&gt;
* [http://www.fiercehealthcare.com/analytics/how-university-rochester-medical-center-uses-patient-generated-data-to-set-expectations University of Rochester Medical Center (URMC) collects patient-reported outcomes by using a Patient-Reported Outcomes Measurement Information System (PROMIS), which requires patients to answer five to seven questions on a tablet. (7/6/17)] &lt;br /&gt;
* [http://www.annfammed.org/content/15/2/158.abstract Patients Typing Their Own Visit Agendas Into an Electronic Medical Record. Patients and clinicians agreed that the agendas improved patient-clinician communication. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Remote Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2488923#Results Study finds readmissions nearly the same for heart failure patients using remote patient monitoring (3/2016)]&lt;br /&gt;
* [http://mobihealthnews.com/content/scripps-wired-health-study-results-show-no-clinical-or-economic-benefit-digital-health Scripps Wired for Health study shows no clinical or economic benefit from digital health monitoring (1/19/16)]&lt;br /&gt;
* [http://khn.org/news/making-the-human-condition-computable/ Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to enable doctors to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails. (12/11/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/can-fall-monitoring-technology-keep-elders-safe/ Can Fall Monitoring Technology Keep Elders Safe? (4/7/14)]&lt;br /&gt;
* [http://www.mddionline.com/article/digital-health-dominates-ces-2014-%E2%80%93-3-trends-watch-3 Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. (1/9/14)]&lt;br /&gt;
&lt;br /&gt;
Screenings &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/doctors-should-screen-patients-for-social-isolation-to-address-loneliness-epidemic Doctors must screen patients for social isolation to address 'loneliness epidemic' (8/8/17)]&lt;br /&gt;
* [https://nam.edu/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool/ Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool. (5/30/17)] [https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf See PDF] &lt;br /&gt;
&lt;br /&gt;
Text Messaging &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/despite-privacy-hoops-text-messaging-offers-unprecedented-convenience Despite privacy hoops, text messaging offers ‘unprecedented convenience’ (5/11/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management - Operational Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/474.abstract Breaking Down Silos Between Health Care And Criminal Justice (3/2014)]&lt;br /&gt;
&lt;br /&gt;
Behavioral Health Integration&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/10/1808.abstract Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care (10/2014)]&lt;br /&gt;
* [http://docs.house.gov/meetings/IF/IF02/20150211/102944/HHRG-114-IF02-Wstate-KohnL-20150211.pdf About 10 million—or 4.2%—of adults in the United States suffered from a serious mental illness in 2013 were supported by 112 different federal programs (2/11/15)]&lt;br /&gt;
&lt;br /&gt;
Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-acute-care-needs-to-be-coordinated-but-it-often-not Only 30% of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7% reported they were fully coordinated. (11/131/6)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/07/20/peds.2015-4182 Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. (7/2016)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/09/difficult-transition-hospital-nursing-home.html The difficult transition between the hospital and nursing home (9/5/13)]&lt;br /&gt;
* [http://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/ One of the most dangerous junctures in medical care: patients leaving the hospital. Nearly a quarter had inadequately reviewed or tracked medications, sometimes even causing fatal events. (5/2/16)] &lt;br /&gt;
* [https://psnet.ahrq.gov/primers/primer/11 Nearly 20% of patients experience adverse events within 3 weeks of hospital discharge, nearly three-quarters of which could have been prevented or ameliorated. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-discharge-risks-persist-for-elderly-patients The transition from hospital to home poses significant risks to patients, especially the elderly, and gaps persist in care during this crucial time. (7/11/16)]&lt;br /&gt;
&lt;br /&gt;
Coordinated Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/nov/healthcare-fragmentation-frequency-diagnostic-tests Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, linked to high rates of hospitalization and emergency department visits as well as lower satisfaction. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients. (11/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/on-lok Program of All-Inclusive Care for the Elderly (PACE) cares for frail elders in the community (8/12/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/12/poor-interoperability-affects-patients.html How poor interoperability affects patients. It often requires duplicate testing that is not only costly (e.g., CT scans), but also invasive and not without risk to the patient (e.g., bronchoscopy, biopsies). (12/17/15)]&lt;br /&gt;
* [http://www.jhsph.edu/news/news-releases/2015/four-in-ten-older-adults-burdened-by-demands-of-health-care-system.html Four in Ten Older Adults Burdened by Demands of Health Care System] (10/14/15)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2014/nov/international-survey-of-older-adults International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care (11/19/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/special-report/5-pieces-care-coordination-puzzle 5 pieces of the care coordination puzzle (6/11/14)]&lt;br /&gt;
* [http://www.healthcare-informatics.com/news-item/lack-coordinated-care-problem-older-patients-survey-says Lack of Coordinated Care is a Problem for Older Patients, Survey Says (4/3/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/10/coordinated-care-critical-reducing-u-s-health-spending/ Coordinated care critical for reducing U.S. health spending  (10/8/13)]&lt;br /&gt;
&lt;br /&gt;
Managing [http://www.patientdeterminants.org/index.php?title=Health_Insight#High_Need.2C_High_Cost_Patients_Insight High Cost High Need Patients] &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? (8/7/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/care-high-need-high-cost-patients Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis (10/29/15)] &lt;br /&gt;
&lt;br /&gt;
Palliative Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/44.abstract Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities (1/2016)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/29/the-challenge-of-financing-sustainable-community-based-palliative-care-programs/ The Challenge Of Financing Sustainable Community-Based Palliative Care Programs (12/29/14)]&lt;br /&gt;
&lt;br /&gt;
Partnering With Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/what-organizations-do-hospitals-partner-with-for-population-health.html What Organizations do Hospitals Partner With for Population Health? (12/5/13)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2014/12/28/the-trouble-with-home-health-care-care-coordination/ The Trouble with Home Health Care &amp;amp; Care Coordination (12/28/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2104.abstract Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Coordinating care and communicating with specialists, hospitals, home care and social service providers. (12/2015)]&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Determinants Health Strategy Activities Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Interventions Activities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Interventions_Determinants Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being. [[Medical Interventions]] Activities are impacted by:&lt;br /&gt;
&lt;br /&gt;
* [[Medical Intervention Access|Access]]&lt;br /&gt;
* [[Medical Intervention Diagnosis|Diagnosis]]&lt;br /&gt;
* [[Medical Intervention Efficacy|Efficacy]]&lt;br /&gt;
* Testing&lt;br /&gt;
* [[Medical Intervention Treatments|Treatments]]&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions Activity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Non-Medical_Interventions_Determinants Non-Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Cardiac Rehabilitation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/cardiac-rehab-improves-health-but-cost-and-access-issues-complicate-success/amp/ Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (8/31/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/07/18/485871530/cardiac-rehab-works-great-so-why-don-t-people-do-it Despite research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer; fewer than a third do. (7/18/16)]&lt;br /&gt;
&lt;br /&gt;
Employee Wellness Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/ Large firms (at least 200 employees) are more likely to offer Employee Wellness Programs than smaller firms (81% vs. 49%) in an effort to promote employee health and productivity and reduce health related cost (5/19/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/71.abstract Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study (1/2016)]&lt;br /&gt;
&lt;br /&gt;
Fall Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-step-up-to-help-seniors-avoid-falls/ Hospitals Step Up To Help Seniors Avoid Falls (1/12/16)]&lt;br /&gt;
&lt;br /&gt;
Health Coaching &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/the-underrated-value-of-coaching-in-healthcare-4-thoughts-from-population-health-expert-dr-william-appelgate.html The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William Appelgate (1/25/17)]&lt;br /&gt;
&lt;br /&gt;
Legal Counseling &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/legal-regulatory-issues/ku-kansas-hospital-to-offer-free-legal-counsel-to-low-income-patients.html Kansas hospital offers free legal counsel to low-income patients (8/18/16)]&lt;br /&gt;
&lt;br /&gt;
Obesity Counseling &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://khn.org/news/few-seniors-benefitting-from-medicare-obesity-counseling/ Few Seniors Benefiting From Medicare Obesity Counseling (2/23/15)]&lt;br /&gt;
* [http://khn.org/news/seniors-obesity-counseling-benefit-goes-largely-unused/ Seniors’ Obesity-Counseling Benefit Goes Largely Unused (11/20/14)]&lt;br /&gt;
&lt;br /&gt;
Opioid Alternative&lt;br /&gt;
* [http://www.denverpost.com/2016/11/30/battling-opioid-epidemic/ How a Colorado health care provider is battling the opioid epidemic with non-pill pain treatments (11/30/16)]&lt;br /&gt;
&lt;br /&gt;
Virtual Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fastcompany.com/3047894/the-future-of-work/how-to-turn-your-smartphone-into-your-personal-therapist Smartphone As A Personal Therapist. Could the technology that causes so much of our stress and anxiety also be the cure? (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence Insight====&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Insight</id>
		<title>Health Insight</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Insight"/>
				<updated>2019-07-16T21:10:41Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Physical Activities Insight */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday there is new insight into our understanding of [[Health Determinants]] and [[barriers]] that impact patient outcomes. This page will curate new insight. While health care is likely the most important determinant of health when a patient has an acute condition, studies show it represents only a part of an overall health outcomes:&lt;br /&gt;
&lt;br /&gt;
[[Health Determinants Insight]]&lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Mission (Health Goals) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Personal Goals Insight===&lt;br /&gt;
===Health Goals (Care Goals) Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Mission_.26_Care_Goals_Determinants Health Goals (Care Goals) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Advanced Directives &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/1-3-u-s-adults-have-completed-advance-directive-study-finds 2 out of 3 adults fail to complete an advance directive (7/6/17)]&lt;br /&gt;
* [http://www.cbsnews.com/news/being-prepared-for-the-final-days/ Being prepared for the final days (4/27/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/lack-advance-directives-leads-to-unwanted-care Lack of advance directives leads to unwanted care (11/2/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/national-healthcare-decisions-day-11-statistics-on-end-of-life-decision-making.html Only 20% of Americans have an advanced directive documenting their wishes for end-of-life medical care. (4/16/15)]&lt;br /&gt;
&lt;br /&gt;
Care Goals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/12/defining-patients-goals-care.html Defining the patient’s goals of care (12/11/13)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1113631#t=article Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)]&lt;br /&gt;
&lt;br /&gt;
End of Life Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/end-life-care-planning-fails-patients End-of-life care, planning fails patients (2/5/15)]&lt;br /&gt;
* [https://www.minnpost.com/second-opinion/2014/06/few-doctors-discuss-end-life-planning-heart-failure-patients-mayo-study-finds Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)]&lt;br /&gt;
* [http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx ''Dying in America'' - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)]&lt;br /&gt;
* [http://khn.org/news/too-many-people-die-in-hospital-instead-of-home-heres-why/ Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)]&lt;br /&gt;
&lt;br /&gt;
Health Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/28/what-outcomes-matter-to-patients-with-rheumatoid-arthritis/ What outcomes matter to patients with Rheumatoid Arthritis? (8/28/17)]&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Strategy (Health Plan) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) Insight===&lt;br /&gt;
====Medical Interventions Insight====&lt;br /&gt;
====Non-Medical Interventions Insight====&lt;br /&gt;
====Intervention Changes Insight====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures===&lt;br /&gt;
===Strategy - Impacting People Insight===&lt;br /&gt;
===Strategy - Impacting Realities Insight===&lt;br /&gt;
===Strategy - Impacting Activities Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Health Conditions ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Physical Conditions ''Insight''==== &lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Physical_Conditions_Determinants Physical Conditions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.cbsnews.com/news/more-u-s-kids-have-chronic-health-problems-study The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest (5/2/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/jan/analysis-of-death-rates-for-middle-aged-whites A lack of progress since 1999 against common illnesses such as heart disease, diabetes, and respiratory disease was largely responsible for higher-than-expected death rates for middle-aged (45–54) white adults in 2014. (1/29/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/07/study-on-aging/ Don’t judge a person on their chronological age; their biological age might be a lot older than you think, aging study says (7/7/15)]&lt;br /&gt;
&lt;br /&gt;
Arthritis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/stateline-states-asthma/ Nationwide, one in 10 children has asthma. (4/16/14)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/science/archive/2017/03/no-cancer-isnt-mostly-bad-luck/521049/ Scientists don't agree 66% of cancer is due to bad luck (3/28/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521219318/cancer-is-partly-caused-by-bad-luck-study-finds Study: Causes of cancer, 66% from random mutations during cell division (bad luck), about 29% from environment and remaining 5% due to heredity. (3/23/17)]&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-cancer-drop-20170105-story.html Death rate from cancer now 25% lower than it was 25 years ago, report says (1/5/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-brain-cancer-now-killing-more-children-than-leukemia.html CDC: Brain cancer now killing more children than leukemia (9/16/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cancer-overtakes-heart-disease-as-leading-cause-of-death-in-22-states-3-things-to-know.html Cancer overtakes heart disease as leading cause of death in 22 states (8/25/16)]&lt;br /&gt;
* [https://www.sciencedaily.com/releases/2015/01/150101142318.htm Study shows two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes, while the remaining third are due to environmental factors and inherited genes. (1/1/15)]&lt;br /&gt;
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Chronic Pain &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/4-things-to-know-about-the-rising-rates-of-chronic-pain-in-the-us.html Number of Americans in their 60s reporting chronic pain increased from 10% in 1998 to 37% in 2010. (3/16/17)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain Estimated 25.3 million adults (11.2%) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6%) experience severe levels of pain. (8/11/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/04/chronic-pain-effect-patients-families.html Chronic pain and the effect on patients’ families (4/17/14)]&lt;br /&gt;
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COPD &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/copd/index.html Chronic lower respiratory disease, primarily COPD, is the third leading cause of death in the United States (3/12/15)]&lt;br /&gt;
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Cystic Fibrosis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/03/13/cystic-fibrosis-canadians-americans/ Canadians with cystic fibrosis outlive Americans by a decade (3/13/17)]&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-more-deadly-than-previously-thought-researchers-say.html Diabetes causes 12 percent of deaths in the United States, making it the third-leading cause of death in the country, according to a new study (1/26/17)] &lt;br /&gt;
* [http://khn.org/news/health-claims-on-the-rise-for-kids-with-type-2-diabetes-obesity-related-conditions/amp/ Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions (1/2/17)]&lt;br /&gt;
* [http://khn.org/news/diabetes-linked-to-risk-of-mental-health-hospitalization-in-young-adults-study/amp/ Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease (7/22/16)]&lt;br /&gt;
* [http://khn.org/news/as-childhood-diabetes-rates-rise-so-do-costs-and-families-feel-the-pinch-study/amp/ Childhood diabetes rates are on the rise. The spent $2,173 per capita in out-of-pocket health care costs in 2014. Nearly five times higher than that of kids without the illness. (6/20/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/americans-diabetes-reach-21-million Americans with diabetes reach 21 million (4/15/14)]&lt;br /&gt;
* [http://www.latimes.com/science/la-sci-sn-diabetes-study-20150908-story.html About half of all Americans have either diabetes or pre-diabetes. (9/8/15)]&lt;br /&gt;
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Heart Attack Risk &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/depression-among-heart-attack-survivors-can-be-deadly-yet-is-often-ignored/ Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (7/20/17)]&lt;br /&gt;
* [http://www.wsj.com/articles/heart-attacks-are-linked-to-what-patients-were-doing-feeling-1477923373 Performing heavy physical activity in a highly emotional state sharply raised the risk of a heart attack. (10/31/16)]&lt;br /&gt;
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High Blood Pressure &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cdc.gov/bloodpressure/facts.htm About 70 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults. (6/16/16)]&lt;br /&gt;
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Life Expectancies &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/death-rates-for-americans-in-prime-years-rise-after-century-of-decline.html The death rate for Americans between the ages of 25 and 44 rose by 8% between 2010 and 2015 after a century of decline. (6/14/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair The mortality rate for white Americans, ages 45 to 54, increased by a half percent each year from 1999 to 2013, attributed to increase in suicide, drugs and alcohol. (3/23/17)]&lt;br /&gt;
Non-Communicable Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-diseases-that-kill-16m-people-cost-the-world-economy-2-35t-annually.html Five non-communicable diseases that kill 16 million people around the world each year, cost the world economy $2.35T annually. 1) Cardiovascular disease, 2) Mental illness, 3) Cancer, 4) Chronic respiratory disease, 5) Diabetes. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
Obesity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/30/506433671/the-wrong-eating-habits-can-hurt-your-brain-not-just-your-waistline Being overweight can raise your blood pressure, cholesterol and risk for developing diabetes. It could be bad for your brain, too. (12/30/16)]&lt;br /&gt;
* [http://www.onemednews.com/2016/12/18/nyt-obesity/ Researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, are many. (12/12/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2016/12/01/nearly-half-of-americas-overweight-people-dont-realize-theyre-overweight/?utm_term=.2963e8177870 Nearly half of America’s overweight people don’t realize they’re overweight (12/1/16)]&lt;br /&gt;
* [http://khn.org/news/another-reason-to-diet-experts-find-additional-evidence-of-obesity-cancer-link/amp/ Experts Find Additional Evidence Of Obesity-Cancer Link (8/24/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/obesity-rates-up-in-us-women-stable-in-men.html Obesity rates up in US women, stable in men. Obesity was 35 percent among men and 40 percent among women in 2013-14 (6/7/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html American obesity rate continues consistent trend upward in 2015 with estimated 30.4% of Americans over 20 years of age obese, more than a 10% increase from 1997 (5/26/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1923.abstract Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013 (11/2015)]&lt;br /&gt;
&lt;br /&gt;
Sepsis &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/sepsis-causes-more-readmissions-than-copd-heart-failure-heart-attack-and-pneumonia.html Sepsis causes more hospital readmissions than COPD, heart failure, heart attack and pneumonia. (1/23/17)]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Mental_Health_Conditions_Determinants Mental Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
Childhood Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/06/01/disruptive-behavior-disorders-children/ Childhood disruptive behavior disorders increases risk for substance use, violent behaviors, victimization, incarceration, and even premature death. An estimated 50 to 75% of youths who move through the juvenile justice system could be diagnosed with a mental health disorder. (6/1/17)]&lt;br /&gt;
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Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/who-depression-leading-cause-of-illness-disability-worldwide.html Depression is the leading cause of illness, disability worldwide according to the World Health Organization (3/31/17)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878#T1 The prevalence of major depressive episodes (MDEs) in adolescents (age 12-17) has increased from 13.1% for girls and 4.5% for boys in 2005 to 17.3% for girls and 5.7% for boys in 2014 (11/2016)]  &lt;br /&gt;
&lt;br /&gt;
Dementia &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/16/536935957/stress-and-poverty-may-explain-high-rates-of-dementia-in-african-americans Stress And Poverty May Explain High Rates Of Dementia In African-Americans (7/16/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-alzheimer-s-deaths-up-by-more-than-50.html In 1999, the rate of Alzheimer's deaths was 16.5 per 100,000 individuals. By 2014, this rate had increased to 25.4 deaths per 100,000, marking a 54.5% increase. (5/26/17)]&lt;br /&gt;
* [http://www.alz.org/documents_custom/2017-facts-and-figures.pdf Estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. By 2025, Alzheimer’s dementia is estimated to reach 7.1 million. By 2050, the number of people with Alzheimer’s dementia may nearly triple to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure Alzheimer’s disease. (3/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587084 Dementia prevalence among US adults 65 years or older declined significantly, from 11.6% in 2000 to 8.8% in 2012. (11/21/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/10-alzheimer-s-patients-had-preventable-hospital-stays One in 10 Alzheimer’s patients have preventable hospital stays (7/27/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/30/472295791/big-financial-costs-are-part-of-alzheimers-toll-on-families Big Financial Costs Are Part Of Alzheimer's Toll On Families (3/30/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2016/02/10/study-finds-dementia-rates-decline/80016390/ Rates of dementia dropped 44% from the late 1970s to the early 2010s. (2/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-dementia-drives-er-visits-admissions-and-mortality-rates How dementia drives ER visits, admissions and mortality rates (11/16/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1642.abstract Dementia has a disproportionate impact on family and unpaid caregiving to older adults] (10/2015)&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1637.abstract Adults with probable dementia received 171 hours of monthly informal care, versus 89 hours for cognitively impaired adults without dementia and 66 hours for cognitively normal adults 10/2015)]&lt;br /&gt;
&lt;br /&gt;
Emotions &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Mental Health Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1024.abstract Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. Innovative federal, state, and local programs have combined social services with mental health interventions to try addressing this. (6/2017)] &lt;br /&gt;
* [http://healthaffairs.org/blog/2016/07/25/patients-with-severe-schizophrenia-arent-getting-the-help-they-need/ Patients With Severe Schizophrenia Aren’t Getting The Help They Need (7/25/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/mind-and-mood/the-prevalence-and-treatment-of-mental-illness-today An estimated 26% of American adults live with a mental disorder in any given year, and 46% will have a mental disorder in their lifetime.] (11/2005)&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html 18% of adults in the U.S. have a mental, behavioral or emotional disorder. Most common are specific phobias (8.7%), such as those related to heights, spiders or flying, social phobia (6.8%) and major depression (6.6%) (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Impact on Health Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.businessinsurance.com/article/20170306/NEWS08/912312232/Detecting-mental-health-issues-can-cut-workers-comp-claims-costs Detecting mental health issues can cut workers comp claims costs. Hartford Financial Services Group analyzed its workers comp claim data from 2002 to 2015 and found that 10% of claims featured at least one psychosocial issue, and that those claims account for 60% of claims costs. (3/6/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/nov/behavioral-health-high-need-adults High-need adults—defined as those with three or more chronic conditions and a functional limitation—who have a diagnosed behavioral health condition among their multiple chronic conditions make greater use of some health care services than their counterparts without a behavioral health condition (11/22/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/36.abstract Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients (1/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/most-readmissions-aren-t-linked-to-suboptimal-care-study-finds.html A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness. (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
Opioid Addiction &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/ Patients With Mental Disorders Get Half Of All Opioid Prescriptions (6/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/ahrq-report-us-hospitals-see-sharp-rise-in-opioid-related-inpatient-stays-ed-visits.html Between 2005 and 2014, opioid-related emergency department visits nearly doubled and opioid-related inpatient stays increased 64% (6/20/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/cdc-likelihood-of-opioid-addiction-spikes-after-a-few-days-of-use.html CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days (3/17/17)]&lt;br /&gt;
* [http://khn.org/news/study-health-spending-related-to-opioid-treatment-rose-more-than-1300-percent/amp/ Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent In Four Year Period (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/prior-authorization-a-hurdle-for-patients-overcoming-opioid-dependency Insurer rules a hurdle for patients overcoming opioid dependency (8/5/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/15/patient-centered-research-can-improve-chronic-pain-care-and-address-opioid-abuse/ Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse (5/15/15)]&lt;br /&gt;
&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf Americans reporting at least one symptom of stress over the past month rose from 71% in August 2016 to 80% in January 2017. This includes headache (34%), feeling overwhelmed (33%), feeling nervous or anxious (33%), or feeling depressed or sad (32%). (2/15/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/12/chronic-stress-heart-attacks-study.amp Emotional stress has long been considered a major risk factor for heart disease. A new study suggests that heightened activity in the amygdala (the brain's fear and stress region) is associated with a greater risk of heart disease and stroke. (1/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/09/27/494922257/chill-out-stress-can-override-benefits-of-healthy-eating Stress Can Override Benefits Of Healthful Eating (9/27/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.technologyreview.com/s/603073/big-pharma-and-distracted-driving-are-killing-americans-early/amp/ Accidental poisoning increased 13%. 97% percent of accidental poisoning was from drug overdoses and alcohol (12/9/16)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin,methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Suicide &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/suicide-rates-for-teen-girls-hits-40-year-high.html Suicide rates for teen girls hits 40-year high (8/8/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-machine-learning-shows-promise-toward-accurately-identifying-suicidal-behavior Study found machine learning is 93% accurate in correctly identifying a suicidal person, and 85% accurate in determining differential diagnosis of mental illness (11/8/16)]&lt;br /&gt;
* [http://www.npr.org/sections/ed/2016/11/04/500659746/middle-school-suicides-reach-an-all-time-high Middle School Suicides Reach An All-Time High (11/4/16)]&lt;br /&gt;
&lt;br /&gt;
Treating Mental Health &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2016/05/13/hlthaff.2015.1659.abstract Mental Disorders top the list of the most costly conditions in the United States: $201 Billion] (5/2016)&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
* [http://hrsonline.isr.umich.edu/ Health and Retirement Study (HRS) surveys 20,000 people in America about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and health care expenditures. (3/2007)]&lt;br /&gt;
&lt;br /&gt;
Chronic Diesease &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/21/the-association-between-observed-mobility-and-quality-of-life-in-the-near-elderly/ Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life. (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Daily Activities Assistance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 6.9% of adults in 2015 over the age of 65 required assistance with personal care. (5/26/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/howardgleckman/2014/10/08/nearly-half-of-all-seniors-need-help-with-daily-activities-far-more-than-we-thought/ Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought] (10/8/14)&lt;br /&gt;
&lt;br /&gt;
Disabilities &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/4/626.abstract If all five risk factors were eliminated, 53% of disability could be prevented nationally if five risk factors were eliminated. The largest were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). (4/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/18/challenges-for-people-with-disabilities-within-the-health-care-safety-net/ Challenges For People With Disabilities Within The Health Care Safety Net. Nearly 57 million Americans had disabilities in 2010. (11/18/14)]&lt;br /&gt;
&lt;br /&gt;
Functional Independence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patients-functional-independence-may-predict-readmissions Patients' functional independence may predict readmissions (5/6/14)]&lt;br /&gt;
&lt;br /&gt;
Healthcare Costs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 The average healthcare cost for adults in the United States (2009-2011) was $4,845, for adults with 3 or more chronic conditions and no functional limitations was $7,526, for adults with 3 or more chronic conditions and functional limitation was $21,021 (8/29/16)]&lt;br /&gt;
&lt;br /&gt;
Homebound &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/26010119 An estimated 1.9 million U.S. adults age 65 or older are completely or mostly homebound, while another 5.3 million have functional limitations that make it hard to  leave their homes. (7/2015)]&lt;br /&gt;
* Homebound - [http://content.healthaffairs.org/content/34/1/21.abstract Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care.] (1/2015)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/q-and-a/2015/jan/invisible-homebound Treating the “Invisible Homebound”: Setting Standards for Health Care Provided at Home (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
Impairments &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. 44% of people with arthritis report activity limitations of everyday tasks, such as walking or lifting bags. (3/7/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/09/hearing-loss-linked-to-increased-risk-of-death/ Adults ages 70 years or older with moderate or more severe hearing impairment have a 54% increased risk of all causes of death (9/25/15)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Usual Activities&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 39.7 million persons (12%) were limited in their usual activities due to one or more chronic health conditions (12/2013)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/books/NBK92521/ About 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis limiting their functional status and adversely impacting their quality of life. The total financial cost of pain to society (health care and productivity estimates) ranges from $560 to $635 billion (2011 Study)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Work&lt;br /&gt;
* [https://www.theatlantic.com/business/archive/2017/03/mortality-of-american-men-and-the-labor-force/520329/ 43% of men in America ages 25 to 54 who are out of the labor force report their health as fair or poor, compared with 12% of employed men and 16% of unemployed men. (3/22/17)]&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 13.8 million adults aged 18–69 (6%) were unable to work due to health problems, and 6.7 million (3%) were limited in the kind or amount of work they could do because of their health (12/2013)]&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Genomic_Profiles_Determinants Genomic Profiles Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [https://www.ted.com/talks/moshe_szyf_how_early_life_experience_is_written_into_dna Epigenetics research suggests living things reprogram their genome in response to social factors like stress and lack of food. The biochemical signals passed from mothers to offspring tell the child what kind of world they're going to live in, changing the expression of genes. (7/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877678/ Scientists believe most, if not all, diseases arise from interactions between the genome, the epigenome (controls gene expression), and the environment (broadly defined to include social, behavioral, and physical agents). (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====High Need, High Cost Patients ''Insight''====&lt;br /&gt;
High-Need, High-Cost Patients &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-superusers-pennsylvania-ring-up-1-25b-tab-0 Superusers represent 3% of hospitalized patients in Pennsylvania consumed $1.25 billion in health care costs. (6/21/17)]&lt;br /&gt;
* [https://www.theatlantic.com/theplatinumpatients/ Each year, 1 in every 20 Americans racks up just as much in medical bills as another 19 combined. (6/15/17)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% did not have good access to services that could help them manage their daily living activities. 58% did not have good access to an informed and up-to-date care coordinator. (12/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 1.2% of employees are high cost claimants who comprise 31% of total health care spending according to a report on 26 large employers. (9/15/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1608511 Caring for High-Need, High-Cost Patients — An Urgent Priority (9/8/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps2 Health care spending for high-need adults exceeded $21,000 per person, nearly three times the average for adults with multiple chronic diseases only ($7,526) and more than four times that of all adults ($4,845). (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/aug/high-need-high-cost-meps Report Profiles The 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs (8/25/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/jun/listening-to-those-living-with-chronic-conditions Top concerns of high-need patients include: Paying for Care, Accessing Care, Insurance Frustrations,  Technology Can Be Helpful, Getting Help at Home (6/16/16)]  &lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2015/dec/primary-care-physicians-in-ten-countries Nearly 25% of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84% say they are not well prepared to manage patients with serious mental illness (12/7/15)]&lt;br /&gt;
* [http://features.commonwealthfund.org/improving-care-for-those-who-need-it-most Researchers are focusing on high-need, high-cost patients—both because they need the most help and because they have the biggest impact on national health spending. 5 percent of the U.S. population accounts for 50 percent of the nation’s health care costs. (11/11/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/8/1312.abstract?=right For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary. Only 28% of super-utilizers remained on top of the list at the end of a year. (8/2015)]&lt;br /&gt;
* [https://hcttf.org/wp-content/uploads/2018/01/WhitePaper-ProactivelyIdentifyingtheHighCostPopulation.pdf Proactively	Identifying the	High Cost Population - White Paper Insights from Health Care Transforamtion Task Force 5/14/15)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1315568?query=TOC&amp;amp; Hospital-dependent patient's medical problems cannot be managed outside the hospital. (2/20/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/challenge-frequent-fliers-20-er-visits-per-year-progress/ The challenge of frequent fliers: 20 ER visits per year is progress (11/11/13)]&lt;br /&gt;
* [http://khn.org/news/one-percent-of-costliest-patients/ Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending (10/7/13)]&lt;br /&gt;
* [http://berkeleyhealthcareforum.berkeley.edu/report/executive-summary/ 53% of California's healthcare expenditures are spent by just 5% of the population (2/2013)]&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Competencies_Determinants Competencies Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Literacy_Determinants Health Literacy Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.georgiahealthnews.com/2016/10/health-literacy-life-or-death-matter/ Health literacy can be a life-or-death matter. 1 out of 3 adult Georgians is functionally illiterate. Without a clear understanding of their health condition, these adults are more likely to skip necessary medical tests and have a harder time with diabetes management or high blood pressure numbers. (10/31/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/guide-surviving-chronic-disease.html A guide to surviving chronic disease (8/3/16)]&lt;br /&gt;
* Education - A [http://www.reuters.com/article/2013/06/26/us-cancer-cure-idUSBRE95P15320130626 survey] of patients with terminal lung cancer found nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. (6/26/13)&lt;br /&gt;
* [http://www.imedicalapps.com/2014/09/knee-guide-app-educates-engages-patients-total-knee-arthroplasty-care/ My Knee Guide App Educates and Engages Patients in Total Knee Arthroplasty Care (9/25/14)]&lt;br /&gt;
* [http://medcitynews.com/2015/05/video-replay-patient-education/ Surgeon entrepreneur develops video replay for specialist appointments to boost patient education (5/28/15)]&lt;br /&gt;
* [https://health.gov/communication/literacy/issuebrief/ 77 Million Adults Have Basic or Below Basic Health Literacy (2003)]&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Education &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/07/patients-need-education-role-care.html Patients need education about their role in care (7/3/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 39% patients admit they’re only somewhat knowledgeable, at best, about how to effectively manage their chronic condition. (7/2017)] from [http://www.jonespr.net/strengthening-chronic-care-download West] Study.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-addressing-alzheimer-s-risk-factors-could-lead-to-medicare-medicaid-savings.html Preventing and effectively managing obesity, diabetes, hypertension and cardiovascular disease can reduce onset and duration of dementia and reduce healthcare costs. (4/11/14)]&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/12/536519077/took-the-wrong-medicine-by-mistake-study-finds-such-errors-are-on-the-rise More People Are Making Mistakes With Medicines At Home (7/12/17)]&lt;br /&gt;
* [http://www.reuters.com/article/us-medication-errors-health-literacy-idUSKBN0FN1SK20140718 More than half of heart patients made mistakes taking their medications or misunderstood instructions (7/18/14)]&lt;br /&gt;
* [http://www.bbc.com/news/health-30556329 Only 7% of asthma sufferers were found to use asthma inhalers in the right way (12/20/14)]&lt;br /&gt;
&lt;br /&gt;
Physician Office Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/can-help-doctor-diagnose.html How a patient can help their physician diagnose them. 3/19/17)]&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Functional Competencies Determinants] that can decisively affect a patient's overall health and well-being. &lt;br /&gt;
&lt;br /&gt;
Literacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.kevinmd.com/blog/2017/08/literacy-health-care-problem-no-one-talks.html It is estimated that there are 23 million adults in the U.S. with limited literacy, defined as below basic literacy or non-literate. (8/18/17)]&lt;br /&gt;
&lt;br /&gt;
====Education ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Education_Determinants Education Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Social ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Patient_.28About_.26_History.29_Determinants Patient (About &amp;amp; History) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-death-rate-rises-for-first-time-in-decade-7-things-to-know.html American death rate rises for first time in decade. Rises in death rates from: Alzheimer's disease, heart diseases, suicide and unintentional injuries (auto accidents and drug overdoses) (6/1/16)]&lt;br /&gt;
* [http://www.pnas.org/content/112/49/15078.full.pdf Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (9/17/15)]&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Events_Determinants Adverse Events Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Adverse Childhood Events (ACEs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/09/29/444451363/childhood-stress-may-prime-pump-for-chronic-disease-later Childhood Stress May Prime Pump For Chronic Disease Later (9/29/15)]&lt;br /&gt;
* [http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime How childhood trauma affects health across a lifetime (9/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/12/2106.abstract Adverse Childhood Events (ACEs) on attributed to higher rates of chronic disease among children (12/2014)]&lt;br /&gt;
&lt;br /&gt;
Elder Abuse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf A study found an elder abuse incidence rate in New York State was nearly 24 times greater than the number of cases referred to social service, law enforcement or legal authorities. (see Page 2) (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Beliefs_Determinants Beliefs Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/aug/improving-population-health-management Patients who don't feel they can manage their health or navigate the health care system are more likely to develop a chronic disease over a three-year period than “activated” patients with good self-management skills. Low patient-activation levels are linked to significantly more hospitalizations and emergency department (ED) use. (8/23/16)]&lt;br /&gt;
&lt;br /&gt;
====Determination ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Determination_Determinants Determination Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Insight''====&lt;br /&gt;
* See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight People]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Resilience_Determinants_-_.28Psychological_Fitness.29 Resilience Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Optimism &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/07/504709736/a-brighter-outlook-could-translate-to-a-longer-life A Brighter Outlook Could Translate To A Longer Life (12/7/16)]&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/490841/ Psychological resilience plays a role in the molecular impact of traumatic experiences. Promoting resilience may have benefits for physical and mental health (7/12/16)]&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2015/10/stressful-jobs-makes-life-shorter/412951/ Study: Stressful Jobs Make Life Shorter. Researchers found that unhealthy workplaces can affect mortality. (10/29/15)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/10/how-stress-makes-you-sick/412699/ How Stress Makes You Sick. Feeling overwhelmed affects everything from digestion to stroke risk. (10/28/15)]&lt;br /&gt;
* [http://www.nature.com/news/bacteria-implicated-in-stress-related-heart-attacks-1.15396 Emotional or physical stress can trigger heart attacks may now have a scientific explanation (6/10/14)]&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Responsibilities_Determinants Responsibilities Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://mobile.reuters.com/article/idUSKCN0VO21Q Family caregivers may be sacrificing their own health to help loved ones (2/15/16)]&lt;br /&gt;
* [http://www.mhealthtalk.com/a-guide-for-the-older-caregiver/?utm_source=rss&amp;amp;utm_medium=rss&amp;amp;utm_campaign=a-guide-for-the-older-caregiver A caregiving spouse who is between the ages of 66 and 96 and under excessive mental or emotional strain has a 63% greater risk of dying compared to those who are not tasked with caregiving. (1/17/14)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282240/ Quality of life: impact of chronic illness on the partner (11/2001)]&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Well-Being_Determinants Social Well-Being Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Defining Well-Being &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2330497 Most medical research focuses on disease rather than wellness. The diverse and interconnected dimensions of physical, emotional and social well-being. It includes achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. (7/14/15)]&lt;br /&gt;
* [http://voxeu.org/article/origins-happiness Depression and Anxiety explains the largest variance in life satisfaction. Study shows eliminating Depression and Anxiety would have 4 times the impact of eliminating poverty in improving life satisfaction. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Competence &amp;amp; Control &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/11/30/independence-its-what-older-people-want/ Independence—It’s What Older People Want (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Loneliness &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/08/07/loneliness-public-health/ Why Loneliness Is a Public Health Threat. People with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles. (8/7/17)] &lt;br /&gt;
* [http://khn.org/news/social-isolation-may-worsen-breast-cancer-prospects/amp/ Social Isolation May Worsen Breast Cancer Prospects. Women with fewer social ties — to friends, family, community and religious groups, as well as spouses or romantic partners — were 43% more likely to see their breast cancer return, 64% more likely to die from breast cancer and 69% more likely to die from any cause (12/13/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors) 37% felt socially isolated and lacked companionship compared to 15% of other adults. (12/9/12)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/loneliness-a-bigger-risk-factor-for-death-than-obesity.html Loneliness a bigger risk factor for death than obesity (9/6/16)]&lt;br /&gt;
* [http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=137534&amp;amp;WT.mc_id=USNSF_51&amp;amp;WT.mc_ev=click The profound power of loneliness can depression and other serious health problems (2/3/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/12/loneliness-social-isolation-and-health/418395/ How Loneliness Wears on the Body. New research supports the idea that social isolation is detrimental to physical health—and that companionship may improve it. (12/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems Loneliness May Warp Our Genes, And Our Immune Systems (11/29/15)]&lt;br /&gt;
* [http://time.com/3747784/loneliness-mortality/ Loneliness increases risk of death by 26%. Social isolation — or lacking social connection — and living alone were found to be even more devastating to a person’s health than feeling lonely, respectively increasing mortality risk by 29% and 32% (3/18/15)]&lt;br /&gt;
* [http://www.pnas.org/content/110/15/5797.full Social isolation and loneliness are associated with increased mortality (9/12/12)]&lt;br /&gt;
&lt;br /&gt;
Love &amp;amp; Connection &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2014/05/isolation-and-death/362063/ Stressful relationships might be significantly shortening your life, are you better off alone? (5/13/14)]&lt;br /&gt;
&lt;br /&gt;
Purpose &amp;amp; Meaning &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/soul-purpose-seniors-with-strong-reasons-to-live-often-live-stronger/ Soul Purpose: Seniors With Strong Reasons To Live Often Live Stronger (8/31/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/28/479751942/could-thinking-positively-about-aging-be-the-secret-of-health People with a sense of purpose and having positive view about aging in late middle age lived about 7 and half years longer than the people who saw aging in a negative light. (5/28/16)]&lt;br /&gt;
&lt;br /&gt;
Social Influence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.time.com/time/health/article/0,8599,1646997,00.html If a friend is obese, there is a 57% greater chance of becoming obese. (7/25/07)]&lt;br /&gt;
&lt;br /&gt;
Social Via Smartphones &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/08/07/542016165/how-smartphones-are-making-kids-unhappy How Smartphones Are Making Kids Unhappy. Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. (8/7/17)]&lt;br /&gt;
&lt;br /&gt;
====Support ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Determinants Support Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Asking For Help &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/alone-and-aging-creating-a-safety-net-for-isolated-seniors/amp/ A growing number of seniors who find themselves alone just when aging and end-of-life care becomes real. They don’t know how to approach a casual acquaintance to ask for help when they need it most. (11/28/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/population-health-means-asking-about-basic-needs-are-your-providers-ready-for-that.html Population Health Means Asking About Basic Needs: Are Your Providers Ready for That? (11/20/13)]&lt;br /&gt;
&lt;br /&gt;
Addressing Social Determinants&lt;br /&gt;
* [http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/ Improving population health will require broader approaches that address social, economic, and environmental factors that influence health. (11/4/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/21/with-the-aca-secure-its-time-to-focus-on-social-determinants/ Literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral, and environmental factors. It’s Time To Focus On Social Determinants. (7/21/15)] &lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/05/why-its-time-to-improve-the-social-determinants-of-health.html Why it’s time to improve the social determinants of health (5/1/15)]&lt;br /&gt;
* [https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf Going Beyond Clinical Walls to address the other 80% of determinants that are often challenging to address in clinical visits. (10/2014)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/may/addressing-patients-social-needs Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment (5/29/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 70 percent of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease. (7/2017)]&lt;br /&gt;
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Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://morningconsult.com/opinions/importance-nonemergency-medical-transportation-vulnerable-patients/ The Importance of Nonemergency Medical Transportation for Vulnerable Patients. One patient has to take two bus rides and walk a mile just to get herself and two young children to the doctor. (1/25/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/antifraud/fierce-exclusive-beneath-patient-transportation-arrangements-a-subtle-layer-fraud Unreliable or inaccessible transportation has emerged as a significant patient care issue. Legal experts say healthcare systems providing rides to patients raises concerns that they could be violating the Anti-Kickback Statute or providing a beneficiary inducement. (8/31/16)]&lt;br /&gt;
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===Socioeconomic ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Socioeconomic_Determinants Socioeconomic Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
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*[https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/ If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. (8/17/17)]&lt;br /&gt;
====Can't Afford Treatments ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Can.27t_Afford_Treatments_Determinants Can't Afford Treatments Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Delay Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-half-of-millennials-have-delayed-medical-care-because-of-cost.html Half of millennials have delayed medical care because of cost (1/1/16)]&lt;br /&gt;
* [http://www.gallup.com/poll/187190/cost-delays-healthcare-one-three.aspx 31% Americans say that they or a family member have put off any sort of medical treatment in the past year because of the cost (11/30/15)]&lt;br /&gt;
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Reduce Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-half-of-aca-exchange-customers-skimp-on-healthcare-to-reduce-costs.html Half of ACA exchange customers skimp on healthcare to reduce costs (10/28/16)]&lt;br /&gt;
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Skip Medical Care &amp;lt;Br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-1-in-3-older-millennials-skips-medical-care-because-of-costs.html Survey: 1 in 3 older millennials skips medical care because of costs (6/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/nov/international-survey-release About one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. (11/16/16)]&lt;br /&gt;
* [http://archpedi.jamanetwork.com/article.aspx?articleid=1872780 Financial Barriers to Care Among Low-Income Children With Asthma (7/2014)]* [http://money.cnn.com/2013/04/26/news/economy/health-care-cost/ 80 million people (43% of America's working-age adults) didn't go to the doctor or access other medical services last year because of the cost (4/26/13)]&lt;br /&gt;
&lt;br /&gt;
====Financial ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Financial_Determinants Financial Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Annual Healthcare Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2016/05/24/annual-healthcare-cost-for-family-of-four-now-at-25826/#33aa77f75226 Healthcare Costs in 2016 for a Family of Four Will Be $25,826 (5/24/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2015/05/19/annual-healthcare-cost-for-family-of-four-now-at-24671/#29d013444dfb Annual Healthcare Cost For Family Of Four Now At $24,671 (5/19/15)]&lt;br /&gt;
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Fear of Healthcare Costs&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/53-of-americans-equate-unaffordable-medical-bills-to-being-diagnosed-with-a-serious-illness.html 53% of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness (3/21/17)]&lt;br /&gt;
* [http://www.healthpopuli.com/2017/02/08/health-care-worries-top-terrorism-far-americans-minds/ Health Care Worries Top Terrorism, By Far, In Americans’ Minds (2/8/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/healthcare-finances-a-source-of-fear-for-75-of-consumers.html Healthcare finances a source of fear for 75% of consumers (2/7/17)]&lt;br /&gt;
* [http://www.businesswire.com/news/home/20141006006149/en/Cigna-Consumer-Survey-%E2%80%98Health-Costs-Derail-Financial#.VDg8PvldXng 75% fear health costs could ruin prospects for secure retirement (10/6/14)]&lt;br /&gt;
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Financial Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthpopuli.com/2017/04/26/financial-stress-health-risk-factor-impacts-americans/ Financial Stress As A Health Risk Factor Impacts More Americans (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% of high-need said they experience stress about their ability to afford housing, utilities or nutritious meals compared to 32% of other adults. (12/9/16)]  &lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-bills-lead-to-serious-debt-for-some-americans-6-things-to-know.html 85% of employees in survey in 2015 reported at least some level of financial stress. 33% were assessed as having serious debt, such as student debt, medical bills and/or credit card debt. (7/20/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/federal-reserve-board-47-of-americans-struggle-to-pay-unexpected-400-bill.html  47% of Americans struggle to pay unexpected $400 bill (6/8/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/54.abstract For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships (1/2016)]&lt;br /&gt;
* [http://www.pwc.com/us/en/private-company-services/publications/financial-well-being-retirement-survey.html Survey shows 52% of employees stressed about their finances. 45% saying that financial matters cause the most stress, nearly as many as stress from job, health, or relationships combined. (2016 Employee Financial Wellness Survey)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/more-americans-struggle-healthcare-costs 46% of Americas described paying for care as a hardship rather than affordable (12/19/14)]&lt;br /&gt;
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Health Inequality &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2017/06/05/america-is-a-world-leader-in-health-inequality/?utm_term=.7c7983e42f5c People in households making less than $22,500 a year, 38% reported being in poor or fair health. That's more than three times the rate of health troubles faced by individuals in households making more than $47,700 a year. (6/5/17)]&lt;br /&gt;
* [http://www.hhnmag.com/articles/7416-look-to-income-inequality-to-help-explain-population-health Having less money is linked to poorer health regardless of personal habits. (7/5/16)]&lt;br /&gt;
* [https://www.brookings.edu/research/what-growing-life-expectancy-gaps-mean-for-the-promise-of-social-security/ Life expectancy is higher for the wealthiest. Among American men born in 1940, the wealthiest 10% are expected to live on average 12 years longer than the poorest 10%. (2/12/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/costs-deter-low-income-patients-from-participating-in-clinical-trials.html Costs deter low-income patients from participating in clinical trials (11/3/15)]&lt;br /&gt;
* [http://www.nytimes.com/2014/04/06/health/even-small-medical-advances-can-mean-big-jumps-in-bills.html?from=homepage&amp;amp;_r=0 New innovative treatments and technology is often out of the reach of low income patients. (4/5/14)]&lt;br /&gt;
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Medical Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/half-of-uninsured-people-face-problems-with-their-medical-bills-9-survey-findings.html Half of uninsured people face problems with their medical bills (8/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/61-of-patients-confused-by-medical-bills-survey-finds.html 61% of patients confused by medical bills, survey finds (7/14/16)]&lt;br /&gt;
* [http://www.cbsnews.com/news/cdc-one-in-five-americans-cant-pay-medical-bills/ CDC: One in five Americans can't pay medical bills (9/30/13)]&lt;br /&gt;
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Prescription Drugs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/sticker-shock-forces-thousands-of-cancer-patients-to-skip-drugs-skimp-on-treatment/amp/ Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (3/15/17)]&lt;br /&gt;
* [http://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/ Faced With Unaffordable Drug Prices, Tens Of Millions Buy Medicine Outside U.S. (12/20/16)]&lt;br /&gt;
&lt;br /&gt;
Price Shopping for Medical Services &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.marketwired.com/press-release/survey-finds-healthcare-providers-benefit-from-up-front-cost-estimates-yet-many-patients-nyse-tru-2192070.htm Survey found 43% said it was somewhat or very difficult to get information on costs, while another 21% of patients had never tried to get procedure cost information. (1/31/17)]&lt;br /&gt;
* [http://khn.org/news/consumer-choices-have-limited-impact-on-u-s-health-care-spending-study/ Less than 7% of total health care spending in 2011 was paid by consumers for “shoppable” services. (3/4/16)]&lt;br /&gt;
&lt;br /&gt;
====Food Insecurity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Food_Insecurity_Determinants Food Insecurity Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.hpoe.org/resources/ahahret-guides/3058 Social Determinants of Health Series: Food Insecurity(8/3/17)]&lt;br /&gt;
* [http://online.liebertpub.com/doi/abs/10.1089/pop.2015.0127 Study of food insecurity in patients with high rates of inpatient hospitalization (“super-utilizers”). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed. Using USDA definition of food insecurity, 30% were food insecure and 25% were marginally food secure. 40% responded that, in the past 30 days, they worried that their food would run out; 17.5% that they did not eat for a full day. 75% were unable to shop for food on their own and 58% were unable to prepare their own food. (12/1/16)]&lt;br /&gt;
* [http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html 42.2 million Americans lived in food insecure households in 2015 (29.1 million adults and 13.1 million children). (2016)]&lt;br /&gt;
* [http://pdf.aarpfoundation.org/i/455086-aarp-foundation-findings-on-nutrition-knowledge-and-food-insecurity-among-older-adults Nearly 9 million older adults in the United States experience food insecurity. (12/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1949.abstract Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1830.abstract Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. (11/2015)]&lt;br /&gt;
* [http://khn.org/news/in-sunlit-paradise-seniors-go-hungry/ In Sunlit Paradise, Seniors Go Hungry (5/26/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/03/food-insecurity-undiagnosed-medical-problem.html Food insecurity is an undiagnosed medical problem (3/6/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/1/116.abstract Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia (1/2014)]&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Insurance_Determinants Health Insurance Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [https://www.nytimes.com/2017/05/08/upshot/a-medicare-drug-incentive-that-leads-to-greater-hospitalizations.html For sicker Medicare beneficiaries, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits (5/8/17)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/09/16/494139538/studies-link-cancer-patients-survival-time-to-insurance-status Studies Link Cancer Patients' Survival Time To Insurance Status (9/16/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/958.abstract?=right Insurance is paying for more of the cost of treating mental health conditions (68%) but not for Substance Use Disorders (46%) (6/2016)]&lt;br /&gt;
* [http://khn.org/news/new-health-plans-offer-discounts-for-diabetes-care/ New health plans offer discounts and give gift cards to encourage patients to use diabetes care (11/17/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aca-health-plans-limit-access-to-specialists-7-findings.html ACA health plans limit access to specialists: 7 findings (10/28/15)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2015/09/21/insurance-healthy-behavior-key-reducing-cost-chronic-disease/72563266/ Study showed total cost for insured members with no chronic conditions was $3,024 a year ($2,204 out-of-pocket) and members with two or more chronic conditions was $11,940 a year ($3,500 out-of-pocket). (9/21/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/why-doctors-must-discuss-costly-treatment-before-patients-receive-bills Why doctors must discuss costly treatment before patients receive bills (10/18/13)]&lt;br /&gt;
&lt;br /&gt;
Denied Coverage &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/many-patients-chronic-illnesses-find-insurance-providers-deny-treatment-new-survey-says 'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says (8/16/17)]&lt;br /&gt;
Dual Eligible Patients (Qualify for Medicare and Medicaid) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://files.kff.org/attachment/Testimony-of-Gretchen-Jacobson-Ways-and-Means-Committee-Subcommittee-on-Health Low-income people on Medicare who receive assistance from Medicaid tend to have more chronic conditions, as well as cognitive and functional limitations, than others on Medicare: 61% vs. 33% need assistance with one or more activities of daily living, such as eating, bathing, and dressing; more than half, 58% vs. 29% have a mental condition or cognitive impairment; 37% vs. 27% have five or more chronic conditions; 18% vs 6% rate their health status as poor. (6/7/17)]&lt;br /&gt;
&lt;br /&gt;
Employer Sponsored Health Insurance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/interactives-and-data/maps-and-data/employer-health-insurance-premiums State-by-State Look at Employer Health Insurance Costs Finds Workers’ Premium Contributions and Deductibles Growing More Slowly But Eating Up Greater Share of Incomes (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/employer-family-plan-premiums-soar-above-18k-in-2016.html Employer family health plan premiums soar above $18k in 2016 (9/14/16)]&lt;br /&gt;
&lt;br /&gt;
High Deductable Health Plans (HDHPs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/10-things-to-know-about-2016-healthcare-consumer-payment-trends.html Consumers insured through high-deductible health plans increased from 10 million in 2010 to 75 million in 2016. The average deductible for individuals with employer-based coverage doubled from $735 in 2010 to $1,478 in 2016. Patient payments to providers increased 58% from 2013 to 2016. (6/13/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/cdc-nearly-40-of-us-adults-have-high-deductible-health-plans.html CDC: Nearly 40% of US adults have high-deductible health plans (6/7/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patients-with-chronic-illness-and-high-deductibles-more-likely-to-delay-care-study-finds.html Patients with chronic illness and high deductibles more likely to delay care, study finds. People with three or more chronic conditions were also nearly three times as likely to delay or avoid care as those without chronic conditions (25% compared to 9%) (11/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/given-the-choice-34-of-employees-choose-hdhps.html Given the choice, 34% of employees choose HDHPs (5/3/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly one-quarter of workers are enrolled in an High Deductable Health Plan, up from 4% in 2006. (2/4/16)]&lt;br /&gt;
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Medicaid &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://healthpayerintelligence.com/news/spike-in-late-stage-cancer-diagnosis-related-to-medicaid-cut Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut (7/5/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare Beneficiaries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/ Half of all Medicare beneficiaries had incomes below $26,200 in 2016 (4/21/17)]&lt;br /&gt;
Patient Out-of-Pocket Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medicare-cancer-patients-without-additional-coverage-hit-with-high-out-of-pocket-costs-4-things-to-know.html Medicare cancer patients without additional coverage hit with high out-of-pocket costs (11/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patient-payment-responsibility-spiked-13-in-2015.html Patient payment responsibility spiked 13% in 2015 (6/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/may/on-medicare-but-at-risk 16 percent of Medicare beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. (5/10/16)]&lt;br /&gt;
* [http://www.healthsystemtracker.org/insight/payments-for-cost-sharing-increasing-rapidly-over-time/?utm_campaign=KFF-2016-Peterson-Cost-Sharing-Analysis&amp;amp;utm_medium=email&amp;amp;_hsenc=p2ANqtz-_fzaJSkoJE-fetaUk0iwQOwPP__Fpq1BkKAV4WPcOHEuKp1Ww3jVG7Fl41gr19-i_hWcUPOy The average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. (4/12/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly half of workers are covered by an insurance plan with a general annual deductible of at least $1,000 for individual coverage. (2/4/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/high-out-pocket-expenses-narrow-insurance-networks-send-more-patients-to-ers High out-of-pocket expenses, narrow insurance networks send more patients to ERs (10/26/15)]&lt;br /&gt;
* [http://kff.org/report-section/ehbs-2015-summary-of-findings/ Workers with health insurance covered by their employers have an annual deductible amount for single coverage of $1,318. (9/22/15)]&lt;br /&gt;
&lt;br /&gt;
Surprise Out-of-Network Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/many-medicare-advantage-members-burned-by-out-of-network-bills.html Many Medicare Advantage members burned by out-of-network bills due to changes in network providers (11/28/16)]&lt;br /&gt;
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Uninsured &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/lists/2016/remaining-uninsured Why Do Millions of U.S. Adults Remain Uninsured? 1) The ACA excludes undocumented immigrants; 2) Nineteen states have not expanded Medicaid eligibility; 3) Many people still don’t know about the health insurance marketplaces; 4) Affordability is a concern; 5) Selecting a plan can be difficult: 6) Many aren’t getting the help they need. (10/21/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/federal-estimate-of-uninsured-falls-to-record-low-7-statistics.html Federal estimate of uninsured falls to record low 8.6% (9/7/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/who-are-the-remaining-uninsured Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? (8/18/16)]&lt;br /&gt;
* [http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf The percentage uninsured in 2015 was 10.5% (28.4 million) (5/2016)]&lt;br /&gt;
* [http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Uninsured nonelderly Americans in 2014 was 32 million. 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Over 5 in 10 of uninsured have family income below 200% of poverty. (10/5/15).]&lt;br /&gt;
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====Income &amp;amp; Work ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Income_.26_Work_Determinants Income &amp;amp; Work Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-working-night-shifts-furthers-health-disparities.html How working night shifts furthers health disparities (10/25/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3064755/work-smart/study-finds-work-life-balance-could-be-a-matter-of-life-and-death Study found that those who work in high-stress jobs with little control are more likely to die sooner than those who have more control over and balance in their work. (10/20/16)]&lt;br /&gt;
&lt;br /&gt;
* [http://healthcare-economist.com/2016/09/26/effect-of-job-loss-on-physical-and-mental-health/ Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results similar for mental health. (9/26/16)]&lt;br /&gt;
* [http://khn.org/news/low-income-patients-face-hurdles-to-care-at-public-hospital-in-miami/ Low-Income Patients Face Hurdles To Care At Public Hospital (8/28/14)]&lt;br /&gt;
* [http://www.nccp.org/topics/childpoverty.html More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level]&lt;br /&gt;
&lt;br /&gt;
Labor Force Participation &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2016-10-07/why-are-so-many-men-not-working-they-re-in-pain A large share of American men between the ages of 25 and 54 who aren’t in the labor force may suffer from serious health conditions that are “a barrier to work” and suffer physical pain, sadness, and stress in their daily lives. (10/7/16)]&lt;br /&gt;
Lack of Sick Leave &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.wbur.org/npr/484960907/hassle-of-being-a-patient-can-turn-into-a-crisis-without-sick-leave Hassle Of Being A Patient Can Turn Into A Crisis Without Sick Leave. Third of working Americans say their jobs don't offer paid sick days (7/11/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/3/520.abstract Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. 3.0 times more likely to forego medical care for themselves and 1.6 times more likely to forego care for family (3/2016)] &lt;br /&gt;
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Low Income Impact on Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/socioeconomic-hardships-hurt-dual-eligibles-health-outcomes Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid (4/2/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/03/screening-poverty-included-medical-curriculum.html Low socioeconomic status (SES) is a risk factor for a multitude of medical conditions including cardiovascular disease, respiratory disease, cancer, and mental illness. (3/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/employment-status-top-socioeconomic-factor-readmissions Employment status top socioeconomic factor in readmissions (12/11/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/08/29/exhibit-of-the-month-income-related-disparities-associated-with-negative-health-outcomes/ Income-Related Disparities Associated With Negative Health Outcomes (8/29/14)]&lt;br /&gt;
* [http://hin.com/Healthcare_Business_Weekly_Update/2014/06/06/data-dive-uncovers-socioeconomics-driving-er-visits-readmissions/ Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions (6/6/14)]&lt;br /&gt;
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Work environment &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/258.abstract?=right Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence (2/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1761.abstract Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups (10/2015)]&lt;br /&gt;
&lt;br /&gt;
====Legal ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Legal_Determinants Legal Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Jail Involved &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/05/499775644/helping-ex-inmates-stay-out-of-the-er-brings-multiple-benefits Early access to primary care for ex-inmates can bring down healthcare costs by keeping them out of the ER (12/5/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/443.abstract The Critical Link Between Health Care And Jails (3/2014)]&lt;br /&gt;
&lt;br /&gt;
===Environmental ''Insight''===&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Access &amp;amp; Logistics ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Access_.26_Logistics_Determinants Access &amp;amp; Logistics Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Disability &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.mentalhealthamerica.net/sites/default/files/Parity%20or%20Disparity%20Report%20FINAL.pdf There is only 1 mental health provider for every 790 individuals. One out of three adults with disability could not see a doctor because of costs. (2015)]&lt;br /&gt;
Rural or Remote Area &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/patients-lacking-pharmacy-access-likely-to-readmitted-to-hospital Patients in rural or remote communities with lack of access to a pharmacy may be more likely to end up back in the hospital (8/4/16)]&lt;br /&gt;
* [https://www.minnpost.com/health/2014/06/late-life-live-home-rural-seniors-need-food-socialization-support Late-in-life: To live at home, rural seniors need food, socialization, support (6/23/14)]&lt;br /&gt;
* [http://www.rand.org/pubs/research_reports/RR578.html Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care. (2015)]&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/ Transportation barriers to health care access are common, and greater for vulnerable populations. (12/2013)]&lt;br /&gt;
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====Communication ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Communication_Determinants Communication Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Community ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Community_Determinants Community Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://cdnfiles.americashealthrankings.org/SiteFiles/Reports/2015_Am_Health_Ranking.pdf America’s Health Rankings of Behaviors, Community &amp;amp; Environment, Policy, and Clinical Care determinants of health that directly influence health outcomes (2015 Edition)]&lt;br /&gt;
* [http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Apr/Community-Factors-and-Hospital-Readmission-Rates.aspx Community factors most strongly associated with lower hospital readmission rates include more general practitioners and fewer specialists per capita and the presence of high-quality nursing home care. (4/17/14)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html Time to Act: Investing in the Health of Our Children and Communities (1/13/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/29/3/503.long Children had a 20-60% higher likelihood of being obese or overweight if living in neighborhoods with unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers. (3/2010)]&lt;br /&gt;
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Clean Air &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html The surprising link between air pollution and Alzheimer’s disease (1/31/17)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/world/air-pollution-smog-who.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ More Than 9 in 10 People Breathe Bad Air, W.H.O. Study Says (9/28/16)]&lt;br /&gt;
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Clean Water &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/08/14/63-million-americans-exposed-unsafe-drinking-water/564278001/ 63 million Americans exposed to unsafe drinking water (8/14/17)]&lt;br /&gt;
* [http://www.reuters.com/investigates/special-report/usa-lead-testing/ Water testing for lead levels found almost 3,000 areas with poisoning rates far higher than in Flint Michigan. Yet many of these lead hotspots are receiving little attention or funding. (12/19/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/as-water-infrastructure-ages-cost-treating-infections-rise Researchers believe as much as $2 billion of healthcare costs each year is tied to the treatment of infections that lurk in water distribution systems. (9/19/16)]&lt;br /&gt;
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Community Related - Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1571 Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990–2013 (8/2017)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/05/08/u-s-life-expectancy-varies-by-more-than-20-years-from-county-to-county/ U.S. life expectancy varies by more than 20 years from county to county (5/8/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/tackling_life_expect.html A person born in Princeton, NJ can expect to live 87 years, his or her neighbor a dozen miles away in Trenton has a life expectancy of 73 years (11/9/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thetwo-way/2016/04/11/473749157/its-not-just-what-you-make-its-where-you-live-says-study-on-life-expectancy Life Expectancy Study: It's Not Just What You Make, It's Where You Live (4/11/16)]&lt;br /&gt;
&lt;br /&gt;
Countries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/when-it-comes-to-healthcare-u-s-once-again-ranks-last-quality-care-compared-to-other When it comes to healthcare, U.S. once again ranks last in quality care compared to other wealthy nations (7/14/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/global-study-700k-smartphone-users-shows-link-between-obesity-and-activity-inequality Global study of 700K smartphone users shows link between obesity and activity inequality within country (7/11/17)]&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.revealnews.org/blog/14-million-kids-could-be-exposed-to-toxic-pcbs-at-school/ 14 million US kids could be exposed to toxic PCBs at school (10/12/16)] &lt;br /&gt;
&lt;br /&gt;
Food Deserts &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0122 Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14 (8/2017)]&lt;br /&gt;
* [http://www.ers.usda.gov/amber-waves/2010-march/access-to-affordable,-nutritious-food-is-limited-in-%E2%80%9Cfood-deserts%E2%80%9D.aspx Some neighborhoods in US, mostly in low-income areas, have been dubbed “food deserts” because they don't have supermarkets or other food retailers that carry affordable and nutritious food. (3/1/2010)]&lt;br /&gt;
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Food Safety &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lead-detected-in-20-of-baby-food-samples-surprising-even-researchers/ Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers (6/15/17)]&lt;br /&gt;
&lt;br /&gt;
Low Income Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/999.abstract One’s neighborhood may drive or influence health disparities, which can be understood as disadvantages in health associated with one’s social, racial, economic, or physical environment, originate in childhood and persist across an individual’s life course. (6/2017)]&lt;br /&gt;
*[http://www.theatlantic.com/business/archive/2016/04/why-the-poor-die-young/477846/ A massive study of health and income found that smoking, obesity, and exercise are the most important determinants of longevity. Poor neighborhoods score worse in all of them. (4/12/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1383.abstract People who live in lower-income neighborhoods have a higher rate of diabetic lower-extremity amputations than those in more affluent areas (8/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/06/13/well/live/noise-may-raise-blood-pressure-risk.html Noise May Raise Blood Pressure Risk based on a study of people who lived near Athens International Airport (6/13/17)]&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
Walkable Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27218630 Higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012 (5/24/16)]&lt;br /&gt;
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====Home ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Home_Determinants Home Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.mhealthtalk.com/common-problems-solutions/ The most common problems as you age in your home. (8/7/16)]&lt;br /&gt;
&lt;br /&gt;
Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.miamiherald.com/opinion/op-ed/article113730634.html Affordable housing, quality healthcare can let seniors age in place (11/9/16)]&lt;br /&gt;
* [http://www.stltoday.com/lifestyles/health-med-fit/health/want-a-better-chance-to-stay-out-of-a-nursing/article_c1b66d15-7afd-5b85-8e95-d83cc13d8f16.html Want a better chance to stay out of a nursing home? Modify your home (11/6/16)]&lt;br /&gt;
* [http://www.nytimes.com/2015/06/23/health/at-home-many-seniors-are-imprisoned-by-their-independence.html?ref=health&amp;amp;_r=3 Many seniors living at home feel imprisoned by their independence] (6/19/15)&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2016/07/gas-leaks-mold-and-rats-millions-of-americans-live-in-hazardous-homes/492689/ Gas Leaks, Mold, and Rats: Millions of Americans Live in Hazardous Homes (7/25/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/01/important-lesson-personalized-patient-care.html Controlling environmental allergens can reduce sneezing and nasal congestion that trigger asthma (1/1/14)]&lt;br /&gt;
* [http://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet Scientists estimate that lung cancer deaths could be reduced by 2 to 4% by addressing the one in 15 homes the EPA believes has too much radon exposure]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/multi-faceted-home-ventilation-intervention-reduces-copd-readmissions-study-finds Multi-faceted home ventilation intervention reduces COPD readmissions, study finds (7/15/15)]&lt;br /&gt;
* [http://www.cdc.gov/nceh/lead/ At least 4 million households have children living in them that are being exposed to high levels of lead (1/29/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2009/07/improving-the-health-of-all-americans-through-safe-and-healthy-h.html Approximately 40% of the 6.7 million children with diagnosed asthma are believed to be attributable to residential exposures (7/2009)]&lt;br /&gt;
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Homelessness &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://academic.oup.com/jpubhealth/article-abstract/doi/10.1093/pubmed/fdx034/3074503/Lifetime-and-1-year-prevalence-of-homelessness-in?redirectedFrom=fulltext Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2% and 1.5%, respectively (3/18/17)]&lt;br /&gt;
&lt;br /&gt;
Home Injuries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commissiononhealth.org/PDF/e434bb61-64d3-4267-9dca-705b9d80ddaa/HousingFactSheetJun09.pdf An estimated 4 million emergency department visits and 70,000 hospital admissions were attributed to injuries at home. (6/2009)]&lt;br /&gt;
&lt;br /&gt;
Housing Instability &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/housing-instability-will-cost-healthcare-industry-111b-over-next-decade.html Housing instability will cost healthcare industry $111B over next decade (8/10/17)]&lt;br /&gt;
&lt;br /&gt;
Housing Quality &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.sciencedirect.com/science/article/pii/S1353829214001087 NYC heat-mortality rates are associated with poverty and poor housing quality. (11/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Security ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Security_Determinants Security Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
Neighborhood Violence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/chicagoans-rank-violence-as-top-concern-in-health-needs-assessment.html Injury and violence was ranked as top concerns among Chicago's South and West Side residents, along with diabetes, nutrition, physical activity and weight, substance abuse and tobacco use, according to a health needs survey. (6/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-link-between-neighborhood-violence-and-biological-stress-in-children.html Study finds link between neighborhood violence and biological stress in children (11/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Content_Determinants Digital Content &amp;amp; Technology Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Records_Determinants Medical Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [http://medcitynews.com/2014/01/trends-healthcare-giving-access-doctor-notes-can-stimulate-patient-engagement/ Giving access to doctor notes can stimulate patient engagement (1/6/14)]&lt;br /&gt;
* [https://www.healthit.gov/patients-families/blue-button/about-blue-button Medicare provides medical history on a mobile app (Blue Button) for patients and caregivers to share with doctors]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Determinants_Records Health Determinants Records] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Records_Determinants Health Interventions Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Outcomes_Records_Determinants Health Outcomes Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Technology_.26_Apps_Determinants Technology &amp;amp; Apps Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.chicagotribune.com/lifestyles/health/sc-devices-to-track-wandering-kids-with-autism-health-0517-20170508-story.html 96% of parents surveyed who said they were using an electronic tracking device for their child with autism claimed it improved their quality of life (5/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/may/mobile-health-and-patient-engagement-in-the-safety-net Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics (5/13/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Making and Condition Management&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/new-apps-aim-guide-men-through-treatment-symptom-management-prostate-cancer New apps aim to guide men through treatment, symptom management of prostate cancer (9/10/16)]&lt;br /&gt;
&lt;br /&gt;
Devices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-patients-often-misuse-wrist-blood-pressure-monitors-leading-inaccurate-readings Study finds patients often misuse wrist blood pressure monitors, leading to inaccurate readings (9/7/16)]&lt;br /&gt;
&lt;br /&gt;
Digital Health Apps &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.engadget.com/amp/2017/07/11/lumosity-does-not-improve-cognitive-skills/ Lumosity doesn’t actually improve your cognitive skills (7/11/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/internet-mobile-disease-interventions-seem-work-longterm-studies-are-lacking Internet, mobile disease interventions seem to work, but long term studies are lacking (9/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-health-apps-near-meaningless-for-low-income-patients-with-chronic-conditions.html Study: Health apps near meaningless for low-income patients with chronic conditions (7/20/16)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/03/rehab-app-shoulder-rotator-cuff/ Rehab App Aims to Improve Shoulder &amp;amp; Rotator Cuff Repair Rehabilitation (3/21/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/commonwealth-fund-reasonably-small-number-chronic-health-apps-are-useful Some 43 percent of iOS health apps and 27 percent of Android health apps are useful. (2/22/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/copd-management-apps/ 5 digital health tools that could improve COPD management (12/3/15)]&lt;br /&gt;
* [http://www.imedicalapps.com/2014/11/cardiosmart-explorer-great-tool-educating-patients-clinic/ CardioSmart Explorer is a great tool for educating patients with cardiac disease (11/21/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/oct/vision-digital-health-tech A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System (10/1/14)]&lt;br /&gt;
* A [http://mobihealthnews.com/23418/most-patients-want-their-doctors-to-prescribe-apps/ study] from Digitas Health found that 90 percent of chronic patients in the US would accept a mobile app prescription as opposed to only 66 percent willing to accept a prescription of medication. (7/1/13)&lt;br /&gt;
&lt;br /&gt;
Digital Health Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-technology-self-monitor-blood-glucose-levels-no-better-traditional-management JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/content/study-patients-are-more-compliant-alivecor-devices-traditional-event-monitors Patients are more compliant to  smartphone-connected heart monitor devices than traditional event monitors (5/5/16)]&lt;br /&gt;
* [http://journals.lww.com/neurologynow/Citation/2015/11040/Wearing_the_Detectives__Wristbands,_smartwatches,.23.aspx Wristbands, smartwatches, and other wearable devices allow for more real-time monitoring of seizures and other neurologic symptoms—and, possibly, more precise treatment. (8/2015)]&lt;br /&gt;
&lt;br /&gt;
Home Automation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/top-home-tech-for-seniors-infographic/ Top Home Tech for Seniors (7/28/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/home-automation-and-home-health-care/ Home automation and in-home care aid gives patients independence without sacrificing their health needs. (3/25/14)]&lt;br /&gt;
&lt;br /&gt;
Internet Access &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/a-growing-number-people-chronic-conditions-also-lack-internet-access A growing number of people with chronic conditions also lack internet access (6/9/17)]&lt;br /&gt;
* [http://www.huffingtonpost.com/jane-sarasohnkahn/broadband-connectivity-is_b_11059720.html Broadband Connectivity Is A Social Determinant Of Health (7/22/16)]&lt;br /&gt;
&lt;br /&gt;
Technology Efficacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/smart-pill-bottles-didn-t-improve-adherence-for-heart-attack-patients-but-researchers-say Smart pill bottles didn’t improve medication adherence for heart attack patients, but earlier intervention could help (6/26/17)]&lt;br /&gt;
&lt;br /&gt;
==Impacting People Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Physicians ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Disciplines_.26_Resources_Determinants Physician Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Primary Care Physicians &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/many-americans-don-t-have-a-primary-care-doctor Some 28% of U.S. men and 17% of women don’t have a personal doctor or healthcare provider, according to a government survey. (1/12/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Team Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_.26_Resources_Determinants Care Team &amp;amp; Resources Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
====Credentialed Care Specialists Insight====&lt;br /&gt;
Nurses &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/how-a-specialist-nurse-can-help-with-dementia/ How a Specialist Nurse can Help with Dementia (6/21/14)]&lt;br /&gt;
&lt;br /&gt;
====Credentialed Support Providers Insight====&lt;br /&gt;
&lt;br /&gt;
====Team-Based Approach====&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/04/526475132/to-bring-down-stubbornly-high-blood-pressure-it-helps-to-have-a-team To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team (5/4/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/team-based-care-can-have-negative-financial-impact-on-primary-care-in-ffs-environment.html Team-based care can have negative financial impact on primary care in FFS environment (8/10/16)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2016/06/15/the-team-sport-of-diagnosis-a-culture-shift-can-reduce-missed-diagnoses/ The Team Sport of Diagnosis: A Culture Shift Can Reduce Missed Diagnoses (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Insight''===&lt;br /&gt;
Caregiver &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170807.061390/full/ More than a million youngsters ages 8–18 are caregivers taking on challenging tasks to help a parent, grandparent, sibling, or other relative. (8/7//17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-70-percent-caregivers-say-tech-plays-no-role-or-minor-role-their-work Survey: 70 percent of caregivers say tech plays no role or a minor role in their work (6/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/new-pennsylvania-law-requires-hospitals-to-educate-caregivers-upon-patient-discharge.html  New Pennsylvania law requires hospitals to educate caregivers upon patient discharge (4/27/17)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family-caregiving-cost-survey-res-ltc.pdf Study: Many Caregivers Spend $7K Annually Out Of Pocket, which is 20% of their income (11/14/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3065403/the-future-of-work/the-hidden-caregiving-crisis-that-the-election-wont-solve The number of U.S. workers struggling to care for ill or aging loved ones is growing fast. But the support they need isn't. (11/8/16)]&lt;br /&gt;
* [http://khn.org/news/study-elderlys-family-caregivers-need-help-too/amp/ Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones (9/14/16)]&lt;br /&gt;
* [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers In Some States, a New Focus on Family Caregivers. Nearly half of family caregivers administer multiple medications, treat wounds or operate specialized medical equipment. (6/22/16)]&lt;br /&gt;
* [http://khn.org/news/who-are-americas-caregivers-nearly-a-quarter-are-millennials/ Who Are The 40 Million American Caregivers? Nearly A Quarter Are Millennials (12/3/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/15-things-to-know-about-caregivers.html 15 things to know about caregivers (11/3/15)]&lt;br /&gt;
* [http://mobihealthnews.com/48054/new-council-will-guide-family-caregivers-to-available-tools/ New council will guide family caregivers to available tools (10/28/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/caregiver-frustration/ Nearly one-third struggle in their caregiving role and want tools to help them and their family members. 64% feel stressed and overwhelmed; nearly half struggle with balancing personal needs and caregiving. (10/24/15)]&lt;br /&gt;
* [http://khn.org/news/dementia-also-takes-toll-on-unpaid-caregivers-study-shows/ Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia (10/16/2015)]&lt;br /&gt;
* [http://www.usnews.com/news/us/articles/2015/07/14/ap-norc-poll-many-californians-unaware-of-caregiver-program Many Californians unaware of caregiver program for low-income seniors, disabled (7/14/15)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-undeniable-progress.pdf In 2013, about 40 million family caregivers in the US provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013. (7/2015)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf An estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the 12 months period in 2014 and 2015. (6/2015)]&lt;br /&gt;
* [http://medcitynews.com/2015/04/care-caregiver/ How Do We Care for the Caregiver (4/23/15)]&lt;br /&gt;
* [https://www.caring.com/about/news-room/costs-of-caregiving-2014 Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs (9/15/14)]&lt;br /&gt;
&lt;br /&gt;
Home Care (Non-Credentialed) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/ Lots Of Responsibility For In-Home Care Providers — But No Training Required (1/6/15)]&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends Determinants] that can decisively affect a patient's overall health and well-being. &amp;lt;br&amp;gt;&lt;br /&gt;
Spouse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.asco.org/about-asco/press-center/news-releases/large-study-finds-association-between-marriage-and-cancer Large Study Finds Association Between Marriage and Cancer Outcomes (9/23/13)]&lt;br /&gt;
&lt;br /&gt;
===Support Team Insight===&lt;br /&gt;
&lt;br /&gt;
Community Health Workers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/ Hospitals Eye Community Health Workers To Cultivate Patients’ Successes (4/11/16)]&lt;br /&gt;
* [http://khn.org/news/in-l-a-community-health-workers-are-part-of-the-medical-team/ In L.A., Community Health Workers Are Part Of The Medical Team (10/26/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/16/how-community-health-workers-can-reinvent-health-care-delivery-in-the-us/ How Community Health Workers Can Reinvent Health Care Delivery In The US (1/16/15)]&lt;br /&gt;
&lt;br /&gt;
Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html How Social Spending Affects Health Outcomes (8/17/16)]&lt;br /&gt;
* [https://thehealthcaremarketer.wordpress.com/2016/08/11/the-health-impact-in-5-years-hi-5-initiative/ Centers for Disease Control and Prevention (CDC) launches new initiative – Health Impact in 5 Years (HI-5). Promotes list of proven non-clinical, community-wide interventions that improved health within five years and are cost-effective or have cost-saving over the lifetime of the population. (8/11/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/politics/2016/05/02/social-service-shortfalls-hinder-health-boost-medical-spending/83625264/ Social service shortfalls hinder health, boost medical spending (5/3/16)] &lt;br /&gt;
* [https://www.icsi.org/_asset/nsnyw1/sharingknowledgedata.pdf Sharing Knowledge and Data at the Community/System Level To Address Social Determinants (4/2015)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/14/to-lower-the-cost-of-health-care-invest-in-social-services/ To Lower The Cost Of Health Care, Low-tech social services also should be considered a key factor in our health care equation. (7/14/15)]&lt;br /&gt;
* [http://www.cdc.gov/chinav/ CDC launches Community Health Improvement Navigator (CHI Navigator) website (5/2015)] with tools and resources from [http://www.thecommunityguide.org/ The Guide to Community Preventive Services], the [http://whatworksforhealth.wisc.edu/ What Works for Health database (on the University of Wisconsin website)], the [https://innovations.ahrq.gov/ AHRQ Health Care Innovations Exchange], the [http://cdc.thehcn.net/index.php?module=promisepractice&amp;amp;controller=index&amp;amp;action=index Healthy Communities Institute Promising Practices] and the [http://healthyamericans.org/ New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/11/understanding-intersection-health-care-social-services.html Understanding the intersection of health care and social services (11/10/13)]&lt;br /&gt;
&lt;br /&gt;
===Organizations Insight===&lt;br /&gt;
====Healthcare Organizations Insight====&lt;br /&gt;
====Government Organizations Insight====&lt;br /&gt;
====Employer Insight====&lt;br /&gt;
====Community and Social Services Organizations Insight====&lt;br /&gt;
====Support Resources Organizations Insight====&lt;br /&gt;
===Other Contributors Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Healthy Lifestyle ''Insight''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1569 The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed (8/2017)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1605086#t=article A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor). Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle. (12/15/16)]&lt;br /&gt;
* [http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract Study finds 2.7% of U.S. adults meet criteria for ‘healthy lifestyle’ (4/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ Scientist assert Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Only 5–10% of all cancer cases were attributed to genetic defects, whereas the remaining 90–95% is lifestyle factors including tobacco (25–30%), diet (30–35% - fried foods, red meat), infections (15–20%) the remaining alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity. (7/15/2008)]&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Insight''===&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/06/26/teenagers-are-as-sedentary-as-60-year-olds-by-age-19/?utm_term=.127016b508d0 Teenagers are as sedentary as 60-year-olds by age 19 (6/26/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/15/why-being-a-weekend-warrior-is-still-good-for-your-health/#EQ6NSxU86kqy Researchers found that the weekend warriors who met physical activity guidelines were less likely to die during the nine-year study period, compared with people who didn't get any exercise. A total of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity over one or two days a week. (1/15/17)]&lt;br /&gt;
* [https://www.technologyreview.com/s/602706/pokemon-go-increased-us-activity-levels-by-144-billion-steps-in-just-30-days/ Pokemon Go Increased U.S. Activity Levels by 144 Billion Steps in Just 30 Days (10/21/16)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ Brain Benefits of Exercise Diminish After Short Rest (9/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-more-than-a-quarter-of-adults-over-50-get-no-exercise-outside-of-daily-life-activities.html CDC: More than a quarter of adults over 50 get no exercise outside of daily life activities (9/20/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/27/study-suggests-new-formula-for-physical-activity-8-hours-of-sitting-means-1-hour-of-exercise/ Study suggests 1 hour of activity per 8 hours of sitting (7/27/16)]&lt;br /&gt;
&lt;br /&gt;
* [https://medlineplus.gov/podcast/transcript071816.html Moderate exercise is associated with a reduced risk of 13 types of cancer (7/18/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html The percentage of adults over 18 who met the 2008 federal physical activity guidelines for aerobic activity increased from 41.4 percent in 2006 to 49.5 percent in 2012. That rate has remained stable through 2015. (5/26/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-common-fund-launches-physical-activity-research-program NIH Common Fund launches physical activity research program to identify biological molecules that change in response to exercise (6/11/15)]&lt;br /&gt;
* [http://www.reuters.com/article/us-sedentary-television-mortality-idUSKBN0F65BW20140701 Too much TV tied to premature death (7/1/14)]&lt;br /&gt;
Children Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/johns-hopkins-us-could-save-21b-in-healthcare-costs-if-kids-played-outside-every-day.html Johns Hopkins: US could save $21B in healthcare costs if kids played outside every day (5/15/17)]&lt;br /&gt;
* [https://www.usatoday.com/story/news/health/2017/05/06/kids-inactivity-rises-creating-health-care-time-bomb/101245982/ The percent of children aged six to 12 who were physically active three or more times a week had its biggest drop in five years and is now under 25% (5/6/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/03/well/move/childs-play-is-good-for-all-of-us.html If all of the children who currently are sedentary started exercising every day in the United States alone, we could expect to save more than $120 billion every year in health care and associated expenses. (5/3/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/902 Modeling The Economic And Health Impact Of Increasing Children’s Physical Activity In The United States (5/2017)]&lt;br /&gt;
&lt;br /&gt;
Sitting &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/09/04/547580952/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later Study of sitting and walking ability over 8 to 10 years, those who sit the most and move the least had more than three times the risk of difficulty walking by the end of the study (9/4/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/sitting-can-be-bad-especially-if-you-do-it-for-more-than-10-hours-a-day/2016/07/22/43f7f228-4f77-11e6-aa14-e0c1087f7583_story.html Sitting can be bad, especially if you do it for more than 10 hours a day (7/24/16)]&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities Insight===&lt;br /&gt;
===Nutrition ''Insight''===&lt;br /&gt;
* [http://fortune.com/2017/07/17/artificial-sweeteners-weight-loss-study/ Artificial Sweeteners Won't Help You Lose Weight, According to a Sad but Important New Study (7/17/17)]&lt;br /&gt;
* [http://ajcn.nutrition.org/content/early/2017/06/07/ajcn.117.154872.abstract?papeto The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. (6/7/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1 Pediatricians Advise No Fruit Juice Until Kids Are 1 (5/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/15/well/eat/red-meat-increases-risk-of-dying-from-8-diseases.html Red meat increase risk of dying from 8 diseases (5/15/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/26/well/diet-sodas-tied-to-dementia-and-stroke.html Diet soda tied to dementia and stroke (4/26/17)] &lt;br /&gt;
* [https://www.statnews.com/2017/01/26/soda-sugary-drinks/ The number of calories per day that children and adults have been getting from soda and other sugar-sweetened beverages has been dropping for steadily for nearly 20 years, but new data show that since 2009 that number has plateaued. (1/26/17)] &lt;br /&gt;
* [http://www.alzheimersanddementia.com/article/S1552-5260(17)30050-X/fulltext Excess sugar consumption has been linked with Alzheimer's disease (AD) pathology in animal models. (1/24/17)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2529628 Dietary Intake Among US Adults, 1999-2012 Improved. The American Heart Association (AHA) primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). (6/21/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2016/03/more-than-half-of-what-americans-eat-is-ultra-processed/472791/ More Than Half of What Americans Eat Is 'Ultra-Processed'. And those foods account for 90 percent of U.S. added sugar intake, new research says.(3/10/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1916.abstract Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; Overall Diet Remains Poor (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1940.abstract Foods with the largest positive associations with three-year excess weight gain (among children and adolescents) were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages (11/2015)]&lt;br /&gt;
* [http://now.tufts.edu/news-releases/sugary-drinks-linked-high-death-tolls-worldwide Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year (6/29/15)]&lt;br /&gt;
* [http://openheart.bmj.com/content/2/1/e000196.full US and UK governments dietary guidelines introduced in 1977 and 1983 to reduce coronary heart disease (CHD) by reducing fat intake didn't have studies to support it. (2/9/15)]&lt;br /&gt;
&lt;br /&gt;
===Functional Activities Insight===&lt;br /&gt;
&lt;br /&gt;
Digital Health Usage &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-21-percent-americans-have-used-virtual-healthcare-78-percent-are-interested Survey: 21 percent of Americans have used virtual healthcare, 78 percent are interested (2/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/senior-citizens-rarely-use-digital-health-resources-5-study-findings.html Seniors rarely use digital health resources: 5 study findings (8/3/16)]&lt;br /&gt;
* [http://mobihealthnews.com/39189/parks-41-percent-of-caregivers-use-a-digital-health-device 41 percent of caregivers use a digital health device (12/18/14)]&lt;br /&gt;
* [http://mobihealthnews.com/38904/kaiser-members-who-use-app-are-more-adherent-satisfied-and-loyal/ Kaiser now has 70% of its 9 million members as active users of its online and mobile offerings, patients are more adherent, satisfied, and loyal (12/10/14)]&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Insight''===&lt;br /&gt;
* [https://www.alz.org/aaic/releases_2017/AAIC17-Tues-Briefing-Sleep.asp Interrupted sleep may lead to Alzheimer’s. Research found significant associations between sleep disordered breathing (SDB) and the accumulation of biomarkers for Alzheimer's disease. (7/18/18)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/06/504448639/drivers-beware-crash-rate-spikes-with-every-hour-of-lost-sleep Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep (12/6/16)]&lt;br /&gt;
* [http://mashable.com/2016/11/30/sleep-deprivation-economic-cost.amp In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death (11/30/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/08/24/432764792/snooze-alert-a-sleep-disorder-may-be-harming-your-body-and-brain Snooze Alert: A Sleep Disorder May Be Harming Your Body And Brain A Sleep Disorder May Be Harming Your Body And Brain. More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea. (8/24/15)]&lt;br /&gt;
* [http://articles.latimes.com/2013/aug/29/science/la-sci-sn-sleeping-pill-use-cdc-20130830 One in 25 American adults takes sleeping pills to help them fall asleep and stay asleep at night (8/29/13)]&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-things-to-know-about-america-s-unhealthy-behaviors.html More than 70 percent of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. (4/5/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-overweight-heart-uspstf-idUSKBN0GP1XA20140825 Overweight patients with risk factors for heart disease need &amp;quot;intensive behavioral counseling&amp;quot; about '''diet''' or '''exercise''', according to USPSTF. (8/25/14)]&lt;br /&gt;
* [https://georgevanantwerp.com/2013/12/30/8-risks-drive-15-conditions-and-80-of-healthcare-costs/ 8 Behavior Risks Drive 15 Conditions And 80% Of Healthcare Costs (12/30/13)]&lt;br /&gt;
&lt;br /&gt;
Alcohol &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://www.bloomberg.com/news/articles/2017-08-09/america-s-drinking-problem-is-much-worse-this-century The number of adults who binge drink at least once a week could be as high as 30 million, according to a study published on Wednesday in JAMA Psychiatry. (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 32% of Americans had a minimum of one heavy drinking day in the last year. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. (5/27/16)]&lt;br /&gt;
* Alcohol Consumption - [https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ The top 10% of American drinkers consume, on average, 74 alcoholic drinks per week. (9/25/14)]&lt;br /&gt;
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Falls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-elderly-patients-treated-for-falls-may-be-more-likely-to-suffer-later-adverse Elderly patients treated for falls may be more likely to suffer later adverse events, study finds (7/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/among-the-elderly-an-epidemic-of-falling.html The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. (9/21/16)] &lt;br /&gt;
* [http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/ The use of 4 or more medications was associated with increased risk of falling and the risk of recurrent falls (9/27/13)]&lt;br /&gt;
&lt;br /&gt;
Risky Behaviors &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/05/29/health/car-accidents-child-deaths-seat-belts.html Car Accidents Remain a Top Child Killer, and Belts a Reliable Savior (5/29/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-high-risk-behaviors-often-persist-even-after-cancer-diagnoses.html Study finds high-risk behaviors often persist after cancer diagnoses. 19.8% of women cancer survivors smoked, compared with 15.8% of women without cancer. No differences existed for fruit and vegetable consumption or body mass index. (9/6/16)]&lt;br /&gt;
&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/01/10/smoking-costs-the-world-economy-1-trillion-per-year-world-health-organization-says/?utm_term=.378ab21f3e8c Smoking costs the world economy $1 trillion per year, World Health Organization says (1/10/17)]&lt;br /&gt;
* [https://directorsblog.nih.gov/2016/12/13/study-finds-no-safe-level-of-smoking/ New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. (12/13/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall Centers for Disease Control and Prevention says smoking rates have fallen from 21% of the adult population in 2005 to 15% in 2015 (11/10/16)]&lt;br /&gt;
* [http://www.sanger.ac.uk/news/view/smoking-pack-day-year-causes-150-mutations-lung-cells Smoking a pack a day for a year causes 150 mutations in lung cells (11/3/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cigarettes-linked-to-nearly-30-of-cancer-deaths-6-things-to-know.html Cigarettes linked to nearly 30% of cancer deaths: 6 things to know (10/24/16)]&lt;br /&gt;
* [http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002020 A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. (5/10/16)]&lt;br /&gt;
* [https://www.boston.com/news/health/2016/05/24/kicking-habit-adult-smoking-rate-us-falling-fast CDC reports smoking rate among adults in the U.S. fell to 15% in 2015, down two percentage points from 2014. (5/24/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/04/19/opioid-addiction-relapse-science/ How drug use changes the brain — and makes relapse all too common (4/19/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://health.usnews.com/health-care/articles/2017-04-19/many-heart-attack-patients-fail-to-stick-with-statins Many Heart Attack Patients Fail to Stick With Statins (4/19/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/25/more-than-half-of-adults-misuse-medications-study-finds/ More than half of adults and 44% of children drug-tested by a national clinical laboratory last year misused their prescription medications, either taking too much, too little or none of their medications. 45 percent of adults were taking drugs (including illicit drugs) that were not prescribed. (7/25/16)]&lt;br /&gt;
* [http://www.mcolblog.com/kcblog/2016/7/12/factors-attributed-to-medication-non-adherence.html 30% of prescriptions are never filled. 69% of nonadherence is due to behavioral issues, such as forgetfulness or procrastination, 16% was due to cost, and 15% say it was medication side effects (7/12/16)]&lt;br /&gt;
*  [http://www.imshealth.com/en/about-us/news/ims-health-study:-low-levels-of-adherence-and-persistence-remain-barriers-to-reducing-the-costs-of-diabetes-complications The U.S. could save $4 billion a year if more seniors with type 2 diabetes followed their doctor’s orders, according to a report by the IMS (7/12/16)]&lt;br /&gt;
* [http://www.hindawi.com/journals/ijfm/2013/901845/ Study found that only 6.5% of patients (only 46 in study) adhered completely to the discharge medication list after average hospital stay of 4.3 days. The average patient age was 76, prescription medications was 10 and number of chronic diseases was 7. (2/24/13)] &lt;br /&gt;
* [http://medcitynews.com/2014/11/study-medication-adherence-prompts/ Study: Medication adherence improved with proper prompts (11/17/14)]&lt;br /&gt;
* [http://well.blogs.nytimes.com/2012/11/15/when-the-patient-is-noncompliant/ When the patient is non-compliant (11/15/12)]&lt;br /&gt;
* [http://healthcare-economist.com/2015/05/31/patient-adherence-to-antipsychotic-medications/ About 40% of patients with schizophrenia are adhering to antipsychotic medications (5/31/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Activation Levels &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/mar/patient-self-management-capability In 2012, ED costs were 37% lower for those at highest activation level versus the lowest ($1,126 vs. $711). In 2014, the difference was 28% (3/8/16)]&lt;br /&gt;
* [http://hpr.weill.cornell.edu/divisions/biostatistics/pdf/Gerber-Research_Seminar_Talk-5-10-07.pdf Effect of the Patient Activation Measure (PAM) on Chronic Care: Baseline Findings from a Cluster Randomized Study (5/10/07)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/3/431 When Patient Activation Levels Change, Health Outcomes And Costs Change, Too (3/2015)]&lt;br /&gt;
&lt;br /&gt;
Prevention &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.ajc.com/news/local/study-finds-percent-sunscreens-don-even-work-how-find-one-that-does/ergzPOJyVv0nM7ZG88yBHK/ Study finds 73 percent of sunscreens don’t even work — how to find one that does (5/26/17)]&lt;br /&gt;
&lt;br /&gt;
Preventive Screening and Vaccinations&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentages of adults who received an influenza vaccination in 2015 was 65.8% for adults aged 65 and over, 46% for ages 50 to 64 and 31.2% for those aged 18 to 49. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentage of adults over 65 years old vaccinated for pneumonia increased rapidly from 42.4% in 1997 to 53.1% in 2000. In 2015, the percentage rose to 63.5% (5/26/16)]&lt;br /&gt;
&lt;br /&gt;
Self Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.reuters.com/article/us-pressure-management-study-idUSKBN0GR2C220140827 Self management may reduce blood pressure (8/27/14)]&lt;br /&gt;
&lt;br /&gt;
Treatment Delays &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://go.americanwell.com/rs/335-QLG-882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf 67% of consumers say they have delayed seeking care for a health problem. They delay because: It costs too much (23%), It takes too long to get in to see a doctor or nurse (23%), They thought the problem would go away on its own (36%), They are too busy (13%) (1/2017)]&lt;br /&gt;
&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-fewer-americans-diet-20170308-story.html American adults either overweight or obese rose from about 53% a generation ago to roughly 66% more recently. 56% of overweight or obese adults reported in 1988 to 1994 they had tried to lose weight in the last year, it has declined to 49% in 2009 to 2014. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Wellness Programs&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/279396/will-every-human-be-health-reward-program-when-it-comes-health-rewards-it-seems 74 percent of employers use health reward program (12/1/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/193551/amount-reward-consumer-health-behavior What Size Reward Drives a Consumer to Take a Desired Health Behavior? (9/9/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/25/workplace-wellness-produces-no-savings/ Workplace Wellness Produces No Savings (11/25/14)]&lt;br /&gt;
&lt;br /&gt;
===Care Planning Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/05/10/addressing-triggers-of-decline-in-older-adults-physical-cognitive-or-mental-health/ “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/07/02/family-caregiving-and-palliative-care-closing-the-policy-gap/ Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)]&lt;br /&gt;
&lt;br /&gt;
Care Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/02/implementing-a-care-planning-system-how-to-fix-the-most-pervasive-errors-in-health-care/ Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/630.abstract Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)] &lt;br /&gt;
* [http://familiesusa.org/press-release/2016/proven-best-choices-guides-health-care-options-launched-icer-and-families-usa Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)]&lt;br /&gt;
* [https://decisionaid.ohri.ca/odsf.html The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/october-november/in-focus Helping Patients Make Better Treatment With Decision Aids (10/2012)]&lt;br /&gt;
&lt;br /&gt;
Evidence-Based Practice &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/primary-care-docs-may-struggle-to-find-high-quality-evidence-to-support-clinical Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/22/credibility-of-evidence-a-reconsideration-of-the-logic-and-strength-of-our-healthcare-decisions/ Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)]&lt;br /&gt;
&lt;br /&gt;
Medical Advocates &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/medical-advocates-can-help-guide-patients-on-difficult-care-choices/ Medical Advocates Can Help Guide Patients On Difficult Care Choices  (1/27/16)]&lt;br /&gt;
&lt;br /&gt;
Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/partners-expands-second-opinion-service-health-advocate-partnership Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/88-of-second-opinions-from-mayo-physicians-result-in-different-diagnosis-study-finds.html 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)]&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/patients-with-more-say-in-treatment-have-fewer-side.html Patients with more say in treatment have fewer side effects (7/13/16)]&lt;br /&gt;
*  [http://khn.org/news/inviting-patients-to-help-decide-their-own-treatment/ Inviting Patients To Help Decide Their Own Treatment (3/16/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/17/shared-decision-making-and-the-use-of-patient-decision-aids/ Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/doctors-patients-critically-medical-decisions.html How should doctors and patients look critically at medical decisions?] (8/16/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/medical-interventions-5050-informs-patient.html Many medical interventions are 50/50: Who informs the patient? (8/13/2013)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management - Communications Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Communicating Instructions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/most-patients-don-t-understand-post-discharge-care-plans-study-finds Most patients don't understand post-discharge care plans, study finds (1/6/2016)]&lt;br /&gt;
&lt;br /&gt;
Difficult Dialog &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/03/377569539/even-some-doctors-fear-these-10-questions The difficulty of asking questions about &amp;quot;adverse childhood experiences&amp;quot; that identifies health risks (3/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/24/394927484/many-doctors-who-diagnose-alzheimers-fail-to-tell-the-patient Many Doctors Who Diagnose Alzheimer's Fail To Tell The Patient (3/24/15)]&lt;br /&gt;
&lt;br /&gt;
Digital Communications &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cio.com/article/3195891/cio-role/kaiser-cio-shares-it-lessons-for-the-future-of-healthcare.html Kaiser Permanente crossed an important threshold last year when 52 percent of its patient interactions were digital. (5/10/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/mhealth-monitor-patients-physicians/ 58% of people in the U.S. with a smartphone shared information with a medical professional using a mobile or wearable device. And 25% used email or text to send a photo of a medical issue to their doctor. (11/15/16)]&lt;br /&gt;
* [http://www.huffingtonpost.com/2015/06/29/doctors-facebook-telehealth_n_7662774.html Communicating With Your Doctor On Facebook May Be The Future Of Healthcare (6/29/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/07/healthcrowd-pilot-finds-mobile-engagement-medicaid-patients-cost-effective/ Pilot project finds mobile engagement with Medicaid patients ‘most cost-effective’ (7/29/14)]&lt;br /&gt;
* [http://mobihealthnews.com/35160/nearly-half-of-kaiser-permanentes-members-use-my-health-manager/ Nearly half of Kaiser Permanente's members use online health management platform (7/25/14)]&lt;br /&gt;
* Electronic Communication - [http://link.springer.com/article/10.1007%2Fs11606-012-2329-5 71% of vulnerable patient populations want to use electronic communication with health care providers.] (2/20/13)&lt;br /&gt;
&lt;br /&gt;
Doctor Patient Discussions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/language-doctors-use-to-talk-to-diabetes-patients-makes-a-difference The language doctors use to talk to diabetes patients makes a difference to success (6/14/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/prudent-antibiotic-prescribing-lowers-patient-satisfaction.html How prudent antibiotic prescribing lowers patient satisfaction (9/13/16)]&lt;br /&gt;
* [http://khn.org/news/attending-to-the-human-element-is-key-to-keeping-patients-healthy/amp/ Study recommends improving communication with racial minorities and lower-income patients, such as better bedside manner (so patients trust their doctors), communication that is easily understood by everyday people and willingness to discuss how price fits into consumers’ health decisions. (9/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/physicians-spend-twice-as-much-time-on-ehr-desk-work-than-with-patients.html Physicians spend twice as much time on EHR, desk work than with patients (9/6/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/06/costs_of_care_getti.html Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. (6/15/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/get-10-minutes-doctor-2/ Why Do I Only Get 10 Minutes With My Doctor? (9/18/14)]&lt;br /&gt;
* [http://khn.org/news/15-minute-doctor-visits/ 15-Minute Visits Take A Toll On The Doctor-Patient Relationship (4/21/14)]&lt;br /&gt;
&lt;br /&gt;
Patient Portals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/ehr/despite-federal-push-to-offer-ehr-access-patient-engagement-low Just 15% of hospital patients electronically accessed their medical records despite 88% of hospitals offering access. Nearly one-third of patients accessed EHRs offered by physician practices. (3/16/17)]&lt;br /&gt;
&lt;br /&gt;
Patient Provided Data&lt;br /&gt;
* [http://www.fiercehealthcare.com/analytics/how-university-rochester-medical-center-uses-patient-generated-data-to-set-expectations University of Rochester Medical Center (URMC) collects patient-reported outcomes by using a Patient-Reported Outcomes Measurement Information System (PROMIS), which requires patients to answer five to seven questions on a tablet. (7/6/17)] &lt;br /&gt;
* [http://www.annfammed.org/content/15/2/158.abstract Patients Typing Their Own Visit Agendas Into an Electronic Medical Record. Patients and clinicians agreed that the agendas improved patient-clinician communication. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Remote Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2488923#Results Study finds readmissions nearly the same for heart failure patients using remote patient monitoring (3/2016)]&lt;br /&gt;
* [http://mobihealthnews.com/content/scripps-wired-health-study-results-show-no-clinical-or-economic-benefit-digital-health Scripps Wired for Health study shows no clinical or economic benefit from digital health monitoring (1/19/16)]&lt;br /&gt;
* [http://khn.org/news/making-the-human-condition-computable/ Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to enable doctors to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails. (12/11/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/can-fall-monitoring-technology-keep-elders-safe/ Can Fall Monitoring Technology Keep Elders Safe? (4/7/14)]&lt;br /&gt;
* [http://www.mddionline.com/article/digital-health-dominates-ces-2014-%E2%80%93-3-trends-watch-3 Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. (1/9/14)]&lt;br /&gt;
&lt;br /&gt;
Screenings &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/doctors-should-screen-patients-for-social-isolation-to-address-loneliness-epidemic Doctors must screen patients for social isolation to address 'loneliness epidemic' (8/8/17)]&lt;br /&gt;
* [https://nam.edu/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool/ Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool. (5/30/17)] [https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf See PDF] &lt;br /&gt;
&lt;br /&gt;
Text Messaging &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/despite-privacy-hoops-text-messaging-offers-unprecedented-convenience Despite privacy hoops, text messaging offers ‘unprecedented convenience’ (5/11/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management - Operational Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/474.abstract Breaking Down Silos Between Health Care And Criminal Justice (3/2014)]&lt;br /&gt;
&lt;br /&gt;
Behavioral Health Integration&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/10/1808.abstract Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care (10/2014)]&lt;br /&gt;
* [http://docs.house.gov/meetings/IF/IF02/20150211/102944/HHRG-114-IF02-Wstate-KohnL-20150211.pdf About 10 million—or 4.2%—of adults in the United States suffered from a serious mental illness in 2013 were supported by 112 different federal programs (2/11/15)]&lt;br /&gt;
&lt;br /&gt;
Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-acute-care-needs-to-be-coordinated-but-it-often-not Only 30% of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7% reported they were fully coordinated. (11/131/6)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/07/20/peds.2015-4182 Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. (7/2016)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/09/difficult-transition-hospital-nursing-home.html The difficult transition between the hospital and nursing home (9/5/13)]&lt;br /&gt;
* [http://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/ One of the most dangerous junctures in medical care: patients leaving the hospital. Nearly a quarter had inadequately reviewed or tracked medications, sometimes even causing fatal events. (5/2/16)] &lt;br /&gt;
* [https://psnet.ahrq.gov/primers/primer/11 Nearly 20% of patients experience adverse events within 3 weeks of hospital discharge, nearly three-quarters of which could have been prevented or ameliorated. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-discharge-risks-persist-for-elderly-patients The transition from hospital to home poses significant risks to patients, especially the elderly, and gaps persist in care during this crucial time. (7/11/16)]&lt;br /&gt;
&lt;br /&gt;
Coordinated Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/nov/healthcare-fragmentation-frequency-diagnostic-tests Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, linked to high rates of hospitalization and emergency department visits as well as lower satisfaction. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients. (11/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/on-lok Program of All-Inclusive Care for the Elderly (PACE) cares for frail elders in the community (8/12/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/12/poor-interoperability-affects-patients.html How poor interoperability affects patients. It often requires duplicate testing that is not only costly (e.g., CT scans), but also invasive and not without risk to the patient (e.g., bronchoscopy, biopsies). (12/17/15)]&lt;br /&gt;
* [http://www.jhsph.edu/news/news-releases/2015/four-in-ten-older-adults-burdened-by-demands-of-health-care-system.html Four in Ten Older Adults Burdened by Demands of Health Care System] (10/14/15)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2014/nov/international-survey-of-older-adults International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care (11/19/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/special-report/5-pieces-care-coordination-puzzle 5 pieces of the care coordination puzzle (6/11/14)]&lt;br /&gt;
* [http://www.healthcare-informatics.com/news-item/lack-coordinated-care-problem-older-patients-survey-says Lack of Coordinated Care is a Problem for Older Patients, Survey Says (4/3/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/10/coordinated-care-critical-reducing-u-s-health-spending/ Coordinated care critical for reducing U.S. health spending  (10/8/13)]&lt;br /&gt;
&lt;br /&gt;
Managing [http://www.patientdeterminants.org/index.php?title=Health_Insight#High_Need.2C_High_Cost_Patients_Insight High Cost High Need Patients] &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? (8/7/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/care-high-need-high-cost-patients Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis (10/29/15)] &lt;br /&gt;
&lt;br /&gt;
Palliative Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/44.abstract Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities (1/2016)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/29/the-challenge-of-financing-sustainable-community-based-palliative-care-programs/ The Challenge Of Financing Sustainable Community-Based Palliative Care Programs (12/29/14)]&lt;br /&gt;
&lt;br /&gt;
Partnering With Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/what-organizations-do-hospitals-partner-with-for-population-health.html What Organizations do Hospitals Partner With for Population Health? (12/5/13)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2014/12/28/the-trouble-with-home-health-care-care-coordination/ The Trouble with Home Health Care &amp;amp; Care Coordination (12/28/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2104.abstract Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Coordinating care and communicating with specialists, hospitals, home care and social service providers. (12/2015)]&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Determinants Health Strategy Activities Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Interventions Activities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Interventions_Determinants Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being. [[Medical Interventions]] Activities are impacted by:&lt;br /&gt;
&lt;br /&gt;
* [[Medical Intervention Access|Access]]&lt;br /&gt;
* [[Medical Intervention Diagnosis|Diagnosis]]&lt;br /&gt;
* [[Medical Intervention Efficacy|Efficacy]]&lt;br /&gt;
* Testing&lt;br /&gt;
* [[Medical Intervention Treatments|Treatments]]&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions Activity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Non-Medical_Interventions_Determinants Non-Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Cardiac Rehabilitation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/cardiac-rehab-improves-health-but-cost-and-access-issues-complicate-success/amp/ Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (8/31/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/07/18/485871530/cardiac-rehab-works-great-so-why-don-t-people-do-it Despite research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer; fewer than a third do. (7/18/16)]&lt;br /&gt;
&lt;br /&gt;
Employee Wellness Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/ Large firms (at least 200 employees) are more likely to offer Employee Wellness Programs than smaller firms (81% vs. 49%) in an effort to promote employee health and productivity and reduce health related cost (5/19/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/71.abstract Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study (1/2016)]&lt;br /&gt;
&lt;br /&gt;
Fall Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-step-up-to-help-seniors-avoid-falls/ Hospitals Step Up To Help Seniors Avoid Falls (1/12/16)]&lt;br /&gt;
&lt;br /&gt;
Health Coaching &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/the-underrated-value-of-coaching-in-healthcare-4-thoughts-from-population-health-expert-dr-william-appelgate.html The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William Appelgate (1/25/17)]&lt;br /&gt;
&lt;br /&gt;
Legal Counseling &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/legal-regulatory-issues/ku-kansas-hospital-to-offer-free-legal-counsel-to-low-income-patients.html Kansas hospital offers free legal counsel to low-income patients (8/18/16)]&lt;br /&gt;
&lt;br /&gt;
Obesity Counseling &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://khn.org/news/few-seniors-benefitting-from-medicare-obesity-counseling/ Few Seniors Benefiting From Medicare Obesity Counseling (2/23/15)]&lt;br /&gt;
* [http://khn.org/news/seniors-obesity-counseling-benefit-goes-largely-unused/ Seniors’ Obesity-Counseling Benefit Goes Largely Unused (11/20/14)]&lt;br /&gt;
&lt;br /&gt;
Opioid Alternative&lt;br /&gt;
* [http://www.denverpost.com/2016/11/30/battling-opioid-epidemic/ How a Colorado health care provider is battling the opioid epidemic with non-pill pain treatments (11/30/16)]&lt;br /&gt;
&lt;br /&gt;
Virtual Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fastcompany.com/3047894/the-future-of-work/how-to-turn-your-smartphone-into-your-personal-therapist Smartphone As A Personal Therapist. Could the technology that causes so much of our stress and anxiety also be the cure? (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence Insight====&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Insight</id>
		<title>Health Insight</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Insight"/>
				<updated>2019-07-16T21:09:55Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Physical Activities Insight */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday there is new insight into our understanding of [[Health Determinants]] and [[barriers]] that impact patient outcomes. This page will curate new insight. While health care is likely the most important determinant of health when a patient has an acute condition, studies show it represents only a part of an overall health outcomes:&lt;br /&gt;
&lt;br /&gt;
[[Health Determinants Insight]]&lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Mission (Health Goals) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Personal Goals Insight===&lt;br /&gt;
===Health Goals (Care Goals) Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Mission_.26_Care_Goals_Determinants Health Goals (Care Goals) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Advanced Directives &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/1-3-u-s-adults-have-completed-advance-directive-study-finds 2 out of 3 adults fail to complete an advance directive (7/6/17)]&lt;br /&gt;
* [http://www.cbsnews.com/news/being-prepared-for-the-final-days/ Being prepared for the final days (4/27/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/lack-advance-directives-leads-to-unwanted-care Lack of advance directives leads to unwanted care (11/2/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/national-healthcare-decisions-day-11-statistics-on-end-of-life-decision-making.html Only 20% of Americans have an advanced directive documenting their wishes for end-of-life medical care. (4/16/15)]&lt;br /&gt;
&lt;br /&gt;
Care Goals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/12/defining-patients-goals-care.html Defining the patient’s goals of care (12/11/13)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1113631#t=article Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)]&lt;br /&gt;
&lt;br /&gt;
End of Life Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/end-life-care-planning-fails-patients End-of-life care, planning fails patients (2/5/15)]&lt;br /&gt;
* [https://www.minnpost.com/second-opinion/2014/06/few-doctors-discuss-end-life-planning-heart-failure-patients-mayo-study-finds Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)]&lt;br /&gt;
* [http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx ''Dying in America'' - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)]&lt;br /&gt;
* [http://khn.org/news/too-many-people-die-in-hospital-instead-of-home-heres-why/ Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)]&lt;br /&gt;
&lt;br /&gt;
Health Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/28/what-outcomes-matter-to-patients-with-rheumatoid-arthritis/ What outcomes matter to patients with Rheumatoid Arthritis? (8/28/17)]&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Strategy (Health Plan) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) Insight===&lt;br /&gt;
====Medical Interventions Insight====&lt;br /&gt;
====Non-Medical Interventions Insight====&lt;br /&gt;
====Intervention Changes Insight====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures===&lt;br /&gt;
===Strategy - Impacting People Insight===&lt;br /&gt;
===Strategy - Impacting Realities Insight===&lt;br /&gt;
===Strategy - Impacting Activities Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Health Conditions ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Physical Conditions ''Insight''==== &lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Physical_Conditions_Determinants Physical Conditions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.cbsnews.com/news/more-u-s-kids-have-chronic-health-problems-study The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest (5/2/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/jan/analysis-of-death-rates-for-middle-aged-whites A lack of progress since 1999 against common illnesses such as heart disease, diabetes, and respiratory disease was largely responsible for higher-than-expected death rates for middle-aged (45–54) white adults in 2014. (1/29/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/07/study-on-aging/ Don’t judge a person on their chronological age; their biological age might be a lot older than you think, aging study says (7/7/15)]&lt;br /&gt;
&lt;br /&gt;
Arthritis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/stateline-states-asthma/ Nationwide, one in 10 children has asthma. (4/16/14)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/science/archive/2017/03/no-cancer-isnt-mostly-bad-luck/521049/ Scientists don't agree 66% of cancer is due to bad luck (3/28/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521219318/cancer-is-partly-caused-by-bad-luck-study-finds Study: Causes of cancer, 66% from random mutations during cell division (bad luck), about 29% from environment and remaining 5% due to heredity. (3/23/17)]&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-cancer-drop-20170105-story.html Death rate from cancer now 25% lower than it was 25 years ago, report says (1/5/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-brain-cancer-now-killing-more-children-than-leukemia.html CDC: Brain cancer now killing more children than leukemia (9/16/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cancer-overtakes-heart-disease-as-leading-cause-of-death-in-22-states-3-things-to-know.html Cancer overtakes heart disease as leading cause of death in 22 states (8/25/16)]&lt;br /&gt;
* [https://www.sciencedaily.com/releases/2015/01/150101142318.htm Study shows two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes, while the remaining third are due to environmental factors and inherited genes. (1/1/15)]&lt;br /&gt;
&lt;br /&gt;
Chronic Pain &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/4-things-to-know-about-the-rising-rates-of-chronic-pain-in-the-us.html Number of Americans in their 60s reporting chronic pain increased from 10% in 1998 to 37% in 2010. (3/16/17)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain Estimated 25.3 million adults (11.2%) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6%) experience severe levels of pain. (8/11/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/04/chronic-pain-effect-patients-families.html Chronic pain and the effect on patients’ families (4/17/14)]&lt;br /&gt;
&lt;br /&gt;
COPD &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/copd/index.html Chronic lower respiratory disease, primarily COPD, is the third leading cause of death in the United States (3/12/15)]&lt;br /&gt;
&lt;br /&gt;
Cystic Fibrosis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/03/13/cystic-fibrosis-canadians-americans/ Canadians with cystic fibrosis outlive Americans by a decade (3/13/17)]&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-more-deadly-than-previously-thought-researchers-say.html Diabetes causes 12 percent of deaths in the United States, making it the third-leading cause of death in the country, according to a new study (1/26/17)] &lt;br /&gt;
* [http://khn.org/news/health-claims-on-the-rise-for-kids-with-type-2-diabetes-obesity-related-conditions/amp/ Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions (1/2/17)]&lt;br /&gt;
* [http://khn.org/news/diabetes-linked-to-risk-of-mental-health-hospitalization-in-young-adults-study/amp/ Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease (7/22/16)]&lt;br /&gt;
* [http://khn.org/news/as-childhood-diabetes-rates-rise-so-do-costs-and-families-feel-the-pinch-study/amp/ Childhood diabetes rates are on the rise. The spent $2,173 per capita in out-of-pocket health care costs in 2014. Nearly five times higher than that of kids without the illness. (6/20/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/americans-diabetes-reach-21-million Americans with diabetes reach 21 million (4/15/14)]&lt;br /&gt;
* [http://www.latimes.com/science/la-sci-sn-diabetes-study-20150908-story.html About half of all Americans have either diabetes or pre-diabetes. (9/8/15)]&lt;br /&gt;
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Heart Attack Risk &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/depression-among-heart-attack-survivors-can-be-deadly-yet-is-often-ignored/ Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (7/20/17)]&lt;br /&gt;
* [http://www.wsj.com/articles/heart-attacks-are-linked-to-what-patients-were-doing-feeling-1477923373 Performing heavy physical activity in a highly emotional state sharply raised the risk of a heart attack. (10/31/16)]&lt;br /&gt;
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High Blood Pressure &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cdc.gov/bloodpressure/facts.htm About 70 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults. (6/16/16)]&lt;br /&gt;
&lt;br /&gt;
Life Expectancies &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/death-rates-for-americans-in-prime-years-rise-after-century-of-decline.html The death rate for Americans between the ages of 25 and 44 rose by 8% between 2010 and 2015 after a century of decline. (6/14/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair The mortality rate for white Americans, ages 45 to 54, increased by a half percent each year from 1999 to 2013, attributed to increase in suicide, drugs and alcohol. (3/23/17)]&lt;br /&gt;
Non-Communicable Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-diseases-that-kill-16m-people-cost-the-world-economy-2-35t-annually.html Five non-communicable diseases that kill 16 million people around the world each year, cost the world economy $2.35T annually. 1) Cardiovascular disease, 2) Mental illness, 3) Cancer, 4) Chronic respiratory disease, 5) Diabetes. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
Obesity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/30/506433671/the-wrong-eating-habits-can-hurt-your-brain-not-just-your-waistline Being overweight can raise your blood pressure, cholesterol and risk for developing diabetes. It could be bad for your brain, too. (12/30/16)]&lt;br /&gt;
* [http://www.onemednews.com/2016/12/18/nyt-obesity/ Researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, are many. (12/12/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2016/12/01/nearly-half-of-americas-overweight-people-dont-realize-theyre-overweight/?utm_term=.2963e8177870 Nearly half of America’s overweight people don’t realize they’re overweight (12/1/16)]&lt;br /&gt;
* [http://khn.org/news/another-reason-to-diet-experts-find-additional-evidence-of-obesity-cancer-link/amp/ Experts Find Additional Evidence Of Obesity-Cancer Link (8/24/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/obesity-rates-up-in-us-women-stable-in-men.html Obesity rates up in US women, stable in men. Obesity was 35 percent among men and 40 percent among women in 2013-14 (6/7/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html American obesity rate continues consistent trend upward in 2015 with estimated 30.4% of Americans over 20 years of age obese, more than a 10% increase from 1997 (5/26/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1923.abstract Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013 (11/2015)]&lt;br /&gt;
&lt;br /&gt;
Sepsis &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/sepsis-causes-more-readmissions-than-copd-heart-failure-heart-attack-and-pneumonia.html Sepsis causes more hospital readmissions than COPD, heart failure, heart attack and pneumonia. (1/23/17)]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Mental_Health_Conditions_Determinants Mental Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
Childhood Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/06/01/disruptive-behavior-disorders-children/ Childhood disruptive behavior disorders increases risk for substance use, violent behaviors, victimization, incarceration, and even premature death. An estimated 50 to 75% of youths who move through the juvenile justice system could be diagnosed with a mental health disorder. (6/1/17)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/who-depression-leading-cause-of-illness-disability-worldwide.html Depression is the leading cause of illness, disability worldwide according to the World Health Organization (3/31/17)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878#T1 The prevalence of major depressive episodes (MDEs) in adolescents (age 12-17) has increased from 13.1% for girls and 4.5% for boys in 2005 to 17.3% for girls and 5.7% for boys in 2014 (11/2016)]  &lt;br /&gt;
&lt;br /&gt;
Dementia &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/16/536935957/stress-and-poverty-may-explain-high-rates-of-dementia-in-african-americans Stress And Poverty May Explain High Rates Of Dementia In African-Americans (7/16/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-alzheimer-s-deaths-up-by-more-than-50.html In 1999, the rate of Alzheimer's deaths was 16.5 per 100,000 individuals. By 2014, this rate had increased to 25.4 deaths per 100,000, marking a 54.5% increase. (5/26/17)]&lt;br /&gt;
* [http://www.alz.org/documents_custom/2017-facts-and-figures.pdf Estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. By 2025, Alzheimer’s dementia is estimated to reach 7.1 million. By 2050, the number of people with Alzheimer’s dementia may nearly triple to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure Alzheimer’s disease. (3/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587084 Dementia prevalence among US adults 65 years or older declined significantly, from 11.6% in 2000 to 8.8% in 2012. (11/21/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/10-alzheimer-s-patients-had-preventable-hospital-stays One in 10 Alzheimer’s patients have preventable hospital stays (7/27/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/30/472295791/big-financial-costs-are-part-of-alzheimers-toll-on-families Big Financial Costs Are Part Of Alzheimer's Toll On Families (3/30/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2016/02/10/study-finds-dementia-rates-decline/80016390/ Rates of dementia dropped 44% from the late 1970s to the early 2010s. (2/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-dementia-drives-er-visits-admissions-and-mortality-rates How dementia drives ER visits, admissions and mortality rates (11/16/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1642.abstract Dementia has a disproportionate impact on family and unpaid caregiving to older adults] (10/2015)&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1637.abstract Adults with probable dementia received 171 hours of monthly informal care, versus 89 hours for cognitively impaired adults without dementia and 66 hours for cognitively normal adults 10/2015)]&lt;br /&gt;
&lt;br /&gt;
Emotions &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Mental Health Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1024.abstract Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. Innovative federal, state, and local programs have combined social services with mental health interventions to try addressing this. (6/2017)] &lt;br /&gt;
* [http://healthaffairs.org/blog/2016/07/25/patients-with-severe-schizophrenia-arent-getting-the-help-they-need/ Patients With Severe Schizophrenia Aren’t Getting The Help They Need (7/25/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/mind-and-mood/the-prevalence-and-treatment-of-mental-illness-today An estimated 26% of American adults live with a mental disorder in any given year, and 46% will have a mental disorder in their lifetime.] (11/2005)&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html 18% of adults in the U.S. have a mental, behavioral or emotional disorder. Most common are specific phobias (8.7%), such as those related to heights, spiders or flying, social phobia (6.8%) and major depression (6.6%) (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Impact on Health Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.businessinsurance.com/article/20170306/NEWS08/912312232/Detecting-mental-health-issues-can-cut-workers-comp-claims-costs Detecting mental health issues can cut workers comp claims costs. Hartford Financial Services Group analyzed its workers comp claim data from 2002 to 2015 and found that 10% of claims featured at least one psychosocial issue, and that those claims account for 60% of claims costs. (3/6/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/nov/behavioral-health-high-need-adults High-need adults—defined as those with three or more chronic conditions and a functional limitation—who have a diagnosed behavioral health condition among their multiple chronic conditions make greater use of some health care services than their counterparts without a behavioral health condition (11/22/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/36.abstract Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients (1/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/most-readmissions-aren-t-linked-to-suboptimal-care-study-finds.html A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness. (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
Opioid Addiction &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/ Patients With Mental Disorders Get Half Of All Opioid Prescriptions (6/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/ahrq-report-us-hospitals-see-sharp-rise-in-opioid-related-inpatient-stays-ed-visits.html Between 2005 and 2014, opioid-related emergency department visits nearly doubled and opioid-related inpatient stays increased 64% (6/20/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/cdc-likelihood-of-opioid-addiction-spikes-after-a-few-days-of-use.html CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days (3/17/17)]&lt;br /&gt;
* [http://khn.org/news/study-health-spending-related-to-opioid-treatment-rose-more-than-1300-percent/amp/ Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent In Four Year Period (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/prior-authorization-a-hurdle-for-patients-overcoming-opioid-dependency Insurer rules a hurdle for patients overcoming opioid dependency (8/5/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/15/patient-centered-research-can-improve-chronic-pain-care-and-address-opioid-abuse/ Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse (5/15/15)]&lt;br /&gt;
&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf Americans reporting at least one symptom of stress over the past month rose from 71% in August 2016 to 80% in January 2017. This includes headache (34%), feeling overwhelmed (33%), feeling nervous or anxious (33%), or feeling depressed or sad (32%). (2/15/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/12/chronic-stress-heart-attacks-study.amp Emotional stress has long been considered a major risk factor for heart disease. A new study suggests that heightened activity in the amygdala (the brain's fear and stress region) is associated with a greater risk of heart disease and stroke. (1/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/09/27/494922257/chill-out-stress-can-override-benefits-of-healthy-eating Stress Can Override Benefits Of Healthful Eating (9/27/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.technologyreview.com/s/603073/big-pharma-and-distracted-driving-are-killing-americans-early/amp/ Accidental poisoning increased 13%. 97% percent of accidental poisoning was from drug overdoses and alcohol (12/9/16)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin,methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Suicide &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/suicide-rates-for-teen-girls-hits-40-year-high.html Suicide rates for teen girls hits 40-year high (8/8/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-machine-learning-shows-promise-toward-accurately-identifying-suicidal-behavior Study found machine learning is 93% accurate in correctly identifying a suicidal person, and 85% accurate in determining differential diagnosis of mental illness (11/8/16)]&lt;br /&gt;
* [http://www.npr.org/sections/ed/2016/11/04/500659746/middle-school-suicides-reach-an-all-time-high Middle School Suicides Reach An All-Time High (11/4/16)]&lt;br /&gt;
&lt;br /&gt;
Treating Mental Health &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2016/05/13/hlthaff.2015.1659.abstract Mental Disorders top the list of the most costly conditions in the United States: $201 Billion] (5/2016)&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
* [http://hrsonline.isr.umich.edu/ Health and Retirement Study (HRS) surveys 20,000 people in America about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and health care expenditures. (3/2007)]&lt;br /&gt;
&lt;br /&gt;
Chronic Diesease &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/21/the-association-between-observed-mobility-and-quality-of-life-in-the-near-elderly/ Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life. (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Daily Activities Assistance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 6.9% of adults in 2015 over the age of 65 required assistance with personal care. (5/26/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/howardgleckman/2014/10/08/nearly-half-of-all-seniors-need-help-with-daily-activities-far-more-than-we-thought/ Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought] (10/8/14)&lt;br /&gt;
&lt;br /&gt;
Disabilities &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/4/626.abstract If all five risk factors were eliminated, 53% of disability could be prevented nationally if five risk factors were eliminated. The largest were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). (4/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/18/challenges-for-people-with-disabilities-within-the-health-care-safety-net/ Challenges For People With Disabilities Within The Health Care Safety Net. Nearly 57 million Americans had disabilities in 2010. (11/18/14)]&lt;br /&gt;
&lt;br /&gt;
Functional Independence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patients-functional-independence-may-predict-readmissions Patients' functional independence may predict readmissions (5/6/14)]&lt;br /&gt;
&lt;br /&gt;
Healthcare Costs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 The average healthcare cost for adults in the United States (2009-2011) was $4,845, for adults with 3 or more chronic conditions and no functional limitations was $7,526, for adults with 3 or more chronic conditions and functional limitation was $21,021 (8/29/16)]&lt;br /&gt;
&lt;br /&gt;
Homebound &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/26010119 An estimated 1.9 million U.S. adults age 65 or older are completely or mostly homebound, while another 5.3 million have functional limitations that make it hard to  leave their homes. (7/2015)]&lt;br /&gt;
* Homebound - [http://content.healthaffairs.org/content/34/1/21.abstract Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care.] (1/2015)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/q-and-a/2015/jan/invisible-homebound Treating the “Invisible Homebound”: Setting Standards for Health Care Provided at Home (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
Impairments &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. 44% of people with arthritis report activity limitations of everyday tasks, such as walking or lifting bags. (3/7/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/09/hearing-loss-linked-to-increased-risk-of-death/ Adults ages 70 years or older with moderate or more severe hearing impairment have a 54% increased risk of all causes of death (9/25/15)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Usual Activities&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 39.7 million persons (12%) were limited in their usual activities due to one or more chronic health conditions (12/2013)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/books/NBK92521/ About 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis limiting their functional status and adversely impacting their quality of life. The total financial cost of pain to society (health care and productivity estimates) ranges from $560 to $635 billion (2011 Study)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Work&lt;br /&gt;
* [https://www.theatlantic.com/business/archive/2017/03/mortality-of-american-men-and-the-labor-force/520329/ 43% of men in America ages 25 to 54 who are out of the labor force report their health as fair or poor, compared with 12% of employed men and 16% of unemployed men. (3/22/17)]&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 13.8 million adults aged 18–69 (6%) were unable to work due to health problems, and 6.7 million (3%) were limited in the kind or amount of work they could do because of their health (12/2013)]&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Genomic_Profiles_Determinants Genomic Profiles Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [https://www.ted.com/talks/moshe_szyf_how_early_life_experience_is_written_into_dna Epigenetics research suggests living things reprogram their genome in response to social factors like stress and lack of food. The biochemical signals passed from mothers to offspring tell the child what kind of world they're going to live in, changing the expression of genes. (7/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877678/ Scientists believe most, if not all, diseases arise from interactions between the genome, the epigenome (controls gene expression), and the environment (broadly defined to include social, behavioral, and physical agents). (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====High Need, High Cost Patients ''Insight''====&lt;br /&gt;
High-Need, High-Cost Patients &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-superusers-pennsylvania-ring-up-1-25b-tab-0 Superusers represent 3% of hospitalized patients in Pennsylvania consumed $1.25 billion in health care costs. (6/21/17)]&lt;br /&gt;
* [https://www.theatlantic.com/theplatinumpatients/ Each year, 1 in every 20 Americans racks up just as much in medical bills as another 19 combined. (6/15/17)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% did not have good access to services that could help them manage their daily living activities. 58% did not have good access to an informed and up-to-date care coordinator. (12/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 1.2% of employees are high cost claimants who comprise 31% of total health care spending according to a report on 26 large employers. (9/15/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1608511 Caring for High-Need, High-Cost Patients — An Urgent Priority (9/8/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps2 Health care spending for high-need adults exceeded $21,000 per person, nearly three times the average for adults with multiple chronic diseases only ($7,526) and more than four times that of all adults ($4,845). (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/aug/high-need-high-cost-meps Report Profiles The 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs (8/25/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/jun/listening-to-those-living-with-chronic-conditions Top concerns of high-need patients include: Paying for Care, Accessing Care, Insurance Frustrations,  Technology Can Be Helpful, Getting Help at Home (6/16/16)]  &lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2015/dec/primary-care-physicians-in-ten-countries Nearly 25% of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84% say they are not well prepared to manage patients with serious mental illness (12/7/15)]&lt;br /&gt;
* [http://features.commonwealthfund.org/improving-care-for-those-who-need-it-most Researchers are focusing on high-need, high-cost patients—both because they need the most help and because they have the biggest impact on national health spending. 5 percent of the U.S. population accounts for 50 percent of the nation’s health care costs. (11/11/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/8/1312.abstract?=right For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary. Only 28% of super-utilizers remained on top of the list at the end of a year. (8/2015)]&lt;br /&gt;
* [https://hcttf.org/wp-content/uploads/2018/01/WhitePaper-ProactivelyIdentifyingtheHighCostPopulation.pdf Proactively	Identifying the	High Cost Population - White Paper Insights from Health Care Transforamtion Task Force 5/14/15)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1315568?query=TOC&amp;amp; Hospital-dependent patient's medical problems cannot be managed outside the hospital. (2/20/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/challenge-frequent-fliers-20-er-visits-per-year-progress/ The challenge of frequent fliers: 20 ER visits per year is progress (11/11/13)]&lt;br /&gt;
* [http://khn.org/news/one-percent-of-costliest-patients/ Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending (10/7/13)]&lt;br /&gt;
* [http://berkeleyhealthcareforum.berkeley.edu/report/executive-summary/ 53% of California's healthcare expenditures are spent by just 5% of the population (2/2013)]&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Competencies_Determinants Competencies Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Literacy_Determinants Health Literacy Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.georgiahealthnews.com/2016/10/health-literacy-life-or-death-matter/ Health literacy can be a life-or-death matter. 1 out of 3 adult Georgians is functionally illiterate. Without a clear understanding of their health condition, these adults are more likely to skip necessary medical tests and have a harder time with diabetes management or high blood pressure numbers. (10/31/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/guide-surviving-chronic-disease.html A guide to surviving chronic disease (8/3/16)]&lt;br /&gt;
* Education - A [http://www.reuters.com/article/2013/06/26/us-cancer-cure-idUSBRE95P15320130626 survey] of patients with terminal lung cancer found nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. (6/26/13)&lt;br /&gt;
* [http://www.imedicalapps.com/2014/09/knee-guide-app-educates-engages-patients-total-knee-arthroplasty-care/ My Knee Guide App Educates and Engages Patients in Total Knee Arthroplasty Care (9/25/14)]&lt;br /&gt;
* [http://medcitynews.com/2015/05/video-replay-patient-education/ Surgeon entrepreneur develops video replay for specialist appointments to boost patient education (5/28/15)]&lt;br /&gt;
* [https://health.gov/communication/literacy/issuebrief/ 77 Million Adults Have Basic or Below Basic Health Literacy (2003)]&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Education &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/07/patients-need-education-role-care.html Patients need education about their role in care (7/3/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 39% patients admit they’re only somewhat knowledgeable, at best, about how to effectively manage their chronic condition. (7/2017)] from [http://www.jonespr.net/strengthening-chronic-care-download West] Study.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-addressing-alzheimer-s-risk-factors-could-lead-to-medicare-medicaid-savings.html Preventing and effectively managing obesity, diabetes, hypertension and cardiovascular disease can reduce onset and duration of dementia and reduce healthcare costs. (4/11/14)]&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/12/536519077/took-the-wrong-medicine-by-mistake-study-finds-such-errors-are-on-the-rise More People Are Making Mistakes With Medicines At Home (7/12/17)]&lt;br /&gt;
* [http://www.reuters.com/article/us-medication-errors-health-literacy-idUSKBN0FN1SK20140718 More than half of heart patients made mistakes taking their medications or misunderstood instructions (7/18/14)]&lt;br /&gt;
* [http://www.bbc.com/news/health-30556329 Only 7% of asthma sufferers were found to use asthma inhalers in the right way (12/20/14)]&lt;br /&gt;
&lt;br /&gt;
Physician Office Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/can-help-doctor-diagnose.html How a patient can help their physician diagnose them. 3/19/17)]&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Functional Competencies Determinants] that can decisively affect a patient's overall health and well-being. &lt;br /&gt;
&lt;br /&gt;
Literacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.kevinmd.com/blog/2017/08/literacy-health-care-problem-no-one-talks.html It is estimated that there are 23 million adults in the U.S. with limited literacy, defined as below basic literacy or non-literate. (8/18/17)]&lt;br /&gt;
&lt;br /&gt;
====Education ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Education_Determinants Education Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Social ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Patient_.28About_.26_History.29_Determinants Patient (About &amp;amp; History) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-death-rate-rises-for-first-time-in-decade-7-things-to-know.html American death rate rises for first time in decade. Rises in death rates from: Alzheimer's disease, heart diseases, suicide and unintentional injuries (auto accidents and drug overdoses) (6/1/16)]&lt;br /&gt;
* [http://www.pnas.org/content/112/49/15078.full.pdf Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (9/17/15)]&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Events_Determinants Adverse Events Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Adverse Childhood Events (ACEs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/09/29/444451363/childhood-stress-may-prime-pump-for-chronic-disease-later Childhood Stress May Prime Pump For Chronic Disease Later (9/29/15)]&lt;br /&gt;
* [http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime How childhood trauma affects health across a lifetime (9/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/12/2106.abstract Adverse Childhood Events (ACEs) on attributed to higher rates of chronic disease among children (12/2014)]&lt;br /&gt;
&lt;br /&gt;
Elder Abuse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf A study found an elder abuse incidence rate in New York State was nearly 24 times greater than the number of cases referred to social service, law enforcement or legal authorities. (see Page 2) (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Beliefs_Determinants Beliefs Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/aug/improving-population-health-management Patients who don't feel they can manage their health or navigate the health care system are more likely to develop a chronic disease over a three-year period than “activated” patients with good self-management skills. Low patient-activation levels are linked to significantly more hospitalizations and emergency department (ED) use. (8/23/16)]&lt;br /&gt;
&lt;br /&gt;
====Determination ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Determination_Determinants Determination Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Insight''====&lt;br /&gt;
* See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight People]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Resilience_Determinants_-_.28Psychological_Fitness.29 Resilience Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Optimism &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/07/504709736/a-brighter-outlook-could-translate-to-a-longer-life A Brighter Outlook Could Translate To A Longer Life (12/7/16)]&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/490841/ Psychological resilience plays a role in the molecular impact of traumatic experiences. Promoting resilience may have benefits for physical and mental health (7/12/16)]&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2015/10/stressful-jobs-makes-life-shorter/412951/ Study: Stressful Jobs Make Life Shorter. Researchers found that unhealthy workplaces can affect mortality. (10/29/15)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/10/how-stress-makes-you-sick/412699/ How Stress Makes You Sick. Feeling overwhelmed affects everything from digestion to stroke risk. (10/28/15)]&lt;br /&gt;
* [http://www.nature.com/news/bacteria-implicated-in-stress-related-heart-attacks-1.15396 Emotional or physical stress can trigger heart attacks may now have a scientific explanation (6/10/14)]&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Responsibilities_Determinants Responsibilities Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://mobile.reuters.com/article/idUSKCN0VO21Q Family caregivers may be sacrificing their own health to help loved ones (2/15/16)]&lt;br /&gt;
* [http://www.mhealthtalk.com/a-guide-for-the-older-caregiver/?utm_source=rss&amp;amp;utm_medium=rss&amp;amp;utm_campaign=a-guide-for-the-older-caregiver A caregiving spouse who is between the ages of 66 and 96 and under excessive mental or emotional strain has a 63% greater risk of dying compared to those who are not tasked with caregiving. (1/17/14)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282240/ Quality of life: impact of chronic illness on the partner (11/2001)]&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Well-Being_Determinants Social Well-Being Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Defining Well-Being &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2330497 Most medical research focuses on disease rather than wellness. The diverse and interconnected dimensions of physical, emotional and social well-being. It includes achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. (7/14/15)]&lt;br /&gt;
* [http://voxeu.org/article/origins-happiness Depression and Anxiety explains the largest variance in life satisfaction. Study shows eliminating Depression and Anxiety would have 4 times the impact of eliminating poverty in improving life satisfaction. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Competence &amp;amp; Control &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/11/30/independence-its-what-older-people-want/ Independence—It’s What Older People Want (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Loneliness &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/08/07/loneliness-public-health/ Why Loneliness Is a Public Health Threat. People with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles. (8/7/17)] &lt;br /&gt;
* [http://khn.org/news/social-isolation-may-worsen-breast-cancer-prospects/amp/ Social Isolation May Worsen Breast Cancer Prospects. Women with fewer social ties — to friends, family, community and religious groups, as well as spouses or romantic partners — were 43% more likely to see their breast cancer return, 64% more likely to die from breast cancer and 69% more likely to die from any cause (12/13/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors) 37% felt socially isolated and lacked companionship compared to 15% of other adults. (12/9/12)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/loneliness-a-bigger-risk-factor-for-death-than-obesity.html Loneliness a bigger risk factor for death than obesity (9/6/16)]&lt;br /&gt;
* [http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=137534&amp;amp;WT.mc_id=USNSF_51&amp;amp;WT.mc_ev=click The profound power of loneliness can depression and other serious health problems (2/3/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/12/loneliness-social-isolation-and-health/418395/ How Loneliness Wears on the Body. New research supports the idea that social isolation is detrimental to physical health—and that companionship may improve it. (12/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems Loneliness May Warp Our Genes, And Our Immune Systems (11/29/15)]&lt;br /&gt;
* [http://time.com/3747784/loneliness-mortality/ Loneliness increases risk of death by 26%. Social isolation — or lacking social connection — and living alone were found to be even more devastating to a person’s health than feeling lonely, respectively increasing mortality risk by 29% and 32% (3/18/15)]&lt;br /&gt;
* [http://www.pnas.org/content/110/15/5797.full Social isolation and loneliness are associated with increased mortality (9/12/12)]&lt;br /&gt;
&lt;br /&gt;
Love &amp;amp; Connection &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2014/05/isolation-and-death/362063/ Stressful relationships might be significantly shortening your life, are you better off alone? (5/13/14)]&lt;br /&gt;
&lt;br /&gt;
Purpose &amp;amp; Meaning &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/soul-purpose-seniors-with-strong-reasons-to-live-often-live-stronger/ Soul Purpose: Seniors With Strong Reasons To Live Often Live Stronger (8/31/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/28/479751942/could-thinking-positively-about-aging-be-the-secret-of-health People with a sense of purpose and having positive view about aging in late middle age lived about 7 and half years longer than the people who saw aging in a negative light. (5/28/16)]&lt;br /&gt;
&lt;br /&gt;
Social Influence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.time.com/time/health/article/0,8599,1646997,00.html If a friend is obese, there is a 57% greater chance of becoming obese. (7/25/07)]&lt;br /&gt;
&lt;br /&gt;
Social Via Smartphones &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/08/07/542016165/how-smartphones-are-making-kids-unhappy How Smartphones Are Making Kids Unhappy. Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. (8/7/17)]&lt;br /&gt;
&lt;br /&gt;
====Support ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Determinants Support Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Asking For Help &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/alone-and-aging-creating-a-safety-net-for-isolated-seniors/amp/ A growing number of seniors who find themselves alone just when aging and end-of-life care becomes real. They don’t know how to approach a casual acquaintance to ask for help when they need it most. (11/28/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/population-health-means-asking-about-basic-needs-are-your-providers-ready-for-that.html Population Health Means Asking About Basic Needs: Are Your Providers Ready for That? (11/20/13)]&lt;br /&gt;
&lt;br /&gt;
Addressing Social Determinants&lt;br /&gt;
* [http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/ Improving population health will require broader approaches that address social, economic, and environmental factors that influence health. (11/4/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/21/with-the-aca-secure-its-time-to-focus-on-social-determinants/ Literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral, and environmental factors. It’s Time To Focus On Social Determinants. (7/21/15)] &lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/05/why-its-time-to-improve-the-social-determinants-of-health.html Why it’s time to improve the social determinants of health (5/1/15)]&lt;br /&gt;
* [https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf Going Beyond Clinical Walls to address the other 80% of determinants that are often challenging to address in clinical visits. (10/2014)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/may/addressing-patients-social-needs Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment (5/29/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 70 percent of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease. (7/2017)]&lt;br /&gt;
&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://morningconsult.com/opinions/importance-nonemergency-medical-transportation-vulnerable-patients/ The Importance of Nonemergency Medical Transportation for Vulnerable Patients. One patient has to take two bus rides and walk a mile just to get herself and two young children to the doctor. (1/25/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/antifraud/fierce-exclusive-beneath-patient-transportation-arrangements-a-subtle-layer-fraud Unreliable or inaccessible transportation has emerged as a significant patient care issue. Legal experts say healthcare systems providing rides to patients raises concerns that they could be violating the Anti-Kickback Statute or providing a beneficiary inducement. (8/31/16)]&lt;br /&gt;
&lt;br /&gt;
===Socioeconomic ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Socioeconomic_Determinants Socioeconomic Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
*[https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/ If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. (8/17/17)]&lt;br /&gt;
====Can't Afford Treatments ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Can.27t_Afford_Treatments_Determinants Can't Afford Treatments Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Delay Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-half-of-millennials-have-delayed-medical-care-because-of-cost.html Half of millennials have delayed medical care because of cost (1/1/16)]&lt;br /&gt;
* [http://www.gallup.com/poll/187190/cost-delays-healthcare-one-three.aspx 31% Americans say that they or a family member have put off any sort of medical treatment in the past year because of the cost (11/30/15)]&lt;br /&gt;
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Reduce Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-half-of-aca-exchange-customers-skimp-on-healthcare-to-reduce-costs.html Half of ACA exchange customers skimp on healthcare to reduce costs (10/28/16)]&lt;br /&gt;
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Skip Medical Care &amp;lt;Br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-1-in-3-older-millennials-skips-medical-care-because-of-costs.html Survey: 1 in 3 older millennials skips medical care because of costs (6/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/nov/international-survey-release About one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. (11/16/16)]&lt;br /&gt;
* [http://archpedi.jamanetwork.com/article.aspx?articleid=1872780 Financial Barriers to Care Among Low-Income Children With Asthma (7/2014)]* [http://money.cnn.com/2013/04/26/news/economy/health-care-cost/ 80 million people (43% of America's working-age adults) didn't go to the doctor or access other medical services last year because of the cost (4/26/13)]&lt;br /&gt;
&lt;br /&gt;
====Financial ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Financial_Determinants Financial Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Annual Healthcare Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2016/05/24/annual-healthcare-cost-for-family-of-four-now-at-25826/#33aa77f75226 Healthcare Costs in 2016 for a Family of Four Will Be $25,826 (5/24/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2015/05/19/annual-healthcare-cost-for-family-of-four-now-at-24671/#29d013444dfb Annual Healthcare Cost For Family Of Four Now At $24,671 (5/19/15)]&lt;br /&gt;
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Fear of Healthcare Costs&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/53-of-americans-equate-unaffordable-medical-bills-to-being-diagnosed-with-a-serious-illness.html 53% of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness (3/21/17)]&lt;br /&gt;
* [http://www.healthpopuli.com/2017/02/08/health-care-worries-top-terrorism-far-americans-minds/ Health Care Worries Top Terrorism, By Far, In Americans’ Minds (2/8/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/healthcare-finances-a-source-of-fear-for-75-of-consumers.html Healthcare finances a source of fear for 75% of consumers (2/7/17)]&lt;br /&gt;
* [http://www.businesswire.com/news/home/20141006006149/en/Cigna-Consumer-Survey-%E2%80%98Health-Costs-Derail-Financial#.VDg8PvldXng 75% fear health costs could ruin prospects for secure retirement (10/6/14)]&lt;br /&gt;
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Financial Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthpopuli.com/2017/04/26/financial-stress-health-risk-factor-impacts-americans/ Financial Stress As A Health Risk Factor Impacts More Americans (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% of high-need said they experience stress about their ability to afford housing, utilities or nutritious meals compared to 32% of other adults. (12/9/16)]  &lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-bills-lead-to-serious-debt-for-some-americans-6-things-to-know.html 85% of employees in survey in 2015 reported at least some level of financial stress. 33% were assessed as having serious debt, such as student debt, medical bills and/or credit card debt. (7/20/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/federal-reserve-board-47-of-americans-struggle-to-pay-unexpected-400-bill.html  47% of Americans struggle to pay unexpected $400 bill (6/8/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/54.abstract For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships (1/2016)]&lt;br /&gt;
* [http://www.pwc.com/us/en/private-company-services/publications/financial-well-being-retirement-survey.html Survey shows 52% of employees stressed about their finances. 45% saying that financial matters cause the most stress, nearly as many as stress from job, health, or relationships combined. (2016 Employee Financial Wellness Survey)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/more-americans-struggle-healthcare-costs 46% of Americas described paying for care as a hardship rather than affordable (12/19/14)]&lt;br /&gt;
&lt;br /&gt;
Health Inequality &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2017/06/05/america-is-a-world-leader-in-health-inequality/?utm_term=.7c7983e42f5c People in households making less than $22,500 a year, 38% reported being in poor or fair health. That's more than three times the rate of health troubles faced by individuals in households making more than $47,700 a year. (6/5/17)]&lt;br /&gt;
* [http://www.hhnmag.com/articles/7416-look-to-income-inequality-to-help-explain-population-health Having less money is linked to poorer health regardless of personal habits. (7/5/16)]&lt;br /&gt;
* [https://www.brookings.edu/research/what-growing-life-expectancy-gaps-mean-for-the-promise-of-social-security/ Life expectancy is higher for the wealthiest. Among American men born in 1940, the wealthiest 10% are expected to live on average 12 years longer than the poorest 10%. (2/12/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/costs-deter-low-income-patients-from-participating-in-clinical-trials.html Costs deter low-income patients from participating in clinical trials (11/3/15)]&lt;br /&gt;
* [http://www.nytimes.com/2014/04/06/health/even-small-medical-advances-can-mean-big-jumps-in-bills.html?from=homepage&amp;amp;_r=0 New innovative treatments and technology is often out of the reach of low income patients. (4/5/14)]&lt;br /&gt;
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Medical Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/half-of-uninsured-people-face-problems-with-their-medical-bills-9-survey-findings.html Half of uninsured people face problems with their medical bills (8/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/61-of-patients-confused-by-medical-bills-survey-finds.html 61% of patients confused by medical bills, survey finds (7/14/16)]&lt;br /&gt;
* [http://www.cbsnews.com/news/cdc-one-in-five-americans-cant-pay-medical-bills/ CDC: One in five Americans can't pay medical bills (9/30/13)]&lt;br /&gt;
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Prescription Drugs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/sticker-shock-forces-thousands-of-cancer-patients-to-skip-drugs-skimp-on-treatment/amp/ Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (3/15/17)]&lt;br /&gt;
* [http://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/ Faced With Unaffordable Drug Prices, Tens Of Millions Buy Medicine Outside U.S. (12/20/16)]&lt;br /&gt;
&lt;br /&gt;
Price Shopping for Medical Services &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.marketwired.com/press-release/survey-finds-healthcare-providers-benefit-from-up-front-cost-estimates-yet-many-patients-nyse-tru-2192070.htm Survey found 43% said it was somewhat or very difficult to get information on costs, while another 21% of patients had never tried to get procedure cost information. (1/31/17)]&lt;br /&gt;
* [http://khn.org/news/consumer-choices-have-limited-impact-on-u-s-health-care-spending-study/ Less than 7% of total health care spending in 2011 was paid by consumers for “shoppable” services. (3/4/16)]&lt;br /&gt;
&lt;br /&gt;
====Food Insecurity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Food_Insecurity_Determinants Food Insecurity Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.hpoe.org/resources/ahahret-guides/3058 Social Determinants of Health Series: Food Insecurity(8/3/17)]&lt;br /&gt;
* [http://online.liebertpub.com/doi/abs/10.1089/pop.2015.0127 Study of food insecurity in patients with high rates of inpatient hospitalization (“super-utilizers”). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed. Using USDA definition of food insecurity, 30% were food insecure and 25% were marginally food secure. 40% responded that, in the past 30 days, they worried that their food would run out; 17.5% that they did not eat for a full day. 75% were unable to shop for food on their own and 58% were unable to prepare their own food. (12/1/16)]&lt;br /&gt;
* [http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html 42.2 million Americans lived in food insecure households in 2015 (29.1 million adults and 13.1 million children). (2016)]&lt;br /&gt;
* [http://pdf.aarpfoundation.org/i/455086-aarp-foundation-findings-on-nutrition-knowledge-and-food-insecurity-among-older-adults Nearly 9 million older adults in the United States experience food insecurity. (12/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1949.abstract Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1830.abstract Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. (11/2015)]&lt;br /&gt;
* [http://khn.org/news/in-sunlit-paradise-seniors-go-hungry/ In Sunlit Paradise, Seniors Go Hungry (5/26/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/03/food-insecurity-undiagnosed-medical-problem.html Food insecurity is an undiagnosed medical problem (3/6/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/1/116.abstract Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia (1/2014)]&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Insurance_Determinants Health Insurance Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [https://www.nytimes.com/2017/05/08/upshot/a-medicare-drug-incentive-that-leads-to-greater-hospitalizations.html For sicker Medicare beneficiaries, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits (5/8/17)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/09/16/494139538/studies-link-cancer-patients-survival-time-to-insurance-status Studies Link Cancer Patients' Survival Time To Insurance Status (9/16/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/958.abstract?=right Insurance is paying for more of the cost of treating mental health conditions (68%) but not for Substance Use Disorders (46%) (6/2016)]&lt;br /&gt;
* [http://khn.org/news/new-health-plans-offer-discounts-for-diabetes-care/ New health plans offer discounts and give gift cards to encourage patients to use diabetes care (11/17/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aca-health-plans-limit-access-to-specialists-7-findings.html ACA health plans limit access to specialists: 7 findings (10/28/15)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2015/09/21/insurance-healthy-behavior-key-reducing-cost-chronic-disease/72563266/ Study showed total cost for insured members with no chronic conditions was $3,024 a year ($2,204 out-of-pocket) and members with two or more chronic conditions was $11,940 a year ($3,500 out-of-pocket). (9/21/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/why-doctors-must-discuss-costly-treatment-before-patients-receive-bills Why doctors must discuss costly treatment before patients receive bills (10/18/13)]&lt;br /&gt;
&lt;br /&gt;
Denied Coverage &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/many-patients-chronic-illnesses-find-insurance-providers-deny-treatment-new-survey-says 'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says (8/16/17)]&lt;br /&gt;
Dual Eligible Patients (Qualify for Medicare and Medicaid) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://files.kff.org/attachment/Testimony-of-Gretchen-Jacobson-Ways-and-Means-Committee-Subcommittee-on-Health Low-income people on Medicare who receive assistance from Medicaid tend to have more chronic conditions, as well as cognitive and functional limitations, than others on Medicare: 61% vs. 33% need assistance with one or more activities of daily living, such as eating, bathing, and dressing; more than half, 58% vs. 29% have a mental condition or cognitive impairment; 37% vs. 27% have five or more chronic conditions; 18% vs 6% rate their health status as poor. (6/7/17)]&lt;br /&gt;
&lt;br /&gt;
Employer Sponsored Health Insurance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/interactives-and-data/maps-and-data/employer-health-insurance-premiums State-by-State Look at Employer Health Insurance Costs Finds Workers’ Premium Contributions and Deductibles Growing More Slowly But Eating Up Greater Share of Incomes (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/employer-family-plan-premiums-soar-above-18k-in-2016.html Employer family health plan premiums soar above $18k in 2016 (9/14/16)]&lt;br /&gt;
&lt;br /&gt;
High Deductable Health Plans (HDHPs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/10-things-to-know-about-2016-healthcare-consumer-payment-trends.html Consumers insured through high-deductible health plans increased from 10 million in 2010 to 75 million in 2016. The average deductible for individuals with employer-based coverage doubled from $735 in 2010 to $1,478 in 2016. Patient payments to providers increased 58% from 2013 to 2016. (6/13/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/cdc-nearly-40-of-us-adults-have-high-deductible-health-plans.html CDC: Nearly 40% of US adults have high-deductible health plans (6/7/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patients-with-chronic-illness-and-high-deductibles-more-likely-to-delay-care-study-finds.html Patients with chronic illness and high deductibles more likely to delay care, study finds. People with three or more chronic conditions were also nearly three times as likely to delay or avoid care as those without chronic conditions (25% compared to 9%) (11/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/given-the-choice-34-of-employees-choose-hdhps.html Given the choice, 34% of employees choose HDHPs (5/3/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly one-quarter of workers are enrolled in an High Deductable Health Plan, up from 4% in 2006. (2/4/16)]&lt;br /&gt;
&lt;br /&gt;
Medicaid &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://healthpayerintelligence.com/news/spike-in-late-stage-cancer-diagnosis-related-to-medicaid-cut Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut (7/5/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare Beneficiaries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/ Half of all Medicare beneficiaries had incomes below $26,200 in 2016 (4/21/17)]&lt;br /&gt;
Patient Out-of-Pocket Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medicare-cancer-patients-without-additional-coverage-hit-with-high-out-of-pocket-costs-4-things-to-know.html Medicare cancer patients without additional coverage hit with high out-of-pocket costs (11/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patient-payment-responsibility-spiked-13-in-2015.html Patient payment responsibility spiked 13% in 2015 (6/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/may/on-medicare-but-at-risk 16 percent of Medicare beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. (5/10/16)]&lt;br /&gt;
* [http://www.healthsystemtracker.org/insight/payments-for-cost-sharing-increasing-rapidly-over-time/?utm_campaign=KFF-2016-Peterson-Cost-Sharing-Analysis&amp;amp;utm_medium=email&amp;amp;_hsenc=p2ANqtz-_fzaJSkoJE-fetaUk0iwQOwPP__Fpq1BkKAV4WPcOHEuKp1Ww3jVG7Fl41gr19-i_hWcUPOy The average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. (4/12/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly half of workers are covered by an insurance plan with a general annual deductible of at least $1,000 for individual coverage. (2/4/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/high-out-pocket-expenses-narrow-insurance-networks-send-more-patients-to-ers High out-of-pocket expenses, narrow insurance networks send more patients to ERs (10/26/15)]&lt;br /&gt;
* [http://kff.org/report-section/ehbs-2015-summary-of-findings/ Workers with health insurance covered by their employers have an annual deductible amount for single coverage of $1,318. (9/22/15)]&lt;br /&gt;
&lt;br /&gt;
Surprise Out-of-Network Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/many-medicare-advantage-members-burned-by-out-of-network-bills.html Many Medicare Advantage members burned by out-of-network bills due to changes in network providers (11/28/16)]&lt;br /&gt;
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Uninsured &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/lists/2016/remaining-uninsured Why Do Millions of U.S. Adults Remain Uninsured? 1) The ACA excludes undocumented immigrants; 2) Nineteen states have not expanded Medicaid eligibility; 3) Many people still don’t know about the health insurance marketplaces; 4) Affordability is a concern; 5) Selecting a plan can be difficult: 6) Many aren’t getting the help they need. (10/21/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/federal-estimate-of-uninsured-falls-to-record-low-7-statistics.html Federal estimate of uninsured falls to record low 8.6% (9/7/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/who-are-the-remaining-uninsured Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? (8/18/16)]&lt;br /&gt;
* [http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf The percentage uninsured in 2015 was 10.5% (28.4 million) (5/2016)]&lt;br /&gt;
* [http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Uninsured nonelderly Americans in 2014 was 32 million. 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Over 5 in 10 of uninsured have family income below 200% of poverty. (10/5/15).]&lt;br /&gt;
&lt;br /&gt;
====Income &amp;amp; Work ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Income_.26_Work_Determinants Income &amp;amp; Work Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-working-night-shifts-furthers-health-disparities.html How working night shifts furthers health disparities (10/25/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3064755/work-smart/study-finds-work-life-balance-could-be-a-matter-of-life-and-death Study found that those who work in high-stress jobs with little control are more likely to die sooner than those who have more control over and balance in their work. (10/20/16)]&lt;br /&gt;
&lt;br /&gt;
* [http://healthcare-economist.com/2016/09/26/effect-of-job-loss-on-physical-and-mental-health/ Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results similar for mental health. (9/26/16)]&lt;br /&gt;
* [http://khn.org/news/low-income-patients-face-hurdles-to-care-at-public-hospital-in-miami/ Low-Income Patients Face Hurdles To Care At Public Hospital (8/28/14)]&lt;br /&gt;
* [http://www.nccp.org/topics/childpoverty.html More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level]&lt;br /&gt;
&lt;br /&gt;
Labor Force Participation &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2016-10-07/why-are-so-many-men-not-working-they-re-in-pain A large share of American men between the ages of 25 and 54 who aren’t in the labor force may suffer from serious health conditions that are “a barrier to work” and suffer physical pain, sadness, and stress in their daily lives. (10/7/16)]&lt;br /&gt;
Lack of Sick Leave &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.wbur.org/npr/484960907/hassle-of-being-a-patient-can-turn-into-a-crisis-without-sick-leave Hassle Of Being A Patient Can Turn Into A Crisis Without Sick Leave. Third of working Americans say their jobs don't offer paid sick days (7/11/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/3/520.abstract Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. 3.0 times more likely to forego medical care for themselves and 1.6 times more likely to forego care for family (3/2016)] &lt;br /&gt;
&lt;br /&gt;
Low Income Impact on Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/socioeconomic-hardships-hurt-dual-eligibles-health-outcomes Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid (4/2/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/03/screening-poverty-included-medical-curriculum.html Low socioeconomic status (SES) is a risk factor for a multitude of medical conditions including cardiovascular disease, respiratory disease, cancer, and mental illness. (3/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/employment-status-top-socioeconomic-factor-readmissions Employment status top socioeconomic factor in readmissions (12/11/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/08/29/exhibit-of-the-month-income-related-disparities-associated-with-negative-health-outcomes/ Income-Related Disparities Associated With Negative Health Outcomes (8/29/14)]&lt;br /&gt;
* [http://hin.com/Healthcare_Business_Weekly_Update/2014/06/06/data-dive-uncovers-socioeconomics-driving-er-visits-readmissions/ Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions (6/6/14)]&lt;br /&gt;
&lt;br /&gt;
Work environment &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/258.abstract?=right Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence (2/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1761.abstract Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups (10/2015)]&lt;br /&gt;
&lt;br /&gt;
====Legal ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Legal_Determinants Legal Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Jail Involved &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/05/499775644/helping-ex-inmates-stay-out-of-the-er-brings-multiple-benefits Early access to primary care for ex-inmates can bring down healthcare costs by keeping them out of the ER (12/5/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/443.abstract The Critical Link Between Health Care And Jails (3/2014)]&lt;br /&gt;
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===Environmental ''Insight''===&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Access &amp;amp; Logistics ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Access_.26_Logistics_Determinants Access &amp;amp; Logistics Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Disability &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.mentalhealthamerica.net/sites/default/files/Parity%20or%20Disparity%20Report%20FINAL.pdf There is only 1 mental health provider for every 790 individuals. One out of three adults with disability could not see a doctor because of costs. (2015)]&lt;br /&gt;
Rural or Remote Area &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/patients-lacking-pharmacy-access-likely-to-readmitted-to-hospital Patients in rural or remote communities with lack of access to a pharmacy may be more likely to end up back in the hospital (8/4/16)]&lt;br /&gt;
* [https://www.minnpost.com/health/2014/06/late-life-live-home-rural-seniors-need-food-socialization-support Late-in-life: To live at home, rural seniors need food, socialization, support (6/23/14)]&lt;br /&gt;
* [http://www.rand.org/pubs/research_reports/RR578.html Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care. (2015)]&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/ Transportation barriers to health care access are common, and greater for vulnerable populations. (12/2013)]&lt;br /&gt;
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====Communication ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Communication_Determinants Communication Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Community ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Community_Determinants Community Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://cdnfiles.americashealthrankings.org/SiteFiles/Reports/2015_Am_Health_Ranking.pdf America’s Health Rankings of Behaviors, Community &amp;amp; Environment, Policy, and Clinical Care determinants of health that directly influence health outcomes (2015 Edition)]&lt;br /&gt;
* [http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Apr/Community-Factors-and-Hospital-Readmission-Rates.aspx Community factors most strongly associated with lower hospital readmission rates include more general practitioners and fewer specialists per capita and the presence of high-quality nursing home care. (4/17/14)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html Time to Act: Investing in the Health of Our Children and Communities (1/13/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/29/3/503.long Children had a 20-60% higher likelihood of being obese or overweight if living in neighborhoods with unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers. (3/2010)]&lt;br /&gt;
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Clean Air &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html The surprising link between air pollution and Alzheimer’s disease (1/31/17)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/world/air-pollution-smog-who.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ More Than 9 in 10 People Breathe Bad Air, W.H.O. Study Says (9/28/16)]&lt;br /&gt;
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Clean Water &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/08/14/63-million-americans-exposed-unsafe-drinking-water/564278001/ 63 million Americans exposed to unsafe drinking water (8/14/17)]&lt;br /&gt;
* [http://www.reuters.com/investigates/special-report/usa-lead-testing/ Water testing for lead levels found almost 3,000 areas with poisoning rates far higher than in Flint Michigan. Yet many of these lead hotspots are receiving little attention or funding. (12/19/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/as-water-infrastructure-ages-cost-treating-infections-rise Researchers believe as much as $2 billion of healthcare costs each year is tied to the treatment of infections that lurk in water distribution systems. (9/19/16)]&lt;br /&gt;
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Community Related - Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1571 Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990–2013 (8/2017)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/05/08/u-s-life-expectancy-varies-by-more-than-20-years-from-county-to-county/ U.S. life expectancy varies by more than 20 years from county to county (5/8/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/tackling_life_expect.html A person born in Princeton, NJ can expect to live 87 years, his or her neighbor a dozen miles away in Trenton has a life expectancy of 73 years (11/9/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thetwo-way/2016/04/11/473749157/its-not-just-what-you-make-its-where-you-live-says-study-on-life-expectancy Life Expectancy Study: It's Not Just What You Make, It's Where You Live (4/11/16)]&lt;br /&gt;
&lt;br /&gt;
Countries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/when-it-comes-to-healthcare-u-s-once-again-ranks-last-quality-care-compared-to-other When it comes to healthcare, U.S. once again ranks last in quality care compared to other wealthy nations (7/14/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/global-study-700k-smartphone-users-shows-link-between-obesity-and-activity-inequality Global study of 700K smartphone users shows link between obesity and activity inequality within country (7/11/17)]&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.revealnews.org/blog/14-million-kids-could-be-exposed-to-toxic-pcbs-at-school/ 14 million US kids could be exposed to toxic PCBs at school (10/12/16)] &lt;br /&gt;
&lt;br /&gt;
Food Deserts &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0122 Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14 (8/2017)]&lt;br /&gt;
* [http://www.ers.usda.gov/amber-waves/2010-march/access-to-affordable,-nutritious-food-is-limited-in-%E2%80%9Cfood-deserts%E2%80%9D.aspx Some neighborhoods in US, mostly in low-income areas, have been dubbed “food deserts” because they don't have supermarkets or other food retailers that carry affordable and nutritious food. (3/1/2010)]&lt;br /&gt;
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Food Safety &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lead-detected-in-20-of-baby-food-samples-surprising-even-researchers/ Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers (6/15/17)]&lt;br /&gt;
&lt;br /&gt;
Low Income Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/999.abstract One’s neighborhood may drive or influence health disparities, which can be understood as disadvantages in health associated with one’s social, racial, economic, or physical environment, originate in childhood and persist across an individual’s life course. (6/2017)]&lt;br /&gt;
*[http://www.theatlantic.com/business/archive/2016/04/why-the-poor-die-young/477846/ A massive study of health and income found that smoking, obesity, and exercise are the most important determinants of longevity. Poor neighborhoods score worse in all of them. (4/12/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1383.abstract People who live in lower-income neighborhoods have a higher rate of diabetic lower-extremity amputations than those in more affluent areas (8/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/06/13/well/live/noise-may-raise-blood-pressure-risk.html Noise May Raise Blood Pressure Risk based on a study of people who lived near Athens International Airport (6/13/17)]&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
Walkable Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27218630 Higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012 (5/24/16)]&lt;br /&gt;
&lt;br /&gt;
====Home ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Home_Determinants Home Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.mhealthtalk.com/common-problems-solutions/ The most common problems as you age in your home. (8/7/16)]&lt;br /&gt;
&lt;br /&gt;
Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.miamiherald.com/opinion/op-ed/article113730634.html Affordable housing, quality healthcare can let seniors age in place (11/9/16)]&lt;br /&gt;
* [http://www.stltoday.com/lifestyles/health-med-fit/health/want-a-better-chance-to-stay-out-of-a-nursing/article_c1b66d15-7afd-5b85-8e95-d83cc13d8f16.html Want a better chance to stay out of a nursing home? Modify your home (11/6/16)]&lt;br /&gt;
* [http://www.nytimes.com/2015/06/23/health/at-home-many-seniors-are-imprisoned-by-their-independence.html?ref=health&amp;amp;_r=3 Many seniors living at home feel imprisoned by their independence] (6/19/15)&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2016/07/gas-leaks-mold-and-rats-millions-of-americans-live-in-hazardous-homes/492689/ Gas Leaks, Mold, and Rats: Millions of Americans Live in Hazardous Homes (7/25/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/01/important-lesson-personalized-patient-care.html Controlling environmental allergens can reduce sneezing and nasal congestion that trigger asthma (1/1/14)]&lt;br /&gt;
* [http://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet Scientists estimate that lung cancer deaths could be reduced by 2 to 4% by addressing the one in 15 homes the EPA believes has too much radon exposure]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/multi-faceted-home-ventilation-intervention-reduces-copd-readmissions-study-finds Multi-faceted home ventilation intervention reduces COPD readmissions, study finds (7/15/15)]&lt;br /&gt;
* [http://www.cdc.gov/nceh/lead/ At least 4 million households have children living in them that are being exposed to high levels of lead (1/29/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2009/07/improving-the-health-of-all-americans-through-safe-and-healthy-h.html Approximately 40% of the 6.7 million children with diagnosed asthma are believed to be attributable to residential exposures (7/2009)]&lt;br /&gt;
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Homelessness &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://academic.oup.com/jpubhealth/article-abstract/doi/10.1093/pubmed/fdx034/3074503/Lifetime-and-1-year-prevalence-of-homelessness-in?redirectedFrom=fulltext Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2% and 1.5%, respectively (3/18/17)]&lt;br /&gt;
&lt;br /&gt;
Home Injuries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commissiononhealth.org/PDF/e434bb61-64d3-4267-9dca-705b9d80ddaa/HousingFactSheetJun09.pdf An estimated 4 million emergency department visits and 70,000 hospital admissions were attributed to injuries at home. (6/2009)]&lt;br /&gt;
&lt;br /&gt;
Housing Instability &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/housing-instability-will-cost-healthcare-industry-111b-over-next-decade.html Housing instability will cost healthcare industry $111B over next decade (8/10/17)]&lt;br /&gt;
&lt;br /&gt;
Housing Quality &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.sciencedirect.com/science/article/pii/S1353829214001087 NYC heat-mortality rates are associated with poverty and poor housing quality. (11/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Security ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Security_Determinants Security Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
Neighborhood Violence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/chicagoans-rank-violence-as-top-concern-in-health-needs-assessment.html Injury and violence was ranked as top concerns among Chicago's South and West Side residents, along with diabetes, nutrition, physical activity and weight, substance abuse and tobacco use, according to a health needs survey. (6/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-link-between-neighborhood-violence-and-biological-stress-in-children.html Study finds link between neighborhood violence and biological stress in children (11/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Content_Determinants Digital Content &amp;amp; Technology Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Records_Determinants Medical Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [http://medcitynews.com/2014/01/trends-healthcare-giving-access-doctor-notes-can-stimulate-patient-engagement/ Giving access to doctor notes can stimulate patient engagement (1/6/14)]&lt;br /&gt;
* [https://www.healthit.gov/patients-families/blue-button/about-blue-button Medicare provides medical history on a mobile app (Blue Button) for patients and caregivers to share with doctors]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Determinants_Records Health Determinants Records] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Records_Determinants Health Interventions Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Outcomes_Records_Determinants Health Outcomes Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Technology_.26_Apps_Determinants Technology &amp;amp; Apps Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.chicagotribune.com/lifestyles/health/sc-devices-to-track-wandering-kids-with-autism-health-0517-20170508-story.html 96% of parents surveyed who said they were using an electronic tracking device for their child with autism claimed it improved their quality of life (5/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/may/mobile-health-and-patient-engagement-in-the-safety-net Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics (5/13/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Making and Condition Management&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/new-apps-aim-guide-men-through-treatment-symptom-management-prostate-cancer New apps aim to guide men through treatment, symptom management of prostate cancer (9/10/16)]&lt;br /&gt;
&lt;br /&gt;
Devices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-patients-often-misuse-wrist-blood-pressure-monitors-leading-inaccurate-readings Study finds patients often misuse wrist blood pressure monitors, leading to inaccurate readings (9/7/16)]&lt;br /&gt;
&lt;br /&gt;
Digital Health Apps &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.engadget.com/amp/2017/07/11/lumosity-does-not-improve-cognitive-skills/ Lumosity doesn’t actually improve your cognitive skills (7/11/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/internet-mobile-disease-interventions-seem-work-longterm-studies-are-lacking Internet, mobile disease interventions seem to work, but long term studies are lacking (9/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-health-apps-near-meaningless-for-low-income-patients-with-chronic-conditions.html Study: Health apps near meaningless for low-income patients with chronic conditions (7/20/16)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/03/rehab-app-shoulder-rotator-cuff/ Rehab App Aims to Improve Shoulder &amp;amp; Rotator Cuff Repair Rehabilitation (3/21/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/commonwealth-fund-reasonably-small-number-chronic-health-apps-are-useful Some 43 percent of iOS health apps and 27 percent of Android health apps are useful. (2/22/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/copd-management-apps/ 5 digital health tools that could improve COPD management (12/3/15)]&lt;br /&gt;
* [http://www.imedicalapps.com/2014/11/cardiosmart-explorer-great-tool-educating-patients-clinic/ CardioSmart Explorer is a great tool for educating patients with cardiac disease (11/21/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/oct/vision-digital-health-tech A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System (10/1/14)]&lt;br /&gt;
* A [http://mobihealthnews.com/23418/most-patients-want-their-doctors-to-prescribe-apps/ study] from Digitas Health found that 90 percent of chronic patients in the US would accept a mobile app prescription as opposed to only 66 percent willing to accept a prescription of medication. (7/1/13)&lt;br /&gt;
&lt;br /&gt;
Digital Health Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-technology-self-monitor-blood-glucose-levels-no-better-traditional-management JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/content/study-patients-are-more-compliant-alivecor-devices-traditional-event-monitors Patients are more compliant to  smartphone-connected heart monitor devices than traditional event monitors (5/5/16)]&lt;br /&gt;
* [http://journals.lww.com/neurologynow/Citation/2015/11040/Wearing_the_Detectives__Wristbands,_smartwatches,.23.aspx Wristbands, smartwatches, and other wearable devices allow for more real-time monitoring of seizures and other neurologic symptoms—and, possibly, more precise treatment. (8/2015)]&lt;br /&gt;
&lt;br /&gt;
Home Automation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/top-home-tech-for-seniors-infographic/ Top Home Tech for Seniors (7/28/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/home-automation-and-home-health-care/ Home automation and in-home care aid gives patients independence without sacrificing their health needs. (3/25/14)]&lt;br /&gt;
&lt;br /&gt;
Internet Access &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/a-growing-number-people-chronic-conditions-also-lack-internet-access A growing number of people with chronic conditions also lack internet access (6/9/17)]&lt;br /&gt;
* [http://www.huffingtonpost.com/jane-sarasohnkahn/broadband-connectivity-is_b_11059720.html Broadband Connectivity Is A Social Determinant Of Health (7/22/16)]&lt;br /&gt;
&lt;br /&gt;
Technology Efficacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/smart-pill-bottles-didn-t-improve-adherence-for-heart-attack-patients-but-researchers-say Smart pill bottles didn’t improve medication adherence for heart attack patients, but earlier intervention could help (6/26/17)]&lt;br /&gt;
&lt;br /&gt;
==Impacting People Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Physicians ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Disciplines_.26_Resources_Determinants Physician Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Primary Care Physicians &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/many-americans-don-t-have-a-primary-care-doctor Some 28% of U.S. men and 17% of women don’t have a personal doctor or healthcare provider, according to a government survey. (1/12/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Team Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_.26_Resources_Determinants Care Team &amp;amp; Resources Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
====Credentialed Care Specialists Insight====&lt;br /&gt;
Nurses &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/how-a-specialist-nurse-can-help-with-dementia/ How a Specialist Nurse can Help with Dementia (6/21/14)]&lt;br /&gt;
&lt;br /&gt;
====Credentialed Support Providers Insight====&lt;br /&gt;
&lt;br /&gt;
====Team-Based Approach====&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/04/526475132/to-bring-down-stubbornly-high-blood-pressure-it-helps-to-have-a-team To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team (5/4/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/team-based-care-can-have-negative-financial-impact-on-primary-care-in-ffs-environment.html Team-based care can have negative financial impact on primary care in FFS environment (8/10/16)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2016/06/15/the-team-sport-of-diagnosis-a-culture-shift-can-reduce-missed-diagnoses/ The Team Sport of Diagnosis: A Culture Shift Can Reduce Missed Diagnoses (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Insight''===&lt;br /&gt;
Caregiver &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170807.061390/full/ More than a million youngsters ages 8–18 are caregivers taking on challenging tasks to help a parent, grandparent, sibling, or other relative. (8/7//17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-70-percent-caregivers-say-tech-plays-no-role-or-minor-role-their-work Survey: 70 percent of caregivers say tech plays no role or a minor role in their work (6/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/new-pennsylvania-law-requires-hospitals-to-educate-caregivers-upon-patient-discharge.html  New Pennsylvania law requires hospitals to educate caregivers upon patient discharge (4/27/17)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family-caregiving-cost-survey-res-ltc.pdf Study: Many Caregivers Spend $7K Annually Out Of Pocket, which is 20% of their income (11/14/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3065403/the-future-of-work/the-hidden-caregiving-crisis-that-the-election-wont-solve The number of U.S. workers struggling to care for ill or aging loved ones is growing fast. But the support they need isn't. (11/8/16)]&lt;br /&gt;
* [http://khn.org/news/study-elderlys-family-caregivers-need-help-too/amp/ Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones (9/14/16)]&lt;br /&gt;
* [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers In Some States, a New Focus on Family Caregivers. Nearly half of family caregivers administer multiple medications, treat wounds or operate specialized medical equipment. (6/22/16)]&lt;br /&gt;
* [http://khn.org/news/who-are-americas-caregivers-nearly-a-quarter-are-millennials/ Who Are The 40 Million American Caregivers? Nearly A Quarter Are Millennials (12/3/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/15-things-to-know-about-caregivers.html 15 things to know about caregivers (11/3/15)]&lt;br /&gt;
* [http://mobihealthnews.com/48054/new-council-will-guide-family-caregivers-to-available-tools/ New council will guide family caregivers to available tools (10/28/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/caregiver-frustration/ Nearly one-third struggle in their caregiving role and want tools to help them and their family members. 64% feel stressed and overwhelmed; nearly half struggle with balancing personal needs and caregiving. (10/24/15)]&lt;br /&gt;
* [http://khn.org/news/dementia-also-takes-toll-on-unpaid-caregivers-study-shows/ Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia (10/16/2015)]&lt;br /&gt;
* [http://www.usnews.com/news/us/articles/2015/07/14/ap-norc-poll-many-californians-unaware-of-caregiver-program Many Californians unaware of caregiver program for low-income seniors, disabled (7/14/15)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-undeniable-progress.pdf In 2013, about 40 million family caregivers in the US provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013. (7/2015)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf An estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the 12 months period in 2014 and 2015. (6/2015)]&lt;br /&gt;
* [http://medcitynews.com/2015/04/care-caregiver/ How Do We Care for the Caregiver (4/23/15)]&lt;br /&gt;
* [https://www.caring.com/about/news-room/costs-of-caregiving-2014 Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs (9/15/14)]&lt;br /&gt;
&lt;br /&gt;
Home Care (Non-Credentialed) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/ Lots Of Responsibility For In-Home Care Providers — But No Training Required (1/6/15)]&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends Determinants] that can decisively affect a patient's overall health and well-being. &amp;lt;br&amp;gt;&lt;br /&gt;
Spouse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.asco.org/about-asco/press-center/news-releases/large-study-finds-association-between-marriage-and-cancer Large Study Finds Association Between Marriage and Cancer Outcomes (9/23/13)]&lt;br /&gt;
&lt;br /&gt;
===Support Team Insight===&lt;br /&gt;
&lt;br /&gt;
Community Health Workers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/ Hospitals Eye Community Health Workers To Cultivate Patients’ Successes (4/11/16)]&lt;br /&gt;
* [http://khn.org/news/in-l-a-community-health-workers-are-part-of-the-medical-team/ In L.A., Community Health Workers Are Part Of The Medical Team (10/26/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/16/how-community-health-workers-can-reinvent-health-care-delivery-in-the-us/ How Community Health Workers Can Reinvent Health Care Delivery In The US (1/16/15)]&lt;br /&gt;
&lt;br /&gt;
Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html How Social Spending Affects Health Outcomes (8/17/16)]&lt;br /&gt;
* [https://thehealthcaremarketer.wordpress.com/2016/08/11/the-health-impact-in-5-years-hi-5-initiative/ Centers for Disease Control and Prevention (CDC) launches new initiative – Health Impact in 5 Years (HI-5). Promotes list of proven non-clinical, community-wide interventions that improved health within five years and are cost-effective or have cost-saving over the lifetime of the population. (8/11/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/politics/2016/05/02/social-service-shortfalls-hinder-health-boost-medical-spending/83625264/ Social service shortfalls hinder health, boost medical spending (5/3/16)] &lt;br /&gt;
* [https://www.icsi.org/_asset/nsnyw1/sharingknowledgedata.pdf Sharing Knowledge and Data at the Community/System Level To Address Social Determinants (4/2015)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/14/to-lower-the-cost-of-health-care-invest-in-social-services/ To Lower The Cost Of Health Care, Low-tech social services also should be considered a key factor in our health care equation. (7/14/15)]&lt;br /&gt;
* [http://www.cdc.gov/chinav/ CDC launches Community Health Improvement Navigator (CHI Navigator) website (5/2015)] with tools and resources from [http://www.thecommunityguide.org/ The Guide to Community Preventive Services], the [http://whatworksforhealth.wisc.edu/ What Works for Health database (on the University of Wisconsin website)], the [https://innovations.ahrq.gov/ AHRQ Health Care Innovations Exchange], the [http://cdc.thehcn.net/index.php?module=promisepractice&amp;amp;controller=index&amp;amp;action=index Healthy Communities Institute Promising Practices] and the [http://healthyamericans.org/ New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/11/understanding-intersection-health-care-social-services.html Understanding the intersection of health care and social services (11/10/13)]&lt;br /&gt;
&lt;br /&gt;
===Organizations Insight===&lt;br /&gt;
====Healthcare Organizations Insight====&lt;br /&gt;
====Government Organizations Insight====&lt;br /&gt;
====Employer Insight====&lt;br /&gt;
====Community and Social Services Organizations Insight====&lt;br /&gt;
====Support Resources Organizations Insight====&lt;br /&gt;
===Other Contributors Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Healthy Lifestyle ''Insight''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1569 The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed (8/2017)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1605086#t=article A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor). Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle. (12/15/16)]&lt;br /&gt;
* [http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract Study finds 2.7% of U.S. adults meet criteria for ‘healthy lifestyle’ (4/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ Scientist assert Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Only 5–10% of all cancer cases were attributed to genetic defects, whereas the remaining 90–95% is lifestyle factors including tobacco (25–30%), diet (30–35% - fried foods, red meat), infections (15–20%) the remaining alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity. (7/15/2008)]&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Insight''===&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/06/26/teenagers-are-as-sedentary-as-60-year-olds-by-age-19/?utm_term=.127016b508d0 Teenagers are as sedentary as 60-year-olds by age 19 (6/26/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/15/why-being-a-weekend-warrior-is-still-good-for-your-health/#EQ6NSxU86kqy Researchers found that the weekend warriors who met physical activity guidelines were less likely to die during the nine-year study period, compared with people who didn't get any exercise. A total of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity over one or two days a week. (1/15/17)]&lt;br /&gt;
* [https://www.technologyreview.com/s/602706/pokemon-go-increased-us-activity-levels-by-144-billion-steps-in-just-30-days/ Pokemon Go Increased U.S. Activity Levels by 144 Billion Steps in Just 30 Days (10/21/16)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ Brain Benefits of Exercise Diminish After Short Rest (9/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-more-than-a-quarter-of-adults-over-50-get-no-exercise-outside-of-daily-life-activities.html CDC: More than a quarter of adults over 50 get no exercise outside of daily life activities (9/20/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/27/study-suggests-new-formula-for-physical-activity-8-hours-of-sitting-means-1-hour-of-exercise/ Study suggests 1 hour of activity per 8 hours of sitting (7/27/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/sitting-can-be-bad-especially-if-you-do-it-for-more-than-10-hours-a-day/2016/07/22/43f7f228-4f77-11e6-aa14-e0c1087f7583_story.html Sitting can be bad, especially if you do it for more than 10 hours a day (7/24/16)]&lt;br /&gt;
* [https://medlineplus.gov/podcast/transcript071816.html Moderate exercise is associated with a reduced risk of 13 types of cancer (7/18/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html The percentage of adults over 18 who met the 2008 federal physical activity guidelines for aerobic activity increased from 41.4 percent in 2006 to 49.5 percent in 2012. That rate has remained stable through 2015. (5/26/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-common-fund-launches-physical-activity-research-program NIH Common Fund launches physical activity research program to identify biological molecules that change in response to exercise (6/11/15)]&lt;br /&gt;
* [http://www.reuters.com/article/us-sedentary-television-mortality-idUSKBN0F65BW20140701 Too much TV tied to premature death (7/1/14)]&lt;br /&gt;
Children Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/johns-hopkins-us-could-save-21b-in-healthcare-costs-if-kids-played-outside-every-day.html Johns Hopkins: US could save $21B in healthcare costs if kids played outside every day (5/15/17)]&lt;br /&gt;
* [https://www.usatoday.com/story/news/health/2017/05/06/kids-inactivity-rises-creating-health-care-time-bomb/101245982/ The percent of children aged six to 12 who were physically active three or more times a week had its biggest drop in five years and is now under 25% (5/6/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/03/well/move/childs-play-is-good-for-all-of-us.html If all of the children who currently are sedentary started exercising every day in the United States alone, we could expect to save more than $120 billion every year in health care and associated expenses. (5/3/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/902 Modeling The Economic And Health Impact Of Increasing Children’s Physical Activity In The United States (5/2017)]&lt;br /&gt;
&lt;br /&gt;
Sitting &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/09/04/547580952/get-off-the-couch-baby-boomers-or-you-may-not-be-able-to-later Study of sitting and walking ability over 8 to 10 years, those who sit the most and move the least had more than three times the risk of difficulty walking by the end of the study (9/4/17)]&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities Insight===&lt;br /&gt;
===Nutrition ''Insight''===&lt;br /&gt;
* [http://fortune.com/2017/07/17/artificial-sweeteners-weight-loss-study/ Artificial Sweeteners Won't Help You Lose Weight, According to a Sad but Important New Study (7/17/17)]&lt;br /&gt;
* [http://ajcn.nutrition.org/content/early/2017/06/07/ajcn.117.154872.abstract?papeto The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. (6/7/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1 Pediatricians Advise No Fruit Juice Until Kids Are 1 (5/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/15/well/eat/red-meat-increases-risk-of-dying-from-8-diseases.html Red meat increase risk of dying from 8 diseases (5/15/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/26/well/diet-sodas-tied-to-dementia-and-stroke.html Diet soda tied to dementia and stroke (4/26/17)] &lt;br /&gt;
* [https://www.statnews.com/2017/01/26/soda-sugary-drinks/ The number of calories per day that children and adults have been getting from soda and other sugar-sweetened beverages has been dropping for steadily for nearly 20 years, but new data show that since 2009 that number has plateaued. (1/26/17)] &lt;br /&gt;
* [http://www.alzheimersanddementia.com/article/S1552-5260(17)30050-X/fulltext Excess sugar consumption has been linked with Alzheimer's disease (AD) pathology in animal models. (1/24/17)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2529628 Dietary Intake Among US Adults, 1999-2012 Improved. The American Heart Association (AHA) primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). (6/21/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2016/03/more-than-half-of-what-americans-eat-is-ultra-processed/472791/ More Than Half of What Americans Eat Is 'Ultra-Processed'. And those foods account for 90 percent of U.S. added sugar intake, new research says.(3/10/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1916.abstract Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; Overall Diet Remains Poor (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1940.abstract Foods with the largest positive associations with three-year excess weight gain (among children and adolescents) were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages (11/2015)]&lt;br /&gt;
* [http://now.tufts.edu/news-releases/sugary-drinks-linked-high-death-tolls-worldwide Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year (6/29/15)]&lt;br /&gt;
* [http://openheart.bmj.com/content/2/1/e000196.full US and UK governments dietary guidelines introduced in 1977 and 1983 to reduce coronary heart disease (CHD) by reducing fat intake didn't have studies to support it. (2/9/15)]&lt;br /&gt;
&lt;br /&gt;
===Functional Activities Insight===&lt;br /&gt;
&lt;br /&gt;
Digital Health Usage &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-21-percent-americans-have-used-virtual-healthcare-78-percent-are-interested Survey: 21 percent of Americans have used virtual healthcare, 78 percent are interested (2/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/senior-citizens-rarely-use-digital-health-resources-5-study-findings.html Seniors rarely use digital health resources: 5 study findings (8/3/16)]&lt;br /&gt;
* [http://mobihealthnews.com/39189/parks-41-percent-of-caregivers-use-a-digital-health-device 41 percent of caregivers use a digital health device (12/18/14)]&lt;br /&gt;
* [http://mobihealthnews.com/38904/kaiser-members-who-use-app-are-more-adherent-satisfied-and-loyal/ Kaiser now has 70% of its 9 million members as active users of its online and mobile offerings, patients are more adherent, satisfied, and loyal (12/10/14)]&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Insight''===&lt;br /&gt;
* [https://www.alz.org/aaic/releases_2017/AAIC17-Tues-Briefing-Sleep.asp Interrupted sleep may lead to Alzheimer’s. Research found significant associations between sleep disordered breathing (SDB) and the accumulation of biomarkers for Alzheimer's disease. (7/18/18)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/06/504448639/drivers-beware-crash-rate-spikes-with-every-hour-of-lost-sleep Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep (12/6/16)]&lt;br /&gt;
* [http://mashable.com/2016/11/30/sleep-deprivation-economic-cost.amp In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death (11/30/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/08/24/432764792/snooze-alert-a-sleep-disorder-may-be-harming-your-body-and-brain Snooze Alert: A Sleep Disorder May Be Harming Your Body And Brain A Sleep Disorder May Be Harming Your Body And Brain. More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea. (8/24/15)]&lt;br /&gt;
* [http://articles.latimes.com/2013/aug/29/science/la-sci-sn-sleeping-pill-use-cdc-20130830 One in 25 American adults takes sleeping pills to help them fall asleep and stay asleep at night (8/29/13)]&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-things-to-know-about-america-s-unhealthy-behaviors.html More than 70 percent of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. (4/5/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-overweight-heart-uspstf-idUSKBN0GP1XA20140825 Overweight patients with risk factors for heart disease need &amp;quot;intensive behavioral counseling&amp;quot; about '''diet''' or '''exercise''', according to USPSTF. (8/25/14)]&lt;br /&gt;
* [https://georgevanantwerp.com/2013/12/30/8-risks-drive-15-conditions-and-80-of-healthcare-costs/ 8 Behavior Risks Drive 15 Conditions And 80% Of Healthcare Costs (12/30/13)]&lt;br /&gt;
&lt;br /&gt;
Alcohol &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://www.bloomberg.com/news/articles/2017-08-09/america-s-drinking-problem-is-much-worse-this-century The number of adults who binge drink at least once a week could be as high as 30 million, according to a study published on Wednesday in JAMA Psychiatry. (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 32% of Americans had a minimum of one heavy drinking day in the last year. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. (5/27/16)]&lt;br /&gt;
* Alcohol Consumption - [https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ The top 10% of American drinkers consume, on average, 74 alcoholic drinks per week. (9/25/14)]&lt;br /&gt;
&lt;br /&gt;
Falls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-elderly-patients-treated-for-falls-may-be-more-likely-to-suffer-later-adverse Elderly patients treated for falls may be more likely to suffer later adverse events, study finds (7/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/among-the-elderly-an-epidemic-of-falling.html The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. (9/21/16)] &lt;br /&gt;
* [http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/ The use of 4 or more medications was associated with increased risk of falling and the risk of recurrent falls (9/27/13)]&lt;br /&gt;
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Risky Behaviors &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/05/29/health/car-accidents-child-deaths-seat-belts.html Car Accidents Remain a Top Child Killer, and Belts a Reliable Savior (5/29/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-high-risk-behaviors-often-persist-even-after-cancer-diagnoses.html Study finds high-risk behaviors often persist after cancer diagnoses. 19.8% of women cancer survivors smoked, compared with 15.8% of women without cancer. No differences existed for fruit and vegetable consumption or body mass index. (9/6/16)]&lt;br /&gt;
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Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/01/10/smoking-costs-the-world-economy-1-trillion-per-year-world-health-organization-says/?utm_term=.378ab21f3e8c Smoking costs the world economy $1 trillion per year, World Health Organization says (1/10/17)]&lt;br /&gt;
* [https://directorsblog.nih.gov/2016/12/13/study-finds-no-safe-level-of-smoking/ New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. (12/13/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall Centers for Disease Control and Prevention says smoking rates have fallen from 21% of the adult population in 2005 to 15% in 2015 (11/10/16)]&lt;br /&gt;
* [http://www.sanger.ac.uk/news/view/smoking-pack-day-year-causes-150-mutations-lung-cells Smoking a pack a day for a year causes 150 mutations in lung cells (11/3/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cigarettes-linked-to-nearly-30-of-cancer-deaths-6-things-to-know.html Cigarettes linked to nearly 30% of cancer deaths: 6 things to know (10/24/16)]&lt;br /&gt;
* [http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002020 A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. (5/10/16)]&lt;br /&gt;
* [https://www.boston.com/news/health/2016/05/24/kicking-habit-adult-smoking-rate-us-falling-fast CDC reports smoking rate among adults in the U.S. fell to 15% in 2015, down two percentage points from 2014. (5/24/16)]&lt;br /&gt;
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Substance Use &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/04/19/opioid-addiction-relapse-science/ How drug use changes the brain — and makes relapse all too common (4/19/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://health.usnews.com/health-care/articles/2017-04-19/many-heart-attack-patients-fail-to-stick-with-statins Many Heart Attack Patients Fail to Stick With Statins (4/19/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/25/more-than-half-of-adults-misuse-medications-study-finds/ More than half of adults and 44% of children drug-tested by a national clinical laboratory last year misused their prescription medications, either taking too much, too little or none of their medications. 45 percent of adults were taking drugs (including illicit drugs) that were not prescribed. (7/25/16)]&lt;br /&gt;
* [http://www.mcolblog.com/kcblog/2016/7/12/factors-attributed-to-medication-non-adherence.html 30% of prescriptions are never filled. 69% of nonadherence is due to behavioral issues, such as forgetfulness or procrastination, 16% was due to cost, and 15% say it was medication side effects (7/12/16)]&lt;br /&gt;
*  [http://www.imshealth.com/en/about-us/news/ims-health-study:-low-levels-of-adherence-and-persistence-remain-barriers-to-reducing-the-costs-of-diabetes-complications The U.S. could save $4 billion a year if more seniors with type 2 diabetes followed their doctor’s orders, according to a report by the IMS (7/12/16)]&lt;br /&gt;
* [http://www.hindawi.com/journals/ijfm/2013/901845/ Study found that only 6.5% of patients (only 46 in study) adhered completely to the discharge medication list after average hospital stay of 4.3 days. The average patient age was 76, prescription medications was 10 and number of chronic diseases was 7. (2/24/13)] &lt;br /&gt;
* [http://medcitynews.com/2014/11/study-medication-adherence-prompts/ Study: Medication adherence improved with proper prompts (11/17/14)]&lt;br /&gt;
* [http://well.blogs.nytimes.com/2012/11/15/when-the-patient-is-noncompliant/ When the patient is non-compliant (11/15/12)]&lt;br /&gt;
* [http://healthcare-economist.com/2015/05/31/patient-adherence-to-antipsychotic-medications/ About 40% of patients with schizophrenia are adhering to antipsychotic medications (5/31/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Activation Levels &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/mar/patient-self-management-capability In 2012, ED costs were 37% lower for those at highest activation level versus the lowest ($1,126 vs. $711). In 2014, the difference was 28% (3/8/16)]&lt;br /&gt;
* [http://hpr.weill.cornell.edu/divisions/biostatistics/pdf/Gerber-Research_Seminar_Talk-5-10-07.pdf Effect of the Patient Activation Measure (PAM) on Chronic Care: Baseline Findings from a Cluster Randomized Study (5/10/07)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/3/431 When Patient Activation Levels Change, Health Outcomes And Costs Change, Too (3/2015)]&lt;br /&gt;
&lt;br /&gt;
Prevention &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.ajc.com/news/local/study-finds-percent-sunscreens-don-even-work-how-find-one-that-does/ergzPOJyVv0nM7ZG88yBHK/ Study finds 73 percent of sunscreens don’t even work — how to find one that does (5/26/17)]&lt;br /&gt;
&lt;br /&gt;
Preventive Screening and Vaccinations&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentages of adults who received an influenza vaccination in 2015 was 65.8% for adults aged 65 and over, 46% for ages 50 to 64 and 31.2% for those aged 18 to 49. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentage of adults over 65 years old vaccinated for pneumonia increased rapidly from 42.4% in 1997 to 53.1% in 2000. In 2015, the percentage rose to 63.5% (5/26/16)]&lt;br /&gt;
&lt;br /&gt;
Self Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.reuters.com/article/us-pressure-management-study-idUSKBN0GR2C220140827 Self management may reduce blood pressure (8/27/14)]&lt;br /&gt;
&lt;br /&gt;
Treatment Delays &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://go.americanwell.com/rs/335-QLG-882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf 67% of consumers say they have delayed seeking care for a health problem. They delay because: It costs too much (23%), It takes too long to get in to see a doctor or nurse (23%), They thought the problem would go away on its own (36%), They are too busy (13%) (1/2017)]&lt;br /&gt;
&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-fewer-americans-diet-20170308-story.html American adults either overweight or obese rose from about 53% a generation ago to roughly 66% more recently. 56% of overweight or obese adults reported in 1988 to 1994 they had tried to lose weight in the last year, it has declined to 49% in 2009 to 2014. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Wellness Programs&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/279396/will-every-human-be-health-reward-program-when-it-comes-health-rewards-it-seems 74 percent of employers use health reward program (12/1/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/193551/amount-reward-consumer-health-behavior What Size Reward Drives a Consumer to Take a Desired Health Behavior? (9/9/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/25/workplace-wellness-produces-no-savings/ Workplace Wellness Produces No Savings (11/25/14)]&lt;br /&gt;
&lt;br /&gt;
===Care Planning Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/05/10/addressing-triggers-of-decline-in-older-adults-physical-cognitive-or-mental-health/ “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/07/02/family-caregiving-and-palliative-care-closing-the-policy-gap/ Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)]&lt;br /&gt;
&lt;br /&gt;
Care Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/02/implementing-a-care-planning-system-how-to-fix-the-most-pervasive-errors-in-health-care/ Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/630.abstract Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)] &lt;br /&gt;
* [http://familiesusa.org/press-release/2016/proven-best-choices-guides-health-care-options-launched-icer-and-families-usa Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)]&lt;br /&gt;
* [https://decisionaid.ohri.ca/odsf.html The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/october-november/in-focus Helping Patients Make Better Treatment With Decision Aids (10/2012)]&lt;br /&gt;
&lt;br /&gt;
Evidence-Based Practice &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/primary-care-docs-may-struggle-to-find-high-quality-evidence-to-support-clinical Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/22/credibility-of-evidence-a-reconsideration-of-the-logic-and-strength-of-our-healthcare-decisions/ Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)]&lt;br /&gt;
&lt;br /&gt;
Medical Advocates &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/medical-advocates-can-help-guide-patients-on-difficult-care-choices/ Medical Advocates Can Help Guide Patients On Difficult Care Choices  (1/27/16)]&lt;br /&gt;
&lt;br /&gt;
Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/partners-expands-second-opinion-service-health-advocate-partnership Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/88-of-second-opinions-from-mayo-physicians-result-in-different-diagnosis-study-finds.html 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)]&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/patients-with-more-say-in-treatment-have-fewer-side.html Patients with more say in treatment have fewer side effects (7/13/16)]&lt;br /&gt;
*  [http://khn.org/news/inviting-patients-to-help-decide-their-own-treatment/ Inviting Patients To Help Decide Their Own Treatment (3/16/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/17/shared-decision-making-and-the-use-of-patient-decision-aids/ Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/doctors-patients-critically-medical-decisions.html How should doctors and patients look critically at medical decisions?] (8/16/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/medical-interventions-5050-informs-patient.html Many medical interventions are 50/50: Who informs the patient? (8/13/2013)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management - Communications Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Communicating Instructions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/most-patients-don-t-understand-post-discharge-care-plans-study-finds Most patients don't understand post-discharge care plans, study finds (1/6/2016)]&lt;br /&gt;
&lt;br /&gt;
Difficult Dialog &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/03/377569539/even-some-doctors-fear-these-10-questions The difficulty of asking questions about &amp;quot;adverse childhood experiences&amp;quot; that identifies health risks (3/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/24/394927484/many-doctors-who-diagnose-alzheimers-fail-to-tell-the-patient Many Doctors Who Diagnose Alzheimer's Fail To Tell The Patient (3/24/15)]&lt;br /&gt;
&lt;br /&gt;
Digital Communications &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cio.com/article/3195891/cio-role/kaiser-cio-shares-it-lessons-for-the-future-of-healthcare.html Kaiser Permanente crossed an important threshold last year when 52 percent of its patient interactions were digital. (5/10/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/mhealth-monitor-patients-physicians/ 58% of people in the U.S. with a smartphone shared information with a medical professional using a mobile or wearable device. And 25% used email or text to send a photo of a medical issue to their doctor. (11/15/16)]&lt;br /&gt;
* [http://www.huffingtonpost.com/2015/06/29/doctors-facebook-telehealth_n_7662774.html Communicating With Your Doctor On Facebook May Be The Future Of Healthcare (6/29/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/07/healthcrowd-pilot-finds-mobile-engagement-medicaid-patients-cost-effective/ Pilot project finds mobile engagement with Medicaid patients ‘most cost-effective’ (7/29/14)]&lt;br /&gt;
* [http://mobihealthnews.com/35160/nearly-half-of-kaiser-permanentes-members-use-my-health-manager/ Nearly half of Kaiser Permanente's members use online health management platform (7/25/14)]&lt;br /&gt;
* Electronic Communication - [http://link.springer.com/article/10.1007%2Fs11606-012-2329-5 71% of vulnerable patient populations want to use electronic communication with health care providers.] (2/20/13)&lt;br /&gt;
&lt;br /&gt;
Doctor Patient Discussions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/language-doctors-use-to-talk-to-diabetes-patients-makes-a-difference The language doctors use to talk to diabetes patients makes a difference to success (6/14/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/prudent-antibiotic-prescribing-lowers-patient-satisfaction.html How prudent antibiotic prescribing lowers patient satisfaction (9/13/16)]&lt;br /&gt;
* [http://khn.org/news/attending-to-the-human-element-is-key-to-keeping-patients-healthy/amp/ Study recommends improving communication with racial minorities and lower-income patients, such as better bedside manner (so patients trust their doctors), communication that is easily understood by everyday people and willingness to discuss how price fits into consumers’ health decisions. (9/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/physicians-spend-twice-as-much-time-on-ehr-desk-work-than-with-patients.html Physicians spend twice as much time on EHR, desk work than with patients (9/6/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/06/costs_of_care_getti.html Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. (6/15/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/get-10-minutes-doctor-2/ Why Do I Only Get 10 Minutes With My Doctor? (9/18/14)]&lt;br /&gt;
* [http://khn.org/news/15-minute-doctor-visits/ 15-Minute Visits Take A Toll On The Doctor-Patient Relationship (4/21/14)]&lt;br /&gt;
&lt;br /&gt;
Patient Portals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/ehr/despite-federal-push-to-offer-ehr-access-patient-engagement-low Just 15% of hospital patients electronically accessed their medical records despite 88% of hospitals offering access. Nearly one-third of patients accessed EHRs offered by physician practices. (3/16/17)]&lt;br /&gt;
&lt;br /&gt;
Patient Provided Data&lt;br /&gt;
* [http://www.fiercehealthcare.com/analytics/how-university-rochester-medical-center-uses-patient-generated-data-to-set-expectations University of Rochester Medical Center (URMC) collects patient-reported outcomes by using a Patient-Reported Outcomes Measurement Information System (PROMIS), which requires patients to answer five to seven questions on a tablet. (7/6/17)] &lt;br /&gt;
* [http://www.annfammed.org/content/15/2/158.abstract Patients Typing Their Own Visit Agendas Into an Electronic Medical Record. Patients and clinicians agreed that the agendas improved patient-clinician communication. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Remote Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2488923#Results Study finds readmissions nearly the same for heart failure patients using remote patient monitoring (3/2016)]&lt;br /&gt;
* [http://mobihealthnews.com/content/scripps-wired-health-study-results-show-no-clinical-or-economic-benefit-digital-health Scripps Wired for Health study shows no clinical or economic benefit from digital health monitoring (1/19/16)]&lt;br /&gt;
* [http://khn.org/news/making-the-human-condition-computable/ Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to enable doctors to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails. (12/11/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/can-fall-monitoring-technology-keep-elders-safe/ Can Fall Monitoring Technology Keep Elders Safe? (4/7/14)]&lt;br /&gt;
* [http://www.mddionline.com/article/digital-health-dominates-ces-2014-%E2%80%93-3-trends-watch-3 Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. (1/9/14)]&lt;br /&gt;
&lt;br /&gt;
Screenings &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/doctors-should-screen-patients-for-social-isolation-to-address-loneliness-epidemic Doctors must screen patients for social isolation to address 'loneliness epidemic' (8/8/17)]&lt;br /&gt;
* [https://nam.edu/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool/ Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool. (5/30/17)] [https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf See PDF] &lt;br /&gt;
&lt;br /&gt;
Text Messaging &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/despite-privacy-hoops-text-messaging-offers-unprecedented-convenience Despite privacy hoops, text messaging offers ‘unprecedented convenience’ (5/11/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management - Operational Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/474.abstract Breaking Down Silos Between Health Care And Criminal Justice (3/2014)]&lt;br /&gt;
&lt;br /&gt;
Behavioral Health Integration&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/10/1808.abstract Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care (10/2014)]&lt;br /&gt;
* [http://docs.house.gov/meetings/IF/IF02/20150211/102944/HHRG-114-IF02-Wstate-KohnL-20150211.pdf About 10 million—or 4.2%—of adults in the United States suffered from a serious mental illness in 2013 were supported by 112 different federal programs (2/11/15)]&lt;br /&gt;
&lt;br /&gt;
Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-acute-care-needs-to-be-coordinated-but-it-often-not Only 30% of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7% reported they were fully coordinated. (11/131/6)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/07/20/peds.2015-4182 Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. (7/2016)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/09/difficult-transition-hospital-nursing-home.html The difficult transition between the hospital and nursing home (9/5/13)]&lt;br /&gt;
* [http://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/ One of the most dangerous junctures in medical care: patients leaving the hospital. Nearly a quarter had inadequately reviewed or tracked medications, sometimes even causing fatal events. (5/2/16)] &lt;br /&gt;
* [https://psnet.ahrq.gov/primers/primer/11 Nearly 20% of patients experience adverse events within 3 weeks of hospital discharge, nearly three-quarters of which could have been prevented or ameliorated. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-discharge-risks-persist-for-elderly-patients The transition from hospital to home poses significant risks to patients, especially the elderly, and gaps persist in care during this crucial time. (7/11/16)]&lt;br /&gt;
&lt;br /&gt;
Coordinated Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/nov/healthcare-fragmentation-frequency-diagnostic-tests Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, linked to high rates of hospitalization and emergency department visits as well as lower satisfaction. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients. (11/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/on-lok Program of All-Inclusive Care for the Elderly (PACE) cares for frail elders in the community (8/12/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/12/poor-interoperability-affects-patients.html How poor interoperability affects patients. It often requires duplicate testing that is not only costly (e.g., CT scans), but also invasive and not without risk to the patient (e.g., bronchoscopy, biopsies). (12/17/15)]&lt;br /&gt;
* [http://www.jhsph.edu/news/news-releases/2015/four-in-ten-older-adults-burdened-by-demands-of-health-care-system.html Four in Ten Older Adults Burdened by Demands of Health Care System] (10/14/15)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2014/nov/international-survey-of-older-adults International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care (11/19/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/special-report/5-pieces-care-coordination-puzzle 5 pieces of the care coordination puzzle (6/11/14)]&lt;br /&gt;
* [http://www.healthcare-informatics.com/news-item/lack-coordinated-care-problem-older-patients-survey-says Lack of Coordinated Care is a Problem for Older Patients, Survey Says (4/3/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/10/coordinated-care-critical-reducing-u-s-health-spending/ Coordinated care critical for reducing U.S. health spending  (10/8/13)]&lt;br /&gt;
&lt;br /&gt;
Managing [http://www.patientdeterminants.org/index.php?title=Health_Insight#High_Need.2C_High_Cost_Patients_Insight High Cost High Need Patients] &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? (8/7/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/care-high-need-high-cost-patients Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis (10/29/15)] &lt;br /&gt;
&lt;br /&gt;
Palliative Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/44.abstract Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities (1/2016)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/29/the-challenge-of-financing-sustainable-community-based-palliative-care-programs/ The Challenge Of Financing Sustainable Community-Based Palliative Care Programs (12/29/14)]&lt;br /&gt;
&lt;br /&gt;
Partnering With Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/what-organizations-do-hospitals-partner-with-for-population-health.html What Organizations do Hospitals Partner With for Population Health? (12/5/13)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2014/12/28/the-trouble-with-home-health-care-care-coordination/ The Trouble with Home Health Care &amp;amp; Care Coordination (12/28/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2104.abstract Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Coordinating care and communicating with specialists, hospitals, home care and social service providers. (12/2015)]&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Determinants Health Strategy Activities Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Interventions Activities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Interventions_Determinants Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being. [[Medical Interventions]] Activities are impacted by:&lt;br /&gt;
&lt;br /&gt;
* [[Medical Intervention Access|Access]]&lt;br /&gt;
* [[Medical Intervention Diagnosis|Diagnosis]]&lt;br /&gt;
* [[Medical Intervention Efficacy|Efficacy]]&lt;br /&gt;
* Testing&lt;br /&gt;
* [[Medical Intervention Treatments|Treatments]]&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions Activity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Non-Medical_Interventions_Determinants Non-Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Cardiac Rehabilitation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/cardiac-rehab-improves-health-but-cost-and-access-issues-complicate-success/amp/ Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (8/31/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/07/18/485871530/cardiac-rehab-works-great-so-why-don-t-people-do-it Despite research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer; fewer than a third do. (7/18/16)]&lt;br /&gt;
&lt;br /&gt;
Employee Wellness Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/ Large firms (at least 200 employees) are more likely to offer Employee Wellness Programs than smaller firms (81% vs. 49%) in an effort to promote employee health and productivity and reduce health related cost (5/19/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/71.abstract Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study (1/2016)]&lt;br /&gt;
&lt;br /&gt;
Fall Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-step-up-to-help-seniors-avoid-falls/ Hospitals Step Up To Help Seniors Avoid Falls (1/12/16)]&lt;br /&gt;
&lt;br /&gt;
Health Coaching &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/the-underrated-value-of-coaching-in-healthcare-4-thoughts-from-population-health-expert-dr-william-appelgate.html The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William Appelgate (1/25/17)]&lt;br /&gt;
&lt;br /&gt;
Legal Counseling &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/legal-regulatory-issues/ku-kansas-hospital-to-offer-free-legal-counsel-to-low-income-patients.html Kansas hospital offers free legal counsel to low-income patients (8/18/16)]&lt;br /&gt;
&lt;br /&gt;
Obesity Counseling &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://khn.org/news/few-seniors-benefitting-from-medicare-obesity-counseling/ Few Seniors Benefiting From Medicare Obesity Counseling (2/23/15)]&lt;br /&gt;
* [http://khn.org/news/seniors-obesity-counseling-benefit-goes-largely-unused/ Seniors’ Obesity-Counseling Benefit Goes Largely Unused (11/20/14)]&lt;br /&gt;
&lt;br /&gt;
Opioid Alternative&lt;br /&gt;
* [http://www.denverpost.com/2016/11/30/battling-opioid-epidemic/ How a Colorado health care provider is battling the opioid epidemic with non-pill pain treatments (11/30/16)]&lt;br /&gt;
&lt;br /&gt;
Virtual Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fastcompany.com/3047894/the-future-of-work/how-to-turn-your-smartphone-into-your-personal-therapist Smartphone As A Personal Therapist. Could the technology that causes so much of our stress and anxiety also be the cure? (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence Insight====&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Performance_Based_Pricing</id>
		<title>Performance Based Pricing</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Performance_Based_Pricing"/>
				<updated>2019-07-16T21:05:38Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;* [https://www.beckershospitalreview.com/supply-chain/novartis-cms-collaborate-on-outcomes-based-pricing-for-465k-leukemia-drug.html Novartis, CMS collaborate on outcomes-based pricing for $475k leukemia drug (8/31/17)]&lt;br /&gt;
* [https://www.fiercehealthcare.com/analytics/patient-generated-data-could-be-missing-piece-to-new-payment-models-for-drugs-and-devices A new consortium of payers, providers and manufacturers at the Duke Margolis Center for Health Policy aims to tackle the complex issue of value-based payment for drugs, medical devices and cutting-edge gene therapy. (7/25/17)]&lt;br /&gt;
* [https://healthpayerintelligence.com/news/amp/harvard-pilgrim-enters-outcomes-based-pharmaceutical-contracts Harvard Pilgrim Health Care has expanded its outcomes-based care contracts for certain pharmaceuticals by using outcomes as a metric for drug costs. (6/2/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/cigna-novartis-agree-on-outcome-based-price-for-heart-drug.html Cigna, Novartis agree on outcome-based price for heart drug (2/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/cigna-first-insurer-to-reach-value-based-agreements-for-new-class-of-cholesterol-drugs.html Cigna first insurer to reach value-based agreements for new class of cholesterol drugs (5/12/16)]&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Performance_Based_Pricing Health Insurance Payment Models - Performance Based Pricing]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Insight</id>
		<title>Health Insight</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Insight"/>
				<updated>2019-07-16T21:02:50Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Social Well-Being Insight */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday there is new insight into our understanding of [[Health Determinants]] and [[barriers]] that impact patient outcomes. This page will curate new insight. While health care is likely the most important determinant of health when a patient has an acute condition, studies show it represents only a part of an overall health outcomes:&lt;br /&gt;
&lt;br /&gt;
[[Health Determinants Insight]]&lt;br /&gt;
&lt;br /&gt;
==Mission (Health Goals) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Mission_.28Health_Goals.29_Determinants Mission (Health Goals) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Personal Goals Insight===&lt;br /&gt;
===Health Goals (Care Goals) Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Mission_.26_Care_Goals_Determinants Health Goals (Care Goals) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Advanced Directives &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/1-3-u-s-adults-have-completed-advance-directive-study-finds 2 out of 3 adults fail to complete an advance directive (7/6/17)]&lt;br /&gt;
* [http://www.cbsnews.com/news/being-prepared-for-the-final-days/ Being prepared for the final days (4/27/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/lack-advance-directives-leads-to-unwanted-care Lack of advance directives leads to unwanted care (11/2/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/national-healthcare-decisions-day-11-statistics-on-end-of-life-decision-making.html Only 20% of Americans have an advanced directive documenting their wishes for end-of-life medical care. (4/16/15)]&lt;br /&gt;
&lt;br /&gt;
Care Goals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/12/defining-patients-goals-care.html Defining the patient’s goals of care (12/11/13)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1113631#t=article Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)]&lt;br /&gt;
&lt;br /&gt;
End of Life Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/end-life-care-planning-fails-patients End-of-life care, planning fails patients (2/5/15)]&lt;br /&gt;
* [https://www.minnpost.com/second-opinion/2014/06/few-doctors-discuss-end-life-planning-heart-failure-patients-mayo-study-finds Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)]&lt;br /&gt;
* [http://www.nationalacademies.org/hmd/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx ''Dying in America'' - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)]&lt;br /&gt;
* [http://khn.org/news/too-many-people-die-in-hospital-instead-of-home-heres-why/ Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)]&lt;br /&gt;
&lt;br /&gt;
Health Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/28/what-outcomes-matter-to-patients-with-rheumatoid-arthritis/ What outcomes matter to patients with Rheumatoid Arthritis? (8/28/17)]&lt;br /&gt;
&lt;br /&gt;
==Strategy (Health Plan) Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Strategy_.28Health_Plan.29_Determinants Strategy (Health Plan) Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Strategy Objectives (Care Plan) ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Strategy Solutions (Interventions) Insight===&lt;br /&gt;
====Medical Interventions Insight====&lt;br /&gt;
====Non-Medical Interventions Insight====&lt;br /&gt;
====Intervention Changes Insight====&lt;br /&gt;
&lt;br /&gt;
===Strategy Measures===&lt;br /&gt;
===Strategy - Impacting People Insight===&lt;br /&gt;
===Strategy - Impacting Realities Insight===&lt;br /&gt;
===Strategy - Impacting Activities Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Realities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Realities_Determinants Impacting Realities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
&lt;br /&gt;
===Health Conditions ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Conditions_Determinants Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Physical Conditions ''Insight''==== &lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Physical_Conditions_Determinants Physical Conditions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.cbsnews.com/news/more-u-s-kids-have-chronic-health-problems-study The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest (5/2/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/jan/analysis-of-death-rates-for-middle-aged-whites A lack of progress since 1999 against common illnesses such as heart disease, diabetes, and respiratory disease was largely responsible for higher-than-expected death rates for middle-aged (45–54) white adults in 2014. (1/29/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/07/study-on-aging/ Don’t judge a person on their chronological age; their biological age might be a lot older than you think, aging study says (7/7/15)]&lt;br /&gt;
&lt;br /&gt;
Arthritis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/stateline-states-asthma/ Nationwide, one in 10 children has asthma. (4/16/14)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/science/archive/2017/03/no-cancer-isnt-mostly-bad-luck/521049/ Scientists don't agree 66% of cancer is due to bad luck (3/28/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521219318/cancer-is-partly-caused-by-bad-luck-study-finds Study: Causes of cancer, 66% from random mutations during cell division (bad luck), about 29% from environment and remaining 5% due to heredity. (3/23/17)]&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-cancer-drop-20170105-story.html Death rate from cancer now 25% lower than it was 25 years ago, report says (1/5/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-brain-cancer-now-killing-more-children-than-leukemia.html CDC: Brain cancer now killing more children than leukemia (9/16/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cancer-overtakes-heart-disease-as-leading-cause-of-death-in-22-states-3-things-to-know.html Cancer overtakes heart disease as leading cause of death in 22 states (8/25/16)]&lt;br /&gt;
* [https://www.sciencedaily.com/releases/2015/01/150101142318.htm Study shows two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes, while the remaining third are due to environmental factors and inherited genes. (1/1/15)]&lt;br /&gt;
&lt;br /&gt;
Chronic Pain &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/4-things-to-know-about-the-rising-rates-of-chronic-pain-in-the-us.html Number of Americans in their 60s reporting chronic pain increased from 10% in 1998 to 37% in 2010. (3/16/17)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain Estimated 25.3 million adults (11.2%) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6%) experience severe levels of pain. (8/11/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/04/chronic-pain-effect-patients-families.html Chronic pain and the effect on patients’ families (4/17/14)]&lt;br /&gt;
&lt;br /&gt;
COPD &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/copd/index.html Chronic lower respiratory disease, primarily COPD, is the third leading cause of death in the United States (3/12/15)]&lt;br /&gt;
&lt;br /&gt;
Cystic Fibrosis &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/03/13/cystic-fibrosis-canadians-americans/ Canadians with cystic fibrosis outlive Americans by a decade (3/13/17)]&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-more-deadly-than-previously-thought-researchers-say.html Diabetes causes 12 percent of deaths in the United States, making it the third-leading cause of death in the country, according to a new study (1/26/17)] &lt;br /&gt;
* [http://khn.org/news/health-claims-on-the-rise-for-kids-with-type-2-diabetes-obesity-related-conditions/amp/ Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions (1/2/17)]&lt;br /&gt;
* [http://khn.org/news/diabetes-linked-to-risk-of-mental-health-hospitalization-in-young-adults-study/amp/ Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease (7/22/16)]&lt;br /&gt;
* [http://khn.org/news/as-childhood-diabetes-rates-rise-so-do-costs-and-families-feel-the-pinch-study/amp/ Childhood diabetes rates are on the rise. The spent $2,173 per capita in out-of-pocket health care costs in 2014. Nearly five times higher than that of kids without the illness. (6/20/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/americans-diabetes-reach-21-million Americans with diabetes reach 21 million (4/15/14)]&lt;br /&gt;
* [http://www.latimes.com/science/la-sci-sn-diabetes-study-20150908-story.html About half of all Americans have either diabetes or pre-diabetes. (9/8/15)]&lt;br /&gt;
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Heart Attack Risk &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/depression-among-heart-attack-survivors-can-be-deadly-yet-is-often-ignored/ Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (7/20/17)]&lt;br /&gt;
* [http://www.wsj.com/articles/heart-attacks-are-linked-to-what-patients-were-doing-feeling-1477923373 Performing heavy physical activity in a highly emotional state sharply raised the risk of a heart attack. (10/31/16)]&lt;br /&gt;
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High Blood Pressure &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cdc.gov/bloodpressure/facts.htm About 70 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults. (6/16/16)]&lt;br /&gt;
&lt;br /&gt;
Life Expectancies &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/death-rates-for-americans-in-prime-years-rise-after-century-of-decline.html The death rate for Americans between the ages of 25 and 44 rose by 8% between 2010 and 2015 after a century of decline. (6/14/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair The mortality rate for white Americans, ages 45 to 54, increased by a half percent each year from 1999 to 2013, attributed to increase in suicide, drugs and alcohol. (3/23/17)]&lt;br /&gt;
Non-Communicable Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-diseases-that-kill-16m-people-cost-the-world-economy-2-35t-annually.html Five non-communicable diseases that kill 16 million people around the world each year, cost the world economy $2.35T annually. 1) Cardiovascular disease, 2) Mental illness, 3) Cancer, 4) Chronic respiratory disease, 5) Diabetes. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
Obesity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/30/506433671/the-wrong-eating-habits-can-hurt-your-brain-not-just-your-waistline Being overweight can raise your blood pressure, cholesterol and risk for developing diabetes. It could be bad for your brain, too. (12/30/16)]&lt;br /&gt;
* [http://www.onemednews.com/2016/12/18/nyt-obesity/ Researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, are many. (12/12/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2016/12/01/nearly-half-of-americas-overweight-people-dont-realize-theyre-overweight/?utm_term=.2963e8177870 Nearly half of America’s overweight people don’t realize they’re overweight (12/1/16)]&lt;br /&gt;
* [http://khn.org/news/another-reason-to-diet-experts-find-additional-evidence-of-obesity-cancer-link/amp/ Experts Find Additional Evidence Of Obesity-Cancer Link (8/24/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/obesity-rates-up-in-us-women-stable-in-men.html Obesity rates up in US women, stable in men. Obesity was 35 percent among men and 40 percent among women in 2013-14 (6/7/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html American obesity rate continues consistent trend upward in 2015 with estimated 30.4% of Americans over 20 years of age obese, more than a 10% increase from 1997 (5/26/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1923.abstract Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013 (11/2015)]&lt;br /&gt;
&lt;br /&gt;
Sepsis &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/sepsis-causes-more-readmissions-than-copd-heart-failure-heart-attack-and-pneumonia.html Sepsis causes more hospital readmissions than COPD, heart failure, heart attack and pneumonia. (1/23/17)]&lt;br /&gt;
&lt;br /&gt;
====Mental Health Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Mental_Health_Conditions_Determinants Mental Health Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
Childhood Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/06/01/disruptive-behavior-disorders-children/ Childhood disruptive behavior disorders increases risk for substance use, violent behaviors, victimization, incarceration, and even premature death. An estimated 50 to 75% of youths who move through the juvenile justice system could be diagnosed with a mental health disorder. (6/1/17)]&lt;br /&gt;
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Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/obesity-and-depression-are-entwined-yet-scientists-dont-know-why/amp/ Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/who-depression-leading-cause-of-illness-disability-worldwide.html Depression is the leading cause of illness, disability worldwide according to the World Health Organization (3/31/17)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/11/10/peds.2016-1878#T1 The prevalence of major depressive episodes (MDEs) in adolescents (age 12-17) has increased from 13.1% for girls and 4.5% for boys in 2005 to 17.3% for girls and 5.7% for boys in 2014 (11/2016)]  &lt;br /&gt;
&lt;br /&gt;
Dementia &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/16/536935957/stress-and-poverty-may-explain-high-rates-of-dementia-in-african-americans Stress And Poverty May Explain High Rates Of Dementia In African-Americans (7/16/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-alzheimer-s-deaths-up-by-more-than-50.html In 1999, the rate of Alzheimer's deaths was 16.5 per 100,000 individuals. By 2014, this rate had increased to 25.4 deaths per 100,000, marking a 54.5% increase. (5/26/17)]&lt;br /&gt;
* [http://www.alz.org/documents_custom/2017-facts-and-figures.pdf Estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. By 2025, Alzheimer’s dementia is estimated to reach 7.1 million. By 2050, the number of people with Alzheimer’s dementia may nearly triple to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure Alzheimer’s disease. (3/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587084 Dementia prevalence among US adults 65 years or older declined significantly, from 11.6% in 2000 to 8.8% in 2012. (11/21/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/10-alzheimer-s-patients-had-preventable-hospital-stays One in 10 Alzheimer’s patients have preventable hospital stays (7/27/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/30/472295791/big-financial-costs-are-part-of-alzheimers-toll-on-families Big Financial Costs Are Part Of Alzheimer's Toll On Families (3/30/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2016/02/10/study-finds-dementia-rates-decline/80016390/ Rates of dementia dropped 44% from the late 1970s to the early 2010s. (2/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-dementia-drives-er-visits-admissions-and-mortality-rates How dementia drives ER visits, admissions and mortality rates (11/16/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1642.abstract Dementia has a disproportionate impact on family and unpaid caregiving to older adults] (10/2015)&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1637.abstract Adults with probable dementia received 171 hours of monthly informal care, versus 89 hours for cognitively impaired adults without dementia and 66 hours for cognitively normal adults 10/2015)]&lt;br /&gt;
&lt;br /&gt;
Emotions &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Mental Health Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1024.abstract Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. Innovative federal, state, and local programs have combined social services with mental health interventions to try addressing this. (6/2017)] &lt;br /&gt;
* [http://healthaffairs.org/blog/2016/07/25/patients-with-severe-schizophrenia-arent-getting-the-help-they-need/ Patients With Severe Schizophrenia Aren’t Getting The Help They Need (7/25/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/mind-and-mood/the-prevalence-and-treatment-of-mental-illness-today An estimated 26% of American adults live with a mental disorder in any given year, and 46% will have a mental disorder in their lifetime.] (11/2005)&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html 18% of adults in the U.S. have a mental, behavioral or emotional disorder. Most common are specific phobias (8.7%), such as those related to heights, spiders or flying, social phobia (6.8%) and major depression (6.6%) (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Impact on Health Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.businessinsurance.com/article/20170306/NEWS08/912312232/Detecting-mental-health-issues-can-cut-workers-comp-claims-costs Detecting mental health issues can cut workers comp claims costs. Hartford Financial Services Group analyzed its workers comp claim data from 2002 to 2015 and found that 10% of claims featured at least one psychosocial issue, and that those claims account for 60% of claims costs. (3/6/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/nov/behavioral-health-high-need-adults High-need adults—defined as those with three or more chronic conditions and a functional limitation—who have a diagnosed behavioral health condition among their multiple chronic conditions make greater use of some health care services than their counterparts without a behavioral health condition (11/22/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/36.abstract Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients (1/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/most-readmissions-aren-t-linked-to-suboptimal-care-study-finds.html A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness. (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
Opioid Addiction &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/ Patients With Mental Disorders Get Half Of All Opioid Prescriptions (6/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/ahrq-report-us-hospitals-see-sharp-rise-in-opioid-related-inpatient-stays-ed-visits.html Between 2005 and 2014, opioid-related emergency department visits nearly doubled and opioid-related inpatient stays increased 64% (6/20/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/opioids/cdc-likelihood-of-opioid-addiction-spikes-after-a-few-days-of-use.html CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days (3/17/17)]&lt;br /&gt;
* [http://khn.org/news/study-health-spending-related-to-opioid-treatment-rose-more-than-1300-percent/amp/ Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent In Four Year Period (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/prior-authorization-a-hurdle-for-patients-overcoming-opioid-dependency Insurer rules a hurdle for patients overcoming opioid dependency (8/5/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/15/patient-centered-research-can-improve-chronic-pain-care-and-address-opioid-abuse/ Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse (5/15/15)]&lt;br /&gt;
&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf Americans reporting at least one symptom of stress over the past month rose from 71% in August 2016 to 80% in January 2017. This includes headache (34%), feeling overwhelmed (33%), feeling nervous or anxious (33%), or feeling depressed or sad (32%). (2/15/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/12/chronic-stress-heart-attacks-study.amp Emotional stress has long been considered a major risk factor for heart disease. A new study suggests that heightened activity in the amygdala (the brain's fear and stress region) is associated with a greater risk of heart disease and stroke. (1/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/09/27/494922257/chill-out-stress-can-override-benefits-of-healthy-eating Stress Can Override Benefits Of Healthful Eating (9/27/16)]&lt;br /&gt;
&lt;br /&gt;
Substance Use Disorders &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.technologyreview.com/s/603073/big-pharma-and-distracted-driving-are-killing-americans-early/amp/ Accidental poisoning increased 13%. 97% percent of accidental poisoning was from drug overdoses and alcohol (12/9/16)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin,methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
&lt;br /&gt;
Suicide &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/suicide-rates-for-teen-girls-hits-40-year-high.html Suicide rates for teen girls hits 40-year high (8/8/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-machine-learning-shows-promise-toward-accurately-identifying-suicidal-behavior Study found machine learning is 93% accurate in correctly identifying a suicidal person, and 85% accurate in determining differential diagnosis of mental illness (11/8/16)]&lt;br /&gt;
* [http://www.npr.org/sections/ed/2016/11/04/500659746/middle-school-suicides-reach-an-all-time-high Middle School Suicides Reach An All-Time High (11/4/16)]&lt;br /&gt;
&lt;br /&gt;
Treating Mental Health &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2016/05/13/hlthaff.2015.1659.abstract Mental Disorders top the list of the most costly conditions in the United States: $201 Billion] (5/2016)&lt;br /&gt;
&lt;br /&gt;
====Functional Conditions ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Determinants#Functional_Conditions_Determinants Functional Conditions Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
* [http://hrsonline.isr.umich.edu/ Health and Retirement Study (HRS) surveys 20,000 people in America about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and health care expenditures. (3/2007)]&lt;br /&gt;
&lt;br /&gt;
Chronic Diesease &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthcare-economist.com/2017/08/21/the-association-between-observed-mobility-and-quality-of-life-in-the-near-elderly/ Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life. (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Daily Activities Assistance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 6.9% of adults in 2015 over the age of 65 required assistance with personal care. (5/26/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/howardgleckman/2014/10/08/nearly-half-of-all-seniors-need-help-with-daily-activities-far-more-than-we-thought/ Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought] (10/8/14)&lt;br /&gt;
&lt;br /&gt;
Disabilities &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/4/626.abstract If all five risk factors were eliminated, 53% of disability could be prevented nationally if five risk factors were eliminated. The largest were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). (4/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/18/challenges-for-people-with-disabilities-within-the-health-care-safety-net/ Challenges For People With Disabilities Within The Health Care Safety Net. Nearly 57 million Americans had disabilities in 2010. (11/18/14)]&lt;br /&gt;
&lt;br /&gt;
Functional Independence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patients-functional-independence-may-predict-readmissions Patients' functional independence may predict readmissions (5/6/14)]&lt;br /&gt;
&lt;br /&gt;
Healthcare Costs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 The average healthcare cost for adults in the United States (2009-2011) was $4,845, for adults with 3 or more chronic conditions and no functional limitations was $7,526, for adults with 3 or more chronic conditions and functional limitation was $21,021 (8/29/16)]&lt;br /&gt;
&lt;br /&gt;
Homebound &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pubmed/26010119 An estimated 1.9 million U.S. adults age 65 or older are completely or mostly homebound, while another 5.3 million have functional limitations that make it hard to  leave their homes. (7/2015)]&lt;br /&gt;
* Homebound - [http://content.healthaffairs.org/content/34/1/21.abstract Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care.] (1/2015)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/q-and-a/2015/jan/invisible-homebound Treating the “Invisible Homebound”: Setting Standards for Health Care Provided at Home (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
Impairments &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/03/07/arthritis-afflicts-about-1-in-4-adults-in-the-u-s-cdc-report-finds/?utm_term=.360146a12c9d Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. 44% of people with arthritis report activity limitations of everyday tasks, such as walking or lifting bags. (3/7/17)]&lt;br /&gt;
* [http://medcitynews.com/2015/09/hearing-loss-linked-to-increased-risk-of-death/ Adults ages 70 years or older with moderate or more severe hearing impairment have a 54% increased risk of all causes of death (9/25/15)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Usual Activities&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 39.7 million persons (12%) were limited in their usual activities due to one or more chronic health conditions (12/2013)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/books/NBK92521/ About 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis limiting their functional status and adversely impacting their quality of life. The total financial cost of pain to society (health care and productivity estimates) ranges from $560 to $635 billion (2011 Study)]&lt;br /&gt;
&lt;br /&gt;
Limitation in Work&lt;br /&gt;
* [https://www.theatlantic.com/business/archive/2017/03/mortality-of-american-men-and-the-labor-force/520329/ 43% of men in America ages 25 to 54 who are out of the labor force report their health as fair or poor, compared with 12% of employed men and 16% of unemployed men. (3/22/17)]&lt;br /&gt;
* [https://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf About 13.8 million adults aged 18–69 (6%) were unable to work due to health problems, and 6.7 million (3%) were limited in the kind or amount of work they could do because of their health (12/2013)]&lt;br /&gt;
&lt;br /&gt;
====Genomic ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Genomic_Profiles_Determinants Genomic Profiles Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [https://www.ted.com/talks/moshe_szyf_how_early_life_experience_is_written_into_dna Epigenetics research suggests living things reprogram their genome in response to social factors like stress and lack of food. The biochemical signals passed from mothers to offspring tell the child what kind of world they're going to live in, changing the expression of genes. (7/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877678/ Scientists believe most, if not all, diseases arise from interactions between the genome, the epigenome (controls gene expression), and the environment (broadly defined to include social, behavioral, and physical agents). (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====High Need, High Cost Patients ''Insight''====&lt;br /&gt;
High-Need, High-Cost Patients &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-superusers-pennsylvania-ring-up-1-25b-tab-0 Superusers represent 3% of hospitalized patients in Pennsylvania consumed $1.25 billion in health care costs. (6/21/17)]&lt;br /&gt;
* [https://www.theatlantic.com/theplatinumpatients/ Each year, 1 in every 20 Americans racks up just as much in medical bills as another 19 combined. (6/15/17)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% did not have good access to services that could help them manage their daily living activities. 58% did not have good access to an informed and up-to-date care coordinator. (12/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 1.2% of employees are high cost claimants who comprise 31% of total health care spending according to a report on 26 large employers. (9/15/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1608511 Caring for High-Need, High-Cost Patients — An Urgent Priority (9/8/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps2 Health care spending for high-need adults exceeded $21,000 per person, nearly three times the average for adults with multiple chronic diseases only ($7,526) and more than four times that of all adults ($4,845). (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-meps1 High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? (8/29/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/aug/high-need-high-cost-meps Report Profiles The 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs (8/25/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2016/jun/listening-to-those-living-with-chronic-conditions Top concerns of high-need patients include: Paying for Care, Accessing Care, Insurance Frustrations,  Technology Can Be Helpful, Getting Help at Home (6/16/16)]  &lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2015/dec/primary-care-physicians-in-ten-countries Nearly 25% of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84% say they are not well prepared to manage patients with serious mental illness (12/7/15)]&lt;br /&gt;
* [http://features.commonwealthfund.org/improving-care-for-those-who-need-it-most Researchers are focusing on high-need, high-cost patients—both because they need the most help and because they have the biggest impact on national health spending. 5 percent of the U.S. population accounts for 50 percent of the nation’s health care costs. (11/11/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/8/1312.abstract?=right For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary. Only 28% of super-utilizers remained on top of the list at the end of a year. (8/2015)]&lt;br /&gt;
* [https://hcttf.org/wp-content/uploads/2018/01/WhitePaper-ProactivelyIdentifyingtheHighCostPopulation.pdf Proactively	Identifying the	High Cost Population - White Paper Insights from Health Care Transforamtion Task Force 5/14/15)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMp1315568?query=TOC&amp;amp; Hospital-dependent patient's medical problems cannot be managed outside the hospital. (2/20/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/challenge-frequent-fliers-20-er-visits-per-year-progress/ The challenge of frequent fliers: 20 ER visits per year is progress (11/11/13)]&lt;br /&gt;
* [http://khn.org/news/one-percent-of-costliest-patients/ Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending (10/7/13)]&lt;br /&gt;
* [http://berkeleyhealthcareforum.berkeley.edu/report/executive-summary/ 53% of California's healthcare expenditures are spent by just 5% of the population (2/2013)]&lt;br /&gt;
&lt;br /&gt;
===Competencies ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Competencies_Determinants Competencies Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Literacy ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Literacy_Determinants Health Literacy Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.georgiahealthnews.com/2016/10/health-literacy-life-or-death-matter/ Health literacy can be a life-or-death matter. 1 out of 3 adult Georgians is functionally illiterate. Without a clear understanding of their health condition, these adults are more likely to skip necessary medical tests and have a harder time with diabetes management or high blood pressure numbers. (10/31/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/08/guide-surviving-chronic-disease.html A guide to surviving chronic disease (8/3/16)]&lt;br /&gt;
* Education - A [http://www.reuters.com/article/2013/06/26/us-cancer-cure-idUSBRE95P15320130626 survey] of patients with terminal lung cancer found nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. (6/26/13)&lt;br /&gt;
* [http://www.imedicalapps.com/2014/09/knee-guide-app-educates-engages-patients-total-knee-arthroplasty-care/ My Knee Guide App Educates and Engages Patients in Total Knee Arthroplasty Care (9/25/14)]&lt;br /&gt;
* [http://medcitynews.com/2015/05/video-replay-patient-education/ Surgeon entrepreneur develops video replay for specialist appointments to boost patient education (5/28/15)]&lt;br /&gt;
* [https://health.gov/communication/literacy/issuebrief/ 77 Million Adults Have Basic or Below Basic Health Literacy (2003)]&lt;br /&gt;
&lt;br /&gt;
====Self-Management Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Competencies_Determinants Self-Management Competencies Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Education &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/07/patients-need-education-role-care.html Patients need education about their role in care (7/3/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 39% patients admit they’re only somewhat knowledgeable, at best, about how to effectively manage their chronic condition. (7/2017)] from [http://www.jonespr.net/strengthening-chronic-care-download West] Study.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-addressing-alzheimer-s-risk-factors-could-lead-to-medicare-medicaid-savings.html Preventing and effectively managing obesity, diabetes, hypertension and cardiovascular disease can reduce onset and duration of dementia and reduce healthcare costs. (4/11/14)]&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/07/12/536519077/took-the-wrong-medicine-by-mistake-study-finds-such-errors-are-on-the-rise More People Are Making Mistakes With Medicines At Home (7/12/17)]&lt;br /&gt;
* [http://www.reuters.com/article/us-medication-errors-health-literacy-idUSKBN0FN1SK20140718 More than half of heart patients made mistakes taking their medications or misunderstood instructions (7/18/14)]&lt;br /&gt;
* [http://www.bbc.com/news/health-30556329 Only 7% of asthma sufferers were found to use asthma inhalers in the right way (12/20/14)]&lt;br /&gt;
&lt;br /&gt;
Physician Office Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kevinmd.com/blog/2017/03/can-help-doctor-diagnose.html How a patient can help their physician diagnose them. 3/19/17)]&lt;br /&gt;
&lt;br /&gt;
====Functional Competencies ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Competencies_Determinants Functional Competencies Determinants] that can decisively affect a patient's overall health and well-being. &lt;br /&gt;
&lt;br /&gt;
Literacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.kevinmd.com/blog/2017/08/literacy-health-care-problem-no-one-talks.html It is estimated that there are 23 million adults in the U.S. with limited literacy, defined as below basic literacy or non-literate. (8/18/17)]&lt;br /&gt;
&lt;br /&gt;
====Education ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Education_Determinants Education Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
===Social ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Determinants Social Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Patient (About &amp;amp; History) ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Patient_.28About_.26_History.29_Determinants Patient (About &amp;amp; History) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-death-rate-rises-for-first-time-in-decade-7-things-to-know.html American death rate rises for first time in decade. Rises in death rates from: Alzheimer's disease, heart diseases, suicide and unintentional injuries (auto accidents and drug overdoses) (6/1/16)]&lt;br /&gt;
* [http://www.pnas.org/content/112/49/15078.full.pdf Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (9/17/15)]&lt;br /&gt;
&lt;br /&gt;
====Adverse Events ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Events_Determinants Adverse Events Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Adverse Childhood Events (ACEs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/09/29/444451363/childhood-stress-may-prime-pump-for-chronic-disease-later Childhood Stress May Prime Pump For Chronic Disease Later (9/29/15)]&lt;br /&gt;
* [http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime How childhood trauma affects health across a lifetime (9/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/12/2106.abstract Adverse Childhood Events (ACEs) on attributed to higher rates of chronic disease among children (12/2014)]&lt;br /&gt;
&lt;br /&gt;
Elder Abuse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf A study found an elder abuse incidence rate in New York State was nearly 24 times greater than the number of cases referred to social service, law enforcement or legal authorities. (see Page 2) (5/2011)]&lt;br /&gt;
&lt;br /&gt;
====Beliefs ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Beliefs_Determinants Beliefs Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/aug/improving-population-health-management Patients who don't feel they can manage their health or navigate the health care system are more likely to develop a chronic disease over a three-year period than “activated” patients with good self-management skills. Low patient-activation levels are linked to significantly more hospitalizations and emergency department (ED) use. (8/23/16)]&lt;br /&gt;
&lt;br /&gt;
====Determination ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Determination_Determinants Determination Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Relationships ''Insight''====&lt;br /&gt;
* See [http://www.patientdeterminants.org/index.php?title=Health_Insight#Impacting_People_Insight People]&lt;br /&gt;
&lt;br /&gt;
====Resilience ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Resilience_Determinants_-_.28Psychological_Fitness.29 Resilience Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Optimism &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/07/504709736/a-brighter-outlook-could-translate-to-a-longer-life A Brighter Outlook Could Translate To A Longer Life (12/7/16)]&lt;br /&gt;
Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/490841/ Psychological resilience plays a role in the molecular impact of traumatic experiences. Promoting resilience may have benefits for physical and mental health (7/12/16)]&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2015/10/stressful-jobs-makes-life-shorter/412951/ Study: Stressful Jobs Make Life Shorter. Researchers found that unhealthy workplaces can affect mortality. (10/29/15)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/10/how-stress-makes-you-sick/412699/ How Stress Makes You Sick. Feeling overwhelmed affects everything from digestion to stroke risk. (10/28/15)]&lt;br /&gt;
* [http://www.nature.com/news/bacteria-implicated-in-stress-related-heart-attacks-1.15396 Emotional or physical stress can trigger heart attacks may now have a scientific explanation (6/10/14)]&lt;br /&gt;
&lt;br /&gt;
====Responsibilities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Responsibilities_Determinants Responsibilities Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://mobile.reuters.com/article/idUSKCN0VO21Q Family caregivers may be sacrificing their own health to help loved ones (2/15/16)]&lt;br /&gt;
* [http://www.mhealthtalk.com/a-guide-for-the-older-caregiver/?utm_source=rss&amp;amp;utm_medium=rss&amp;amp;utm_campaign=a-guide-for-the-older-caregiver A caregiving spouse who is between the ages of 66 and 96 and under excessive mental or emotional strain has a 63% greater risk of dying compared to those who are not tasked with caregiving. (1/17/14)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282240/ Quality of life: impact of chronic illness on the partner (11/2001)]&lt;br /&gt;
&lt;br /&gt;
====Social Well-Being ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Social_Well-Being_Determinants Social Well-Being Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Defining Well-Being &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2330497 Most medical research focuses on disease rather than wellness. The diverse and interconnected dimensions of physical, emotional and social well-being. It includes achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. (7/14/15)]&lt;br /&gt;
* [http://voxeu.org/article/origins-happiness Depression and Anxiety explains the largest variance in life satisfaction. Study shows eliminating Depression and Anxiety would have 4 times the impact of eliminating poverty in improving life satisfaction. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Competence &amp;amp; Control &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/11/30/independence-its-what-older-people-want/ Independence—It’s What Older People Want (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Loneliness &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/08/07/loneliness-public-health/ Why Loneliness Is a Public Health Threat. People with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles. (8/7/17)] &lt;br /&gt;
* [http://khn.org/news/social-isolation-may-worsen-breast-cancer-prospects/amp/ Social Isolation May Worsen Breast Cancer Prospects. Women with fewer social ties — to friends, family, community and religious groups, as well as spouses or romantic partners — were 43% more likely to see their breast cancer return, 64% more likely to die from breast cancer and 69% more likely to die from any cause (12/13/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors) 37% felt socially isolated and lacked companionship compared to 15% of other adults. (12/9/12)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/loneliness-a-bigger-risk-factor-for-death-than-obesity.html Loneliness a bigger risk factor for death than obesity (9/6/16)]&lt;br /&gt;
* [http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=137534&amp;amp;WT.mc_id=USNSF_51&amp;amp;WT.mc_ev=click The profound power of loneliness can depression and other serious health problems (2/3/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2015/12/loneliness-social-isolation-and-health/418395/ How Loneliness Wears on the Body. New research supports the idea that social isolation is detrimental to physical health—and that companionship may improve it. (12/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems Loneliness May Warp Our Genes, And Our Immune Systems (11/29/15)]&lt;br /&gt;
* [http://time.com/3747784/loneliness-mortality/ Loneliness increases risk of death by 26%. Social isolation — or lacking social connection — and living alone were found to be even more devastating to a person’s health than feeling lonely, respectively increasing mortality risk by 29% and 32% (3/18/15)]&lt;br /&gt;
* [http://www.pnas.org/content/110/15/5797.full Social isolation and loneliness are associated with increased mortality (9/12/12)]&lt;br /&gt;
&lt;br /&gt;
Love &amp;amp; Connection &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2014/05/isolation-and-death/362063/ Stressful relationships might be significantly shortening your life, are you better off alone? (5/13/14)]&lt;br /&gt;
&lt;br /&gt;
Purpose &amp;amp; Meaning &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/soul-purpose-seniors-with-strong-reasons-to-live-often-live-stronger/ Soul Purpose: Seniors With Strong Reasons To Live Often Live Stronger (8/31/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/28/479751942/could-thinking-positively-about-aging-be-the-secret-of-health People with a sense of purpose and having positive view about aging in late middle age lived about 7 and half years longer than the people who saw aging in a negative light. (5/28/16)]&lt;br /&gt;
&lt;br /&gt;
Social Influence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.time.com/time/health/article/0,8599,1646997,00.html If a friend is obese, there is a 57% greater chance of becoming obese. (7/25/07)]&lt;br /&gt;
&lt;br /&gt;
Social Via Smartphones &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.npr.org/sections/health-shots/2017/08/07/542016165/how-smartphones-are-making-kids-unhappy How Smartphones Are Making Kids Unhappy. Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. (8/7/17)]&lt;br /&gt;
&lt;br /&gt;
====Support ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Support_Determinants Support Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Asking For Help &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/alone-and-aging-creating-a-safety-net-for-isolated-seniors/amp/ A growing number of seniors who find themselves alone just when aging and end-of-life care becomes real. They don’t know how to approach a casual acquaintance to ask for help when they need it most. (11/28/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/population-health-means-asking-about-basic-needs-are-your-providers-ready-for-that.html Population Health Means Asking About Basic Needs: Are Your Providers Ready for That? (11/20/13)]&lt;br /&gt;
&lt;br /&gt;
Addressing Social Determinants&lt;br /&gt;
* [http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/ Improving population health will require broader approaches that address social, economic, and environmental factors that influence health. (11/4/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/21/with-the-aca-secure-its-time-to-focus-on-social-determinants/ Literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral, and environmental factors. It’s Time To Focus On Social Determinants. (7/21/15)] &lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/05/why-its-time-to-improve-the-social-determinants-of-health.html Why it’s time to improve the social determinants of health (5/1/15)]&lt;br /&gt;
* [https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf Going Beyond Clinical Walls to address the other 80% of determinants that are often challenging to address in clinical visits. (10/2014)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/may/addressing-patients-social-needs Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment (5/29/14)]&lt;br /&gt;
&lt;br /&gt;
Managing Chronic Conditions &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/West%20Chronic%20Disease%20Report_Final.pdf?t=1523547312917 70 percent of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease. (7/2017)]&lt;br /&gt;
&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://morningconsult.com/opinions/importance-nonemergency-medical-transportation-vulnerable-patients/ The Importance of Nonemergency Medical Transportation for Vulnerable Patients. One patient has to take two bus rides and walk a mile just to get herself and two young children to the doctor. (1/25/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/antifraud/fierce-exclusive-beneath-patient-transportation-arrangements-a-subtle-layer-fraud Unreliable or inaccessible transportation has emerged as a significant patient care issue. Legal experts say healthcare systems providing rides to patients raises concerns that they could be violating the Anti-Kickback Statute or providing a beneficiary inducement. (8/31/16)]&lt;br /&gt;
&lt;br /&gt;
===Socioeconomic ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Socioeconomic_Determinants Socioeconomic Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
*[https://www.healthaffairs.org/do/10.1377/hblog20170817.061561/full/ If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. (8/17/17)]&lt;br /&gt;
====Can't Afford Treatments ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Can.27t_Afford_Treatments_Determinants Can't Afford Treatments Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Delay Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-half-of-millennials-have-delayed-medical-care-because-of-cost.html Half of millennials have delayed medical care because of cost (1/1/16)]&lt;br /&gt;
* [http://www.gallup.com/poll/187190/cost-delays-healthcare-one-three.aspx 31% Americans say that they or a family member have put off any sort of medical treatment in the past year because of the cost (11/30/15)]&lt;br /&gt;
&lt;br /&gt;
Reduce Medical Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-half-of-aca-exchange-customers-skimp-on-healthcare-to-reduce-costs.html Half of ACA exchange customers skimp on healthcare to reduce costs (10/28/16)]&lt;br /&gt;
&lt;br /&gt;
Skip Medical Care &amp;lt;Br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/survey-1-in-3-older-millennials-skips-medical-care-because-of-costs.html Survey: 1 in 3 older millennials skips medical care because of costs (6/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/press-releases/2016/nov/international-survey-release About one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. (11/16/16)]&lt;br /&gt;
* [http://archpedi.jamanetwork.com/article.aspx?articleid=1872780 Financial Barriers to Care Among Low-Income Children With Asthma (7/2014)]* [http://money.cnn.com/2013/04/26/news/economy/health-care-cost/ 80 million people (43% of America's working-age adults) didn't go to the doctor or access other medical services last year because of the cost (4/26/13)]&lt;br /&gt;
&lt;br /&gt;
====Financial ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Financial_Determinants Financial Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Annual Healthcare Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2016/05/24/annual-healthcare-cost-for-family-of-four-now-at-25826/#33aa77f75226 Healthcare Costs in 2016 for a Family of Four Will Be $25,826 (5/24/16)]&lt;br /&gt;
* [http://www.forbes.com/sites/danmunro/2015/05/19/annual-healthcare-cost-for-family-of-four-now-at-24671/#29d013444dfb Annual Healthcare Cost For Family Of Four Now At $24,671 (5/19/15)]&lt;br /&gt;
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Fear of Healthcare Costs&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/53-of-americans-equate-unaffordable-medical-bills-to-being-diagnosed-with-a-serious-illness.html 53% of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness (3/21/17)]&lt;br /&gt;
* [http://www.healthpopuli.com/2017/02/08/health-care-worries-top-terrorism-far-americans-minds/ Health Care Worries Top Terrorism, By Far, In Americans’ Minds (2/8/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/healthcare-finances-a-source-of-fear-for-75-of-consumers.html Healthcare finances a source of fear for 75% of consumers (2/7/17)]&lt;br /&gt;
* [http://www.businesswire.com/news/home/20141006006149/en/Cigna-Consumer-Survey-%E2%80%98Health-Costs-Derail-Financial#.VDg8PvldXng 75% fear health costs could ruin prospects for secure retirement (10/6/14)]&lt;br /&gt;
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Financial Stress &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthpopuli.com/2017/04/26/financial-stress-health-risk-factor-impacts-americans/ Financial Stress As A Health Risk Factor Impacts More Americans (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/10-statistics-about-treating-patients-with-complex-needs.html In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% of high-need said they experience stress about their ability to afford housing, utilities or nutritious meals compared to 32% of other adults. (12/9/16)]  &lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-bills-lead-to-serious-debt-for-some-americans-6-things-to-know.html 85% of employees in survey in 2015 reported at least some level of financial stress. 33% were assessed as having serious debt, such as student debt, medical bills and/or credit card debt. (7/20/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/federal-reserve-board-47-of-americans-struggle-to-pay-unexpected-400-bill.html  47% of Americans struggle to pay unexpected $400 bill (6/8/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/54.abstract For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships (1/2016)]&lt;br /&gt;
* [http://www.pwc.com/us/en/private-company-services/publications/financial-well-being-retirement-survey.html Survey shows 52% of employees stressed about their finances. 45% saying that financial matters cause the most stress, nearly as many as stress from job, health, or relationships combined. (2016 Employee Financial Wellness Survey)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/more-americans-struggle-healthcare-costs 46% of Americas described paying for care as a hardship rather than affordable (12/19/14)]&lt;br /&gt;
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Health Inequality &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/wonk/wp/2017/06/05/america-is-a-world-leader-in-health-inequality/?utm_term=.7c7983e42f5c People in households making less than $22,500 a year, 38% reported being in poor or fair health. That's more than three times the rate of health troubles faced by individuals in households making more than $47,700 a year. (6/5/17)]&lt;br /&gt;
* [http://www.hhnmag.com/articles/7416-look-to-income-inequality-to-help-explain-population-health Having less money is linked to poorer health regardless of personal habits. (7/5/16)]&lt;br /&gt;
* [https://www.brookings.edu/research/what-growing-life-expectancy-gaps-mean-for-the-promise-of-social-security/ Life expectancy is higher for the wealthiest. Among American men born in 1940, the wealthiest 10% are expected to live on average 12 years longer than the poorest 10%. (2/12/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/costs-deter-low-income-patients-from-participating-in-clinical-trials.html Costs deter low-income patients from participating in clinical trials (11/3/15)]&lt;br /&gt;
* [http://www.nytimes.com/2014/04/06/health/even-small-medical-advances-can-mean-big-jumps-in-bills.html?from=homepage&amp;amp;_r=0 New innovative treatments and technology is often out of the reach of low income patients. (4/5/14)]&lt;br /&gt;
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Medical Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/half-of-uninsured-people-face-problems-with-their-medical-bills-9-survey-findings.html Half of uninsured people face problems with their medical bills (8/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/61-of-patients-confused-by-medical-bills-survey-finds.html 61% of patients confused by medical bills, survey finds (7/14/16)]&lt;br /&gt;
* [http://www.cbsnews.com/news/cdc-one-in-five-americans-cant-pay-medical-bills/ CDC: One in five Americans can't pay medical bills (9/30/13)]&lt;br /&gt;
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Prescription Drugs &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/sticker-shock-forces-thousands-of-cancer-patients-to-skip-drugs-skimp-on-treatment/amp/ Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (3/15/17)]&lt;br /&gt;
* [http://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/ Faced With Unaffordable Drug Prices, Tens Of Millions Buy Medicine Outside U.S. (12/20/16)]&lt;br /&gt;
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Price Shopping for Medical Services &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.marketwired.com/press-release/survey-finds-healthcare-providers-benefit-from-up-front-cost-estimates-yet-many-patients-nyse-tru-2192070.htm Survey found 43% said it was somewhat or very difficult to get information on costs, while another 21% of patients had never tried to get procedure cost information. (1/31/17)]&lt;br /&gt;
* [http://khn.org/news/consumer-choices-have-limited-impact-on-u-s-health-care-spending-study/ Less than 7% of total health care spending in 2011 was paid by consumers for “shoppable” services. (3/4/16)]&lt;br /&gt;
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====Food Insecurity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Food_Insecurity_Determinants Food Insecurity Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.hpoe.org/resources/ahahret-guides/3058 Social Determinants of Health Series: Food Insecurity(8/3/17)]&lt;br /&gt;
* [http://online.liebertpub.com/doi/abs/10.1089/pop.2015.0127 Study of food insecurity in patients with high rates of inpatient hospitalization (“super-utilizers”). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed. Using USDA definition of food insecurity, 30% were food insecure and 25% were marginally food secure. 40% responded that, in the past 30 days, they worried that their food would run out; 17.5% that they did not eat for a full day. 75% were unable to shop for food on their own and 58% were unable to prepare their own food. (12/1/16)]&lt;br /&gt;
* [http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html 42.2 million Americans lived in food insecure households in 2015 (29.1 million adults and 13.1 million children). (2016)]&lt;br /&gt;
* [http://pdf.aarpfoundation.org/i/455086-aarp-foundation-findings-on-nutrition-knowledge-and-food-insecurity-among-older-adults Nearly 9 million older adults in the United States experience food insecurity. (12/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1949.abstract Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1830.abstract Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. (11/2015)]&lt;br /&gt;
* [http://khn.org/news/in-sunlit-paradise-seniors-go-hungry/ In Sunlit Paradise, Seniors Go Hungry (5/26/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/03/food-insecurity-undiagnosed-medical-problem.html Food insecurity is an undiagnosed medical problem (3/6/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/1/116.abstract Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia (1/2014)]&lt;br /&gt;
&lt;br /&gt;
====Health Insurance ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Insurance_Determinants Health Insurance Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [https://www.nytimes.com/2017/05/08/upshot/a-medicare-drug-incentive-that-leads-to-greater-hospitalizations.html For sicker Medicare beneficiaries, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits (5/8/17)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/09/16/494139538/studies-link-cancer-patients-survival-time-to-insurance-status Studies Link Cancer Patients' Survival Time To Insurance Status (9/16/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/958.abstract?=right Insurance is paying for more of the cost of treating mental health conditions (68%) but not for Substance Use Disorders (46%) (6/2016)]&lt;br /&gt;
* [http://khn.org/news/new-health-plans-offer-discounts-for-diabetes-care/ New health plans offer discounts and give gift cards to encourage patients to use diabetes care (11/17/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aca-health-plans-limit-access-to-specialists-7-findings.html ACA health plans limit access to specialists: 7 findings (10/28/15)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/2015/09/21/insurance-healthy-behavior-key-reducing-cost-chronic-disease/72563266/ Study showed total cost for insured members with no chronic conditions was $3,024 a year ($2,204 out-of-pocket) and members with two or more chronic conditions was $11,940 a year ($3,500 out-of-pocket). (9/21/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/why-doctors-must-discuss-costly-treatment-before-patients-receive-bills Why doctors must discuss costly treatment before patients receive bills (10/18/13)]&lt;br /&gt;
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Denied Coverage &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/many-patients-chronic-illnesses-find-insurance-providers-deny-treatment-new-survey-says 'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says (8/16/17)]&lt;br /&gt;
Dual Eligible Patients (Qualify for Medicare and Medicaid) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://files.kff.org/attachment/Testimony-of-Gretchen-Jacobson-Ways-and-Means-Committee-Subcommittee-on-Health Low-income people on Medicare who receive assistance from Medicaid tend to have more chronic conditions, as well as cognitive and functional limitations, than others on Medicare: 61% vs. 33% need assistance with one or more activities of daily living, such as eating, bathing, and dressing; more than half, 58% vs. 29% have a mental condition or cognitive impairment; 37% vs. 27% have five or more chronic conditions; 18% vs 6% rate their health status as poor. (6/7/17)]&lt;br /&gt;
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Employer Sponsored Health Insurance &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/interactives-and-data/maps-and-data/employer-health-insurance-premiums State-by-State Look at Employer Health Insurance Costs Finds Workers’ Premium Contributions and Deductibles Growing More Slowly But Eating Up Greater Share of Incomes (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/employer-family-plan-premiums-soar-above-18k-in-2016.html Employer family health plan premiums soar above $18k in 2016 (9/14/16)]&lt;br /&gt;
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High Deductable Health Plans (HDHPs) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/10-things-to-know-about-2016-healthcare-consumer-payment-trends.html Consumers insured through high-deductible health plans increased from 10 million in 2010 to 75 million in 2016. The average deductible for individuals with employer-based coverage doubled from $735 in 2010 to $1,478 in 2016. Patient payments to providers increased 58% from 2013 to 2016. (6/13/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/cdc-nearly-40-of-us-adults-have-high-deductible-health-plans.html CDC: Nearly 40% of US adults have high-deductible health plans (6/7/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patients-with-chronic-illness-and-high-deductibles-more-likely-to-delay-care-study-finds.html Patients with chronic illness and high deductibles more likely to delay care, study finds. People with three or more chronic conditions were also nearly three times as likely to delay or avoid care as those without chronic conditions (25% compared to 9%) (11/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/given-the-choice-34-of-employees-choose-hdhps.html Given the choice, 34% of employees choose HDHPs (5/3/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly one-quarter of workers are enrolled in an High Deductable Health Plan, up from 4% in 2006. (2/4/16)]&lt;br /&gt;
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Medicaid &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://healthpayerintelligence.com/news/spike-in-late-stage-cancer-diagnosis-related-to-medicaid-cut Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut (7/5/17)]&lt;br /&gt;
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Medicare Beneficiaries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/ Half of all Medicare beneficiaries had incomes below $26,200 in 2016 (4/21/17)]&lt;br /&gt;
Patient Out-of-Pocket Cost &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medicare-cancer-patients-without-additional-coverage-hit-with-high-out-of-pocket-costs-4-things-to-know.html Medicare cancer patients without additional coverage hit with high out-of-pocket costs (11/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/patient-payment-responsibility-spiked-13-in-2015.html Patient payment responsibility spiked 13% in 2015 (6/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/may/on-medicare-but-at-risk 16 percent of Medicare beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. (5/10/16)]&lt;br /&gt;
* [http://www.healthsystemtracker.org/insight/payments-for-cost-sharing-increasing-rapidly-over-time/?utm_campaign=KFF-2016-Peterson-Cost-Sharing-Analysis&amp;amp;utm_medium=email&amp;amp;_hsenc=p2ANqtz-_fzaJSkoJE-fetaUk0iwQOwPP__Fpq1BkKAV4WPcOHEuKp1Ww3jVG7Fl41gr19-i_hWcUPOy The average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. (4/12/16)]&lt;br /&gt;
* [http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_152.pdf Nearly half of workers are covered by an insurance plan with a general annual deductible of at least $1,000 for individual coverage. (2/4/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/high-out-pocket-expenses-narrow-insurance-networks-send-more-patients-to-ers High out-of-pocket expenses, narrow insurance networks send more patients to ERs (10/26/15)]&lt;br /&gt;
* [http://kff.org/report-section/ehbs-2015-summary-of-findings/ Workers with health insurance covered by their employers have an annual deductible amount for single coverage of $1,318. (9/22/15)]&lt;br /&gt;
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Surprise Out-of-Network Bills &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/many-medicare-advantage-members-burned-by-out-of-network-bills.html Many Medicare Advantage members burned by out-of-network bills due to changes in network providers (11/28/16)]&lt;br /&gt;
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Uninsured &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/lists/2016/remaining-uninsured Why Do Millions of U.S. Adults Remain Uninsured? 1) The ACA excludes undocumented immigrants; 2) Nineteen states have not expanded Medicaid eligibility; 3) Many people still don’t know about the health insurance marketplaces; 4) Affordability is a concern; 5) Selecting a plan can be difficult: 6) Many aren’t getting the help they need. (10/21/16)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/federal-estimate-of-uninsured-falls-to-record-low-7-statistics.html Federal estimate of uninsured falls to record low 8.6% (9/7/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2016/aug/who-are-the-remaining-uninsured Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? (8/18/16)]&lt;br /&gt;
* [http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf The percentage uninsured in 2015 was 10.5% (28.4 million) (5/2016)]&lt;br /&gt;
* [http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Uninsured nonelderly Americans in 2014 was 32 million. 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Over 5 in 10 of uninsured have family income below 200% of poverty. (10/5/15).]&lt;br /&gt;
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====Income &amp;amp; Work ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Income_.26_Work_Determinants Income &amp;amp; Work Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-working-night-shifts-furthers-health-disparities.html How working night shifts furthers health disparities (10/25/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3064755/work-smart/study-finds-work-life-balance-could-be-a-matter-of-life-and-death Study found that those who work in high-stress jobs with little control are more likely to die sooner than those who have more control over and balance in their work. (10/20/16)]&lt;br /&gt;
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* [http://healthcare-economist.com/2016/09/26/effect-of-job-loss-on-physical-and-mental-health/ Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results similar for mental health. (9/26/16)]&lt;br /&gt;
* [http://khn.org/news/low-income-patients-face-hurdles-to-care-at-public-hospital-in-miami/ Low-Income Patients Face Hurdles To Care At Public Hospital (8/28/14)]&lt;br /&gt;
* [http://www.nccp.org/topics/childpoverty.html More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level]&lt;br /&gt;
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Labor Force Participation &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2016-10-07/why-are-so-many-men-not-working-they-re-in-pain A large share of American men between the ages of 25 and 54 who aren’t in the labor force may suffer from serious health conditions that are “a barrier to work” and suffer physical pain, sadness, and stress in their daily lives. (10/7/16)]&lt;br /&gt;
Lack of Sick Leave &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.wbur.org/npr/484960907/hassle-of-being-a-patient-can-turn-into-a-crisis-without-sick-leave Hassle Of Being A Patient Can Turn Into A Crisis Without Sick Leave. Third of working Americans say their jobs don't offer paid sick days (7/11/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/3/520.abstract Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. 3.0 times more likely to forego medical care for themselves and 1.6 times more likely to forego care for family (3/2016)] &lt;br /&gt;
&lt;br /&gt;
Low Income Impact on Outcomes &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/socioeconomic-hardships-hurt-dual-eligibles-health-outcomes Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid (4/2/15)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/03/screening-poverty-included-medical-curriculum.html Low socioeconomic status (SES) is a risk factor for a multitude of medical conditions including cardiovascular disease, respiratory disease, cancer, and mental illness. (3/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/employment-status-top-socioeconomic-factor-readmissions Employment status top socioeconomic factor in readmissions (12/11/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/08/29/exhibit-of-the-month-income-related-disparities-associated-with-negative-health-outcomes/ Income-Related Disparities Associated With Negative Health Outcomes (8/29/14)]&lt;br /&gt;
* [http://hin.com/Healthcare_Business_Weekly_Update/2014/06/06/data-dive-uncovers-socioeconomics-driving-er-visits-readmissions/ Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions (6/6/14)]&lt;br /&gt;
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Work environment &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/258.abstract?=right Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence (2/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/10/1761.abstract Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups (10/2015)]&lt;br /&gt;
&lt;br /&gt;
====Legal ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Legal_Determinants Legal Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
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Jail Involved &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/05/499775644/helping-ex-inmates-stay-out-of-the-er-brings-multiple-benefits Early access to primary care for ex-inmates can bring down healthcare costs by keeping them out of the ER (12/5/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/443.abstract The Critical Link Between Health Care And Jails (3/2014)]&lt;br /&gt;
&lt;br /&gt;
===Environmental ''Insight''===&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Determinants#Environmental_Determinants Environmental Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
====Access &amp;amp; Logistics ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Access_.26_Logistics_Determinants Access &amp;amp; Logistics Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Disability &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.mentalhealthamerica.net/sites/default/files/Parity%20or%20Disparity%20Report%20FINAL.pdf There is only 1 mental health provider for every 790 individuals. One out of three adults with disability could not see a doctor because of costs. (2015)]&lt;br /&gt;
Rural or Remote Area &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/patients-lacking-pharmacy-access-likely-to-readmitted-to-hospital Patients in rural or remote communities with lack of access to a pharmacy may be more likely to end up back in the hospital (8/4/16)]&lt;br /&gt;
* [https://www.minnpost.com/health/2014/06/late-life-live-home-rural-seniors-need-food-socialization-support Late-in-life: To live at home, rural seniors need food, socialization, support (6/23/14)]&lt;br /&gt;
* [http://www.rand.org/pubs/research_reports/RR578.html Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care. (2015)]&lt;br /&gt;
Transportation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/ Transportation barriers to health care access are common, and greater for vulnerable populations. (12/2013)]&lt;br /&gt;
&lt;br /&gt;
====Communication ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Communication_Determinants Communication Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
====Community ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Community_Determinants Community Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://cdnfiles.americashealthrankings.org/SiteFiles/Reports/2015_Am_Health_Ranking.pdf America’s Health Rankings of Behaviors, Community &amp;amp; Environment, Policy, and Clinical Care determinants of health that directly influence health outcomes (2015 Edition)]&lt;br /&gt;
* [http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Apr/Community-Factors-and-Hospital-Readmission-Rates.aspx Community factors most strongly associated with lower hospital readmission rates include more general practitioners and fewer specialists per capita and the presence of high-quality nursing home care. (4/17/14)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html Time to Act: Investing in the Health of Our Children and Communities (1/13/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/29/3/503.long Children had a 20-60% higher likelihood of being obese or overweight if living in neighborhoods with unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers. (3/2010)]&lt;br /&gt;
&lt;br /&gt;
Clean Air &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html The surprising link between air pollution and Alzheimer’s disease (1/31/17)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/world/air-pollution-smog-who.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ More Than 9 in 10 People Breathe Bad Air, W.H.O. Study Says (9/28/16)]&lt;br /&gt;
&lt;br /&gt;
Clean Water &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/08/14/63-million-americans-exposed-unsafe-drinking-water/564278001/ 63 million Americans exposed to unsafe drinking water (8/14/17)]&lt;br /&gt;
* [http://www.reuters.com/investigates/special-report/usa-lead-testing/ Water testing for lead levels found almost 3,000 areas with poisoning rates far higher than in Flint Michigan. Yet many of these lead hotspots are receiving little attention or funding. (12/19/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/as-water-infrastructure-ages-cost-treating-infections-rise Researchers believe as much as $2 billion of healthcare costs each year is tied to the treatment of infections that lurk in water distribution systems. (9/19/16)]&lt;br /&gt;
&lt;br /&gt;
Community Related - Life Expectancy &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1571 Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990–2013 (8/2017)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/05/08/u-s-life-expectancy-varies-by-more-than-20-years-from-county-to-county/ U.S. life expectancy varies by more than 20 years from county to county (5/8/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/tackling_life_expect.html A person born in Princeton, NJ can expect to live 87 years, his or her neighbor a dozen miles away in Trenton has a life expectancy of 73 years (11/9/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thetwo-way/2016/04/11/473749157/its-not-just-what-you-make-its-where-you-live-says-study-on-life-expectancy Life Expectancy Study: It's Not Just What You Make, It's Where You Live (4/11/16)]&lt;br /&gt;
&lt;br /&gt;
Countries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/when-it-comes-to-healthcare-u-s-once-again-ranks-last-quality-care-compared-to-other When it comes to healthcare, U.S. once again ranks last in quality care compared to other wealthy nations (7/14/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/global-study-700k-smartphone-users-shows-link-between-obesity-and-activity-inequality Global study of 700K smartphone users shows link between obesity and activity inequality within country (7/11/17)]&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.revealnews.org/blog/14-million-kids-could-be-exposed-to-toxic-pcbs-at-school/ 14 million US kids could be exposed to toxic PCBs at school (10/12/16)] &lt;br /&gt;
&lt;br /&gt;
Food Deserts &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0122 Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14 (8/2017)]&lt;br /&gt;
* [http://www.ers.usda.gov/amber-waves/2010-march/access-to-affordable,-nutritious-food-is-limited-in-%E2%80%9Cfood-deserts%E2%80%9D.aspx Some neighborhoods in US, mostly in low-income areas, have been dubbed “food deserts” because they don't have supermarkets or other food retailers that carry affordable and nutritious food. (3/1/2010)]&lt;br /&gt;
&lt;br /&gt;
Food Safety &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lead-detected-in-20-of-baby-food-samples-surprising-even-researchers/ Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers (6/15/17)]&lt;br /&gt;
&lt;br /&gt;
Low Income Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/999.abstract One’s neighborhood may drive or influence health disparities, which can be understood as disadvantages in health associated with one’s social, racial, economic, or physical environment, originate in childhood and persist across an individual’s life course. (6/2017)]&lt;br /&gt;
*[http://www.theatlantic.com/business/archive/2016/04/why-the-poor-die-young/477846/ A massive study of health and income found that smoking, obesity, and exercise are the most important determinants of longevity. Poor neighborhoods score worse in all of them. (4/12/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1383.abstract People who live in lower-income neighborhoods have a higher rate of diabetic lower-extremity amputations than those in more affluent areas (8/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/06/13/well/live/noise-may-raise-blood-pressure-risk.html Noise May Raise Blood Pressure Risk based on a study of people who lived near Athens International Airport (6/13/17)]&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
Walkable Neighborhoods &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27218630 Higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012 (5/24/16)]&lt;br /&gt;
&lt;br /&gt;
====Home ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Home_Determinants Home Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.mhealthtalk.com/common-problems-solutions/ The most common problems as you age in your home. (8/7/16)]&lt;br /&gt;
&lt;br /&gt;
Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.miamiherald.com/opinion/op-ed/article113730634.html Affordable housing, quality healthcare can let seniors age in place (11/9/16)]&lt;br /&gt;
* [http://www.stltoday.com/lifestyles/health-med-fit/health/want-a-better-chance-to-stay-out-of-a-nursing/article_c1b66d15-7afd-5b85-8e95-d83cc13d8f16.html Want a better chance to stay out of a nursing home? Modify your home (11/6/16)]&lt;br /&gt;
* [http://www.nytimes.com/2015/06/23/health/at-home-many-seniors-are-imprisoned-by-their-independence.html?ref=health&amp;amp;_r=3 Many seniors living at home feel imprisoned by their independence] (6/19/15)&lt;br /&gt;
&lt;br /&gt;
Environmental Exposures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.theatlantic.com/business/archive/2016/07/gas-leaks-mold-and-rats-millions-of-americans-live-in-hazardous-homes/492689/ Gas Leaks, Mold, and Rats: Millions of Americans Live in Hazardous Homes (7/25/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2014/01/important-lesson-personalized-patient-care.html Controlling environmental allergens can reduce sneezing and nasal congestion that trigger asthma (1/1/14)]&lt;br /&gt;
* [http://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet Scientists estimate that lung cancer deaths could be reduced by 2 to 4% by addressing the one in 15 homes the EPA believes has too much radon exposure]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/multi-faceted-home-ventilation-intervention-reduces-copd-readmissions-study-finds Multi-faceted home ventilation intervention reduces COPD readmissions, study finds (7/15/15)]&lt;br /&gt;
* [http://www.cdc.gov/nceh/lead/ At least 4 million households have children living in them that are being exposed to high levels of lead (1/29/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/research/2009/07/improving-the-health-of-all-americans-through-safe-and-healthy-h.html Approximately 40% of the 6.7 million children with diagnosed asthma are believed to be attributable to residential exposures (7/2009)]&lt;br /&gt;
&lt;br /&gt;
Homelessness &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://academic.oup.com/jpubhealth/article-abstract/doi/10.1093/pubmed/fdx034/3074503/Lifetime-and-1-year-prevalence-of-homelessness-in?redirectedFrom=fulltext Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2% and 1.5%, respectively (3/18/17)]&lt;br /&gt;
&lt;br /&gt;
Home Injuries &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commissiononhealth.org/PDF/e434bb61-64d3-4267-9dca-705b9d80ddaa/HousingFactSheetJun09.pdf An estimated 4 million emergency department visits and 70,000 hospital admissions were attributed to injuries at home. (6/2009)]&lt;br /&gt;
&lt;br /&gt;
Housing Instability &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/population-health/housing-instability-will-cost-healthcare-industry-111b-over-next-decade.html Housing instability will cost healthcare industry $111B over next decade (8/10/17)]&lt;br /&gt;
&lt;br /&gt;
Housing Quality &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.sciencedirect.com/science/article/pii/S1353829214001087 NYC heat-mortality rates are associated with poverty and poor housing quality. (11/2014)]&lt;br /&gt;
&lt;br /&gt;
Noise &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthworkscollective.com/noise-disrupts-circadian-rhythms-and-causes-other-health-issues/ Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)]&lt;br /&gt;
* [http://articles.mercola.com/sites/articles/archive/2015/06/20/noise-pollution.aspx Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Security ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Security_Determinants Security Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
Neighborhood Violence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/chicagoans-rank-violence-as-top-concern-in-health-needs-assessment.html Injury and violence was ranked as top concerns among Chicago's South and West Side residents, along with diabetes, nutrition, physical activity and weight, substance abuse and tobacco use, according to a health needs survey. (6/23/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-link-between-neighborhood-violence-and-biological-stress-in-children.html Study finds link between neighborhood violence and biological stress in children (11/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Digital Content &amp;amp; Technology ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Content_Determinants Digital Content &amp;amp; Technology Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Records_Determinants Medical Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
* [http://medcitynews.com/2014/01/trends-healthcare-giving-access-doctor-notes-can-stimulate-patient-engagement/ Giving access to doctor notes can stimulate patient engagement (1/6/14)]&lt;br /&gt;
* [https://www.healthit.gov/patients-families/blue-button/about-blue-button Medicare provides medical history on a mobile app (Blue Button) for patients and caregivers to share with doctors]&lt;br /&gt;
&lt;br /&gt;
====Health Determinants Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Determinants_Records Health Determinants Records] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Interventions Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Records_Determinants Health Interventions Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Health Outcomes Records ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Outcomes_Records_Determinants Health Outcomes Records Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Technology &amp;amp; Apps ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Technology_.26_Apps_Determinants Technology &amp;amp; Apps Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://www.chicagotribune.com/lifestyles/health/sc-devices-to-track-wandering-kids-with-autism-health-0517-20170508-story.html 96% of parents surveyed who said they were using an electronic tracking device for their child with autism claimed it improved their quality of life (5/8/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/may/mobile-health-and-patient-engagement-in-the-safety-net Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics (5/13/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Making and Condition Management&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/new-apps-aim-guide-men-through-treatment-symptom-management-prostate-cancer New apps aim to guide men through treatment, symptom management of prostate cancer (9/10/16)]&lt;br /&gt;
&lt;br /&gt;
Devices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-patients-often-misuse-wrist-blood-pressure-monitors-leading-inaccurate-readings Study finds patients often misuse wrist blood pressure monitors, leading to inaccurate readings (9/7/16)]&lt;br /&gt;
&lt;br /&gt;
Digital Health Apps &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.engadget.com/amp/2017/07/11/lumosity-does-not-improve-cognitive-skills/ Lumosity doesn’t actually improve your cognitive skills (7/11/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/internet-mobile-disease-interventions-seem-work-longterm-studies-are-lacking Internet, mobile disease interventions seem to work, but long term studies are lacking (9/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-health-apps-near-meaningless-for-low-income-patients-with-chronic-conditions.html Study: Health apps near meaningless for low-income patients with chronic conditions (7/20/16)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/03/rehab-app-shoulder-rotator-cuff/ Rehab App Aims to Improve Shoulder &amp;amp; Rotator Cuff Repair Rehabilitation (3/21/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/commonwealth-fund-reasonably-small-number-chronic-health-apps-are-useful Some 43 percent of iOS health apps and 27 percent of Android health apps are useful. (2/22/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/12/copd-management-apps/ 5 digital health tools that could improve COPD management (12/3/15)]&lt;br /&gt;
* [http://www.imedicalapps.com/2014/11/cardiosmart-explorer-great-tool-educating-patients-clinic/ CardioSmart Explorer is a great tool for educating patients with cardiac disease (11/21/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/fund-reports/2014/oct/vision-digital-health-tech A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System (10/1/14)]&lt;br /&gt;
* A [http://mobihealthnews.com/23418/most-patients-want-their-doctors-to-prescribe-apps/ study] from Digitas Health found that 90 percent of chronic patients in the US would accept a mobile app prescription as opposed to only 66 percent willing to accept a prescription of medication. (7/1/13)&lt;br /&gt;
&lt;br /&gt;
Digital Health Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-technology-self-monitor-blood-glucose-levels-no-better-traditional-management JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/content/study-patients-are-more-compliant-alivecor-devices-traditional-event-monitors Patients are more compliant to  smartphone-connected heart monitor devices than traditional event monitors (5/5/16)]&lt;br /&gt;
* [http://journals.lww.com/neurologynow/Citation/2015/11040/Wearing_the_Detectives__Wristbands,_smartwatches,.23.aspx Wristbands, smartwatches, and other wearable devices allow for more real-time monitoring of seizures and other neurologic symptoms—and, possibly, more precise treatment. (8/2015)]&lt;br /&gt;
&lt;br /&gt;
Home Automation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/top-home-tech-for-seniors-infographic/ Top Home Tech for Seniors (7/28/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/home-automation-and-home-health-care/ Home automation and in-home care aid gives patients independence without sacrificing their health needs. (3/25/14)]&lt;br /&gt;
&lt;br /&gt;
Internet Access &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/a-growing-number-people-chronic-conditions-also-lack-internet-access A growing number of people with chronic conditions also lack internet access (6/9/17)]&lt;br /&gt;
* [http://www.huffingtonpost.com/jane-sarasohnkahn/broadband-connectivity-is_b_11059720.html Broadband Connectivity Is A Social Determinant Of Health (7/22/16)]&lt;br /&gt;
&lt;br /&gt;
Technology Efficacy &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/smart-pill-bottles-didn-t-improve-adherence-for-heart-attack-patients-but-researchers-say Smart pill bottles didn’t improve medication adherence for heart attack patients, but earlier intervention could help (6/26/17)]&lt;br /&gt;
&lt;br /&gt;
==Impacting People Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_People_Determinants Impacting People Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Physicians ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Disciplines_.26_Resources_Determinants Physician Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Primary Care Physicians &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/many-americans-don-t-have-a-primary-care-doctor Some 28% of U.S. men and 17% of women don’t have a personal doctor or healthcare provider, according to a government survey. (1/12/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Team Insight===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Team_.26_Resources_Determinants Care Team &amp;amp; Resources Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
====Credentialed Care Specialists Insight====&lt;br /&gt;
Nurses &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mhealthtalk.com/how-a-specialist-nurse-can-help-with-dementia/ How a Specialist Nurse can Help with Dementia (6/21/14)]&lt;br /&gt;
&lt;br /&gt;
====Credentialed Support Providers Insight====&lt;br /&gt;
&lt;br /&gt;
====Team-Based Approach====&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/04/526475132/to-bring-down-stubbornly-high-blood-pressure-it-helps-to-have-a-team To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team (5/4/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/team-based-care-can-have-negative-financial-impact-on-primary-care-in-ffs-environment.html Team-based care can have negative financial impact on primary care in FFS environment (8/10/16)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2016/06/15/the-team-sport-of-diagnosis-a-culture-shift-can-reduce-missed-diagnoses/ The Team Sport of Diagnosis: A Culture Shift Can Reduce Missed Diagnoses (6/15/16)]&lt;br /&gt;
&lt;br /&gt;
===Caregivers ''Insight''===&lt;br /&gt;
Caregiver &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170807.061390/full/ More than a million youngsters ages 8–18 are caregivers taking on challenging tasks to help a parent, grandparent, sibling, or other relative. (8/7//17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-70-percent-caregivers-say-tech-plays-no-role-or-minor-role-their-work Survey: 70 percent of caregivers say tech plays no role or a minor role in their work (6/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-engagement/new-pennsylvania-law-requires-hospitals-to-educate-caregivers-upon-patient-discharge.html  New Pennsylvania law requires hospitals to educate caregivers upon patient discharge (4/27/17)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family-caregiving-cost-survey-res-ltc.pdf Study: Many Caregivers Spend $7K Annually Out Of Pocket, which is 20% of their income (11/14/16)]&lt;br /&gt;
* [https://www.fastcompany.com/3065403/the-future-of-work/the-hidden-caregiving-crisis-that-the-election-wont-solve The number of U.S. workers struggling to care for ill or aging loved ones is growing fast. But the support they need isn't. (11/8/16)]&lt;br /&gt;
* [http://khn.org/news/study-elderlys-family-caregivers-need-help-too/amp/ Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones (9/14/16)]&lt;br /&gt;
* [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers In Some States, a New Focus on Family Caregivers. Nearly half of family caregivers administer multiple medications, treat wounds or operate specialized medical equipment. (6/22/16)]&lt;br /&gt;
* [http://khn.org/news/who-are-americas-caregivers-nearly-a-quarter-are-millennials/ Who Are The 40 Million American Caregivers? Nearly A Quarter Are Millennials (12/3/15)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/15-things-to-know-about-caregivers.html 15 things to know about caregivers (11/3/15)]&lt;br /&gt;
* [http://mobihealthnews.com/48054/new-council-will-guide-family-caregivers-to-available-tools/ New council will guide family caregivers to available tools (10/28/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/caregiver-frustration/ Nearly one-third struggle in their caregiving role and want tools to help them and their family members. 64% feel stressed and overwhelmed; nearly half struggle with balancing personal needs and caregiving. (10/24/15)]&lt;br /&gt;
* [http://khn.org/news/dementia-also-takes-toll-on-unpaid-caregivers-study-shows/ Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia (10/16/2015)]&lt;br /&gt;
* [http://www.usnews.com/news/us/articles/2015/07/14/ap-norc-poll-many-californians-unaware-of-caregiver-program Many Californians unaware of caregiver program for low-income seniors, disabled (7/14/15)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-undeniable-progress.pdf In 2013, about 40 million family caregivers in the US provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013. (7/2015)]&lt;br /&gt;
* [http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf An estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the 12 months period in 2014 and 2015. (6/2015)]&lt;br /&gt;
* [http://medcitynews.com/2015/04/care-caregiver/ How Do We Care for the Caregiver (4/23/15)]&lt;br /&gt;
* [https://www.caring.com/about/news-room/costs-of-caregiving-2014 Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs (9/15/14)]&lt;br /&gt;
&lt;br /&gt;
Home Care (Non-Credentialed) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/ Lots Of Responsibility For In-Home Care Providers — But No Training Required (1/6/15)]&lt;br /&gt;
&lt;br /&gt;
===Family Members &amp;amp; Friends ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Family_Members_.26_Friends_Determinants Family Members &amp;amp; Friends Determinants] that can decisively affect a patient's overall health and well-being. &amp;lt;br&amp;gt;&lt;br /&gt;
Spouse &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.asco.org/about-asco/press-center/news-releases/large-study-finds-association-between-marriage-and-cancer Large Study Finds Association Between Marriage and Cancer Outcomes (9/23/13)]&lt;br /&gt;
&lt;br /&gt;
===Support Team Insight===&lt;br /&gt;
&lt;br /&gt;
Community Health Workers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/ Hospitals Eye Community Health Workers To Cultivate Patients’ Successes (4/11/16)]&lt;br /&gt;
* [http://khn.org/news/in-l-a-community-health-workers-are-part-of-the-medical-team/ In L.A., Community Health Workers Are Part Of The Medical Team (10/26/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/16/how-community-health-workers-can-reinvent-health-care-delivery-in-the-us/ How Community Health Workers Can Reinvent Health Care Delivery In The US (1/16/15)]&lt;br /&gt;
&lt;br /&gt;
Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html How Social Spending Affects Health Outcomes (8/17/16)]&lt;br /&gt;
* [https://thehealthcaremarketer.wordpress.com/2016/08/11/the-health-impact-in-5-years-hi-5-initiative/ Centers for Disease Control and Prevention (CDC) launches new initiative – Health Impact in 5 Years (HI-5). Promotes list of proven non-clinical, community-wide interventions that improved health within five years and are cost-effective or have cost-saving over the lifetime of the population. (8/11/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/politics/2016/05/02/social-service-shortfalls-hinder-health-boost-medical-spending/83625264/ Social service shortfalls hinder health, boost medical spending (5/3/16)] &lt;br /&gt;
* [https://www.icsi.org/_asset/nsnyw1/sharingknowledgedata.pdf Sharing Knowledge and Data at the Community/System Level To Address Social Determinants (4/2015)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/07/14/to-lower-the-cost-of-health-care-invest-in-social-services/ To Lower The Cost Of Health Care, Low-tech social services also should be considered a key factor in our health care equation. (7/14/15)]&lt;br /&gt;
* [http://www.cdc.gov/chinav/ CDC launches Community Health Improvement Navigator (CHI Navigator) website (5/2015)] with tools and resources from [http://www.thecommunityguide.org/ The Guide to Community Preventive Services], the [http://whatworksforhealth.wisc.edu/ What Works for Health database (on the University of Wisconsin website)], the [https://innovations.ahrq.gov/ AHRQ Health Care Innovations Exchange], the [http://cdc.thehcn.net/index.php?module=promisepractice&amp;amp;controller=index&amp;amp;action=index Healthy Communities Institute Promising Practices] and the [http://healthyamericans.org/ New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/11/understanding-intersection-health-care-social-services.html Understanding the intersection of health care and social services (11/10/13)]&lt;br /&gt;
&lt;br /&gt;
===Organizations Insight===&lt;br /&gt;
====Healthcare Organizations Insight====&lt;br /&gt;
====Government Organizations Insight====&lt;br /&gt;
====Employer Insight====&lt;br /&gt;
====Community and Social Services Organizations Insight====&lt;br /&gt;
====Support Resources Organizations Insight====&lt;br /&gt;
===Other Contributors Insight===&lt;br /&gt;
&lt;br /&gt;
==Impacting Activities Insight==&lt;br /&gt;
Insights into the [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Impacting_Activities_Determinants Impacting Activities Determinants] that can impact a patient's [[Health Outcomes|health outcomes]] and [[Health Status|health status]].&lt;br /&gt;
===Healthy Lifestyle ''Insight''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1569 The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed (8/2017)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1605086#t=article A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor). Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle. (12/15/16)]&lt;br /&gt;
* [http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract Study finds 2.7% of U.S. adults meet criteria for ‘healthy lifestyle’ (4/2016)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ Scientist assert Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Only 5–10% of all cancer cases were attributed to genetic defects, whereas the remaining 90–95% is lifestyle factors including tobacco (25–30%), diet (30–35% - fried foods, red meat), infections (15–20%) the remaining alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity. (7/15/2008)]&lt;br /&gt;
&lt;br /&gt;
===Physical Activities ''Insight''===&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/06/26/teenagers-are-as-sedentary-as-60-year-olds-by-age-19/?utm_term=.127016b508d0 Teenagers are as sedentary as 60-year-olds by age 19 (6/26/17)]&lt;br /&gt;
* [http://mashable.com/2017/01/15/why-being-a-weekend-warrior-is-still-good-for-your-health/#EQ6NSxU86kqy Researchers found that the weekend warriors who met physical activity guidelines were less likely to die during the nine-year study period, compared with people who didn't get any exercise. A total of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity over one or two days a week. (1/15/17)]&lt;br /&gt;
* [https://www.technologyreview.com/s/602706/pokemon-go-increased-us-activity-levels-by-144-billion-steps-in-just-30-days/ Pokemon Go Increased U.S. Activity Levels by 144 Billion Steps in Just 30 Days (10/21/16)]&lt;br /&gt;
* [http://mobile.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?_r=0&amp;amp;referer=http://khn.org/morning-breakout/first-edition-september-28-2016/ Brain Benefits of Exercise Diminish After Short Rest (9/28/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cdc-more-than-a-quarter-of-adults-over-50-get-no-exercise-outside-of-daily-life-activities.html CDC: More than a quarter of adults over 50 get no exercise outside of daily life activities (9/20/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/27/study-suggests-new-formula-for-physical-activity-8-hours-of-sitting-means-1-hour-of-exercise/ Study suggests 1 hour of activity per 8 hours of sitting (7/27/16)]&lt;br /&gt;
* [https://www.washingtonpost.com/national/health-science/sitting-can-be-bad-especially-if-you-do-it-for-more-than-10-hours-a-day/2016/07/22/43f7f228-4f77-11e6-aa14-e0c1087f7583_story.html Sitting can be bad, especially if you do it for more than 10 hours a day (7/24/16)]&lt;br /&gt;
* [https://medlineplus.gov/podcast/transcript071816.html Moderate exercise is associated with a reduced risk of 13 types of cancer (7/18/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html The percentage of adults over 18 who met the 2008 federal physical activity guidelines for aerobic activity increased from 41.4 percent in 2006 to 49.5 percent in 2012. That rate has remained stable through 2015. (5/26/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/nih-common-fund-launches-physical-activity-research-program NIH Common Fund launches physical activity research program to identify biological molecules that change in response to exercise (6/11/15)]&lt;br /&gt;
* [http://www.reuters.com/article/us-sedentary-television-mortality-idUSKBN0F65BW20140701 Too much TV tied to premature death (7/1/14)]&lt;br /&gt;
Children Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/johns-hopkins-us-could-save-21b-in-healthcare-costs-if-kids-played-outside-every-day.html Johns Hopkins: US could save $21B in healthcare costs if kids played outside every day (5/15/17)]&lt;br /&gt;
* [https://www.usatoday.com/story/news/health/2017/05/06/kids-inactivity-rises-creating-health-care-time-bomb/101245982/ The percent of children aged six to 12 who were physically active three or more times a week had its biggest drop in five years and is now under 25% (5/6/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/03/well/move/childs-play-is-good-for-all-of-us.html If all of the children who currently are sedentary started exercising every day in the United States alone, we could expect to save more than $120 billion every year in health care and associated expenses. (5/3/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/902 Modeling The Economic And Health Impact Of Increasing Children’s Physical Activity In The United States (5/2017)]&lt;br /&gt;
&lt;br /&gt;
===Social &amp;amp; Passion Activities Insight===&lt;br /&gt;
===Nutrition ''Insight''===&lt;br /&gt;
* [http://fortune.com/2017/07/17/artificial-sweeteners-weight-loss-study/ Artificial Sweeteners Won't Help You Lose Weight, According to a Sad but Important New Study (7/17/17)]&lt;br /&gt;
* [http://ajcn.nutrition.org/content/early/2017/06/07/ajcn.117.154872.abstract?papeto The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. (6/7/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1 Pediatricians Advise No Fruit Juice Until Kids Are 1 (5/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/15/well/eat/red-meat-increases-risk-of-dying-from-8-diseases.html Red meat increase risk of dying from 8 diseases (5/15/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/26/well/diet-sodas-tied-to-dementia-and-stroke.html Diet soda tied to dementia and stroke (4/26/17)] &lt;br /&gt;
* [https://www.statnews.com/2017/01/26/soda-sugary-drinks/ The number of calories per day that children and adults have been getting from soda and other sugar-sweetened beverages has been dropping for steadily for nearly 20 years, but new data show that since 2009 that number has plateaued. (1/26/17)] &lt;br /&gt;
* [http://www.alzheimersanddementia.com/article/S1552-5260(17)30050-X/fulltext Excess sugar consumption has been linked with Alzheimer's disease (AD) pathology in animal models. (1/24/17)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2529628 Dietary Intake Among US Adults, 1999-2012 Improved. The American Heart Association (AHA) primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). (6/21/16)]&lt;br /&gt;
* [http://www.theatlantic.com/health/archive/2016/03/more-than-half-of-what-americans-eat-is-ultra-processed/472791/ More Than Half of What Americans Eat Is 'Ultra-Processed'. And those foods account for 90 percent of U.S. added sugar intake, new research says.(3/10/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1916.abstract Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; Overall Diet Remains Poor (11/2015)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1940.abstract Foods with the largest positive associations with three-year excess weight gain (among children and adolescents) were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages (11/2015)]&lt;br /&gt;
* [http://now.tufts.edu/news-releases/sugary-drinks-linked-high-death-tolls-worldwide Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year (6/29/15)]&lt;br /&gt;
* [http://openheart.bmj.com/content/2/1/e000196.full US and UK governments dietary guidelines introduced in 1977 and 1983 to reduce coronary heart disease (CHD) by reducing fat intake didn't have studies to support it. (2/9/15)]&lt;br /&gt;
&lt;br /&gt;
===Functional Activities Insight===&lt;br /&gt;
&lt;br /&gt;
Digital Health Usage &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/survey-21-percent-americans-have-used-virtual-healthcare-78-percent-are-interested Survey: 21 percent of Americans have used virtual healthcare, 78 percent are interested (2/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/senior-citizens-rarely-use-digital-health-resources-5-study-findings.html Seniors rarely use digital health resources: 5 study findings (8/3/16)]&lt;br /&gt;
* [http://mobihealthnews.com/39189/parks-41-percent-of-caregivers-use-a-digital-health-device 41 percent of caregivers use a digital health device (12/18/14)]&lt;br /&gt;
* [http://mobihealthnews.com/38904/kaiser-members-who-use-app-are-more-adherent-satisfied-and-loyal/ Kaiser now has 70% of its 9 million members as active users of its online and mobile offerings, patients are more adherent, satisfied, and loyal (12/10/14)]&lt;br /&gt;
&lt;br /&gt;
===Sleep ''Insight''===&lt;br /&gt;
* [https://www.alz.org/aaic/releases_2017/AAIC17-Tues-Briefing-Sleep.asp Interrupted sleep may lead to Alzheimer’s. Research found significant associations between sleep disordered breathing (SDB) and the accumulation of biomarkers for Alzheimer's disease. (7/18/18)] &lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/12/06/504448639/drivers-beware-crash-rate-spikes-with-every-hour-of-lost-sleep Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep (12/6/16)]&lt;br /&gt;
* [http://mashable.com/2016/11/30/sleep-deprivation-economic-cost.amp In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death (11/30/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/08/24/432764792/snooze-alert-a-sleep-disorder-may-be-harming-your-body-and-brain Snooze Alert: A Sleep Disorder May Be Harming Your Body And Brain A Sleep Disorder May Be Harming Your Body And Brain. More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea. (8/24/15)]&lt;br /&gt;
* [http://articles.latimes.com/2013/aug/29/science/la-sci-sn-sleeping-pill-use-cdc-20130830 One in 25 American adults takes sleeping pills to help them fall asleep and stay asleep at night (8/29/13)]&lt;br /&gt;
&lt;br /&gt;
===Adverse Behaviors ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Adverse_Behaviors_Determinants Adverse Behaviors Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/5-things-to-know-about-america-s-unhealthy-behaviors.html More than 70 percent of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. (4/5/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-overweight-heart-uspstf-idUSKBN0GP1XA20140825 Overweight patients with risk factors for heart disease need &amp;quot;intensive behavioral counseling&amp;quot; about '''diet''' or '''exercise''', according to USPSTF. (8/25/14)]&lt;br /&gt;
* [https://georgevanantwerp.com/2013/12/30/8-risks-drive-15-conditions-and-80-of-healthcare-costs/ 8 Behavior Risks Drive 15 Conditions And 80% Of Healthcare Costs (12/30/13)]&lt;br /&gt;
&lt;br /&gt;
Alcohol &amp;lt;br&amp;gt; &lt;br /&gt;
* [https://www.bloomberg.com/news/articles/2017-08-09/america-s-drinking-problem-is-much-worse-this-century The number of adults who binge drink at least once a week could be as high as 30 million, according to a study published on Wednesday in JAMA Psychiatry. (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html An estimated 32% of Americans had a minimum of one heavy drinking day in the last year. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. (5/27/16)]&lt;br /&gt;
* Alcohol Consumption - [https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ The top 10% of American drinkers consume, on average, 74 alcoholic drinks per week. (9/25/14)]&lt;br /&gt;
&lt;br /&gt;
Falls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-elderly-patients-treated-for-falls-may-be-more-likely-to-suffer-later-adverse Elderly patients treated for falls may be more likely to suffer later adverse events, study finds (7/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/among-the-elderly-an-epidemic-of-falling.html The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. (9/21/16)] &lt;br /&gt;
* [http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/ The use of 4 or more medications was associated with increased risk of falling and the risk of recurrent falls (9/27/13)]&lt;br /&gt;
&lt;br /&gt;
Risky Behaviors &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/05/29/health/car-accidents-child-deaths-seat-belts.html Car Accidents Remain a Top Child Killer, and Belts a Reliable Savior (5/29/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-finds-high-risk-behaviors-often-persist-even-after-cancer-diagnoses.html Study finds high-risk behaviors often persist after cancer diagnoses. 19.8% of women cancer survivors smoked, compared with 15.8% of women without cancer. No differences existed for fruit and vegetable consumption or body mass index. (9/6/16)]&lt;br /&gt;
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Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2017/01/10/smoking-costs-the-world-economy-1-trillion-per-year-world-health-organization-says/?utm_term=.378ab21f3e8c Smoking costs the world economy $1 trillion per year, World Health Organization says (1/10/17)]&lt;br /&gt;
* [https://directorsblog.nih.gov/2016/12/13/study-finds-no-safe-level-of-smoking/ New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. (12/13/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall Centers for Disease Control and Prevention says smoking rates have fallen from 21% of the adult population in 2005 to 15% in 2015 (11/10/16)]&lt;br /&gt;
* [http://www.sanger.ac.uk/news/view/smoking-pack-day-year-causes-150-mutations-lung-cells Smoking a pack a day for a year causes 150 mutations in lung cells (11/3/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/cigarettes-linked-to-nearly-30-of-cancer-deaths-6-things-to-know.html Cigarettes linked to nearly 30% of cancer deaths: 6 things to know (10/24/16)]&lt;br /&gt;
* [http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002020 A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. (5/10/16)]&lt;br /&gt;
* [https://www.boston.com/news/health/2016/05/24/kicking-habit-adult-smoking-rate-us-falling-fast CDC reports smoking rate among adults in the U.S. fell to 15% in 2015, down two percentage points from 2014. (5/24/16)]&lt;br /&gt;
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Substance Use &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.statnews.com/2017/04/19/opioid-addiction-relapse-science/ How drug use changes the brain — and makes relapse all too common (4/19/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2587685 Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/share-of-us-employees-testing-positive-for-illicit-drug-reaches-10-year-peak.html 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/opioid-dependence-leads-to-tsunami-of-medical-services-study-finds/amp/ 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/7-statistics-on-current-costs-outcomes-for-mental-health-and-substance-abuse-disorders.html In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/opioid-ods-caused-100k-er-visits-2010 Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)]&lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2014-05/hfhs-med051514.php Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)]&lt;br /&gt;
&lt;br /&gt;
===Self-Management Behavior ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Self-Management_Behavior_Determinants Self-Management Behavior Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Medication Adherence &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://health.usnews.com/health-care/articles/2017-04-19/many-heart-attack-patients-fail-to-stick-with-statins Many Heart Attack Patients Fail to Stick With Statins (4/19/17)]&lt;br /&gt;
* [https://www.washingtonpost.com/news/to-your-health/wp/2016/07/25/more-than-half-of-adults-misuse-medications-study-finds/ More than half of adults and 44% of children drug-tested by a national clinical laboratory last year misused their prescription medications, either taking too much, too little or none of their medications. 45 percent of adults were taking drugs (including illicit drugs) that were not prescribed. (7/25/16)]&lt;br /&gt;
* [http://www.mcolblog.com/kcblog/2016/7/12/factors-attributed-to-medication-non-adherence.html 30% of prescriptions are never filled. 69% of nonadherence is due to behavioral issues, such as forgetfulness or procrastination, 16% was due to cost, and 15% say it was medication side effects (7/12/16)]&lt;br /&gt;
*  [http://www.imshealth.com/en/about-us/news/ims-health-study:-low-levels-of-adherence-and-persistence-remain-barriers-to-reducing-the-costs-of-diabetes-complications The U.S. could save $4 billion a year if more seniors with type 2 diabetes followed their doctor’s orders, according to a report by the IMS (7/12/16)]&lt;br /&gt;
* [http://www.hindawi.com/journals/ijfm/2013/901845/ Study found that only 6.5% of patients (only 46 in study) adhered completely to the discharge medication list after average hospital stay of 4.3 days. The average patient age was 76, prescription medications was 10 and number of chronic diseases was 7. (2/24/13)] &lt;br /&gt;
* [http://medcitynews.com/2014/11/study-medication-adherence-prompts/ Study: Medication adherence improved with proper prompts (11/17/14)]&lt;br /&gt;
* [http://well.blogs.nytimes.com/2012/11/15/when-the-patient-is-noncompliant/ When the patient is non-compliant (11/15/12)]&lt;br /&gt;
* [http://healthcare-economist.com/2015/05/31/patient-adherence-to-antipsychotic-medications/ About 40% of patients with schizophrenia are adhering to antipsychotic medications (5/31/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Activation Levels &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2016/mar/patient-self-management-capability In 2012, ED costs were 37% lower for those at highest activation level versus the lowest ($1,126 vs. $711). In 2014, the difference was 28% (3/8/16)]&lt;br /&gt;
* [http://hpr.weill.cornell.edu/divisions/biostatistics/pdf/Gerber-Research_Seminar_Talk-5-10-07.pdf Effect of the Patient Activation Measure (PAM) on Chronic Care: Baseline Findings from a Cluster Randomized Study (5/10/07)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/3/431 When Patient Activation Levels Change, Health Outcomes And Costs Change, Too (3/2015)]&lt;br /&gt;
&lt;br /&gt;
Prevention &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.ajc.com/news/local/study-finds-percent-sunscreens-don-even-work-how-find-one-that-does/ergzPOJyVv0nM7ZG88yBHK/ Study finds 73 percent of sunscreens don’t even work — how to find one that does (5/26/17)]&lt;br /&gt;
&lt;br /&gt;
Preventive Screening and Vaccinations&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentages of adults who received an influenza vaccination in 2015 was 65.8% for adults aged 65 and over, 46% for ages 50 to 64 and 31.2% for those aged 18 to 49. (5/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/american-health-by-the-numbers-15-points-from-cdc-s-2015-national-health-interview-survey.html Percentage of adults over 65 years old vaccinated for pneumonia increased rapidly from 42.4% in 1997 to 53.1% in 2000. In 2015, the percentage rose to 63.5% (5/26/16)]&lt;br /&gt;
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Self Management &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.reuters.com/article/us-pressure-management-study-idUSKBN0GR2C220140827 Self management may reduce blood pressure (8/27/14)]&lt;br /&gt;
&lt;br /&gt;
Treatment Delays &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://go.americanwell.com/rs/335-QLG-882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf 67% of consumers say they have delayed seeking care for a health problem. They delay because: It costs too much (23%), It takes too long to get in to see a doctor or nurse (23%), They thought the problem would go away on its own (36%), They are too busy (13%) (1/2017)]&lt;br /&gt;
&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-fewer-americans-diet-20170308-story.html American adults either overweight or obese rose from about 53% a generation ago to roughly 66% more recently. 56% of overweight or obese adults reported in 1988 to 1994 they had tried to lose weight in the last year, it has declined to 49% in 2009 to 2014. (3/7/17)]&lt;br /&gt;
&lt;br /&gt;
Wellness Programs&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/279396/will-every-human-be-health-reward-program-when-it-comes-health-rewards-it-seems 74 percent of employers use health reward program (12/1/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/michaeldermer/193551/amount-reward-consumer-health-behavior What Size Reward Drives a Consumer to Take a Desired Health Behavior? (9/9/14)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/11/25/workplace-wellness-produces-no-savings/ Workplace Wellness Produces No Savings (11/25/14)]&lt;br /&gt;
&lt;br /&gt;
===Care Planning Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Strategies_.26_Care_Planning_Determinants Strategy Objectives (Care Plan) Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/05/10/addressing-triggers-of-decline-in-older-adults-physical-cognitive-or-mental-health/ “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/07/02/family-caregiving-and-palliative-care-closing-the-policy-gap/ Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)]&lt;br /&gt;
&lt;br /&gt;
Care Planning &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/01/02/implementing-a-care-planning-system-how-to-fix-the-most-pervasive-errors-in-health-care/ Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)]&lt;br /&gt;
&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/630.abstract Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)] &lt;br /&gt;
* [http://familiesusa.org/press-release/2016/proven-best-choices-guides-health-care-options-launched-icer-and-families-usa Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)]&lt;br /&gt;
* [https://decisionaid.ohri.ca/odsf.html The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/quality-matters/2012/october-november/in-focus Helping Patients Make Better Treatment With Decision Aids (10/2012)]&lt;br /&gt;
&lt;br /&gt;
Evidence-Based Practice &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/primary-care-docs-may-struggle-to-find-high-quality-evidence-to-support-clinical Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2015/05/22/credibility-of-evidence-a-reconsideration-of-the-logic-and-strength-of-our-healthcare-decisions/ Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)]&lt;br /&gt;
&lt;br /&gt;
Medical Advocates &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/medical-advocates-can-help-guide-patients-on-difficult-care-choices/ Medical Advocates Can Help Guide Patients On Difficult Care Choices  (1/27/16)]&lt;br /&gt;
&lt;br /&gt;
Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/partners-expands-second-opinion-service-health-advocate-partnership Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/88-of-second-opinions-from-mayo-physicians-result-in-different-diagnosis-study-finds.html 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)]&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/patients-with-more-say-in-treatment-have-fewer-side.html Patients with more say in treatment have fewer side effects (7/13/16)]&lt;br /&gt;
*  [http://khn.org/news/inviting-patients-to-help-decide-their-own-treatment/ Inviting Patients To Help Decide Their Own Treatment (3/16/15)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/17/shared-decision-making-and-the-use-of-patient-decision-aids/ Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/doctors-patients-critically-medical-decisions.html How should doctors and patients look critically at medical decisions?] (8/16/13)&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/medical-interventions-5050-informs-patient.html Many medical interventions are 50/50: Who informs the patient? (8/13/2013)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Communications ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Communications_Determinants Care Management - Communications Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Communicating Instructions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/most-patients-don-t-understand-post-discharge-care-plans-study-finds Most patients don't understand post-discharge care plans, study finds (1/6/2016)]&lt;br /&gt;
&lt;br /&gt;
Difficult Dialog &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/03/377569539/even-some-doctors-fear-these-10-questions The difficulty of asking questions about &amp;quot;adverse childhood experiences&amp;quot; that identifies health risks (3/3/15)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/03/24/394927484/many-doctors-who-diagnose-alzheimers-fail-to-tell-the-patient Many Doctors Who Diagnose Alzheimer's Fail To Tell The Patient (3/24/15)]&lt;br /&gt;
&lt;br /&gt;
Digital Communications &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.cio.com/article/3195891/cio-role/kaiser-cio-shares-it-lessons-for-the-future-of-healthcare.html Kaiser Permanente crossed an important threshold last year when 52 percent of its patient interactions were digital. (5/10/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/mhealth-monitor-patients-physicians/ 58% of people in the U.S. with a smartphone shared information with a medical professional using a mobile or wearable device. And 25% used email or text to send a photo of a medical issue to their doctor. (11/15/16)]&lt;br /&gt;
* [http://www.huffingtonpost.com/2015/06/29/doctors-facebook-telehealth_n_7662774.html Communicating With Your Doctor On Facebook May Be The Future Of Healthcare (6/29/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/07/healthcrowd-pilot-finds-mobile-engagement-medicaid-patients-cost-effective/ Pilot project finds mobile engagement with Medicaid patients ‘most cost-effective’ (7/29/14)]&lt;br /&gt;
* [http://mobihealthnews.com/35160/nearly-half-of-kaiser-permanentes-members-use-my-health-manager/ Nearly half of Kaiser Permanente's members use online health management platform (7/25/14)]&lt;br /&gt;
* Electronic Communication - [http://link.springer.com/article/10.1007%2Fs11606-012-2329-5 71% of vulnerable patient populations want to use electronic communication with health care providers.] (2/20/13)&lt;br /&gt;
&lt;br /&gt;
Doctor Patient Discussions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/language-doctors-use-to-talk-to-diabetes-patients-makes-a-difference The language doctors use to talk to diabetes patients makes a difference to success (6/14/17)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/09/prudent-antibiotic-prescribing-lowers-patient-satisfaction.html How prudent antibiotic prescribing lowers patient satisfaction (9/13/16)]&lt;br /&gt;
* [http://khn.org/news/attending-to-the-human-element-is-key-to-keeping-patients-healthy/amp/ Study recommends improving communication with racial minorities and lower-income patients, such as better bedside manner (so patients trust their doctors), communication that is easily understood by everyday people and willingness to discuss how price fits into consumers’ health decisions. (9/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/physicians-spend-twice-as-much-time-on-ehr-desk-work-than-with-patients.html Physicians spend twice as much time on EHR, desk work than with patients (9/6/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/06/costs_of_care_getti.html Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. (6/15/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/get-10-minutes-doctor-2/ Why Do I Only Get 10 Minutes With My Doctor? (9/18/14)]&lt;br /&gt;
* [http://khn.org/news/15-minute-doctor-visits/ 15-Minute Visits Take A Toll On The Doctor-Patient Relationship (4/21/14)]&lt;br /&gt;
&lt;br /&gt;
Patient Portals &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/ehr/despite-federal-push-to-offer-ehr-access-patient-engagement-low Just 15% of hospital patients electronically accessed their medical records despite 88% of hospitals offering access. Nearly one-third of patients accessed EHRs offered by physician practices. (3/16/17)]&lt;br /&gt;
&lt;br /&gt;
Patient Provided Data&lt;br /&gt;
* [http://www.fiercehealthcare.com/analytics/how-university-rochester-medical-center-uses-patient-generated-data-to-set-expectations University of Rochester Medical Center (URMC) collects patient-reported outcomes by using a Patient-Reported Outcomes Measurement Information System (PROMIS), which requires patients to answer five to seven questions on a tablet. (7/6/17)] &lt;br /&gt;
* [http://www.annfammed.org/content/15/2/158.abstract Patients Typing Their Own Visit Agendas Into an Electronic Medical Record. Patients and clinicians agreed that the agendas improved patient-clinician communication. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Remote Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2488923#Results Study finds readmissions nearly the same for heart failure patients using remote patient monitoring (3/2016)]&lt;br /&gt;
* [http://mobihealthnews.com/content/scripps-wired-health-study-results-show-no-clinical-or-economic-benefit-digital-health Scripps Wired for Health study shows no clinical or economic benefit from digital health monitoring (1/19/16)]&lt;br /&gt;
* [http://khn.org/news/making-the-human-condition-computable/ Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to enable doctors to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails. (12/11/14)]&lt;br /&gt;
* [http://www.mhealthtalk.com/can-fall-monitoring-technology-keep-elders-safe/ Can Fall Monitoring Technology Keep Elders Safe? (4/7/14)]&lt;br /&gt;
* [http://www.mddionline.com/article/digital-health-dominates-ces-2014-%E2%80%93-3-trends-watch-3 Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. (1/9/14)]&lt;br /&gt;
&lt;br /&gt;
Screenings &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/doctors-should-screen-patients-for-social-isolation-to-address-loneliness-epidemic Doctors must screen patients for social isolation to address 'loneliness epidemic' (8/8/17)]&lt;br /&gt;
* [https://nam.edu/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool/ Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool. (5/30/17)] [https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf See PDF] &lt;br /&gt;
&lt;br /&gt;
Text Messaging &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/despite-privacy-hoops-text-messaging-offers-unprecedented-convenience Despite privacy hoops, text messaging offers ‘unprecedented convenience’ (5/11/17)]&lt;br /&gt;
&lt;br /&gt;
===Care Management - Operational ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Care_Management_-_Operational_Determinants Care Management - Operational Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/3/474.abstract Breaking Down Silos Between Health Care And Criminal Justice (3/2014)]&lt;br /&gt;
&lt;br /&gt;
Behavioral Health Integration&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/10/1808.abstract Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care (10/2014)]&lt;br /&gt;
* [http://docs.house.gov/meetings/IF/IF02/20150211/102944/HHRG-114-IF02-Wstate-KohnL-20150211.pdf About 10 million—or 4.2%—of adults in the United States suffered from a serious mental illness in 2013 were supported by 112 different federal programs (2/11/15)]&lt;br /&gt;
&lt;br /&gt;
Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-acute-care-needs-to-be-coordinated-but-it-often-not Only 30% of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7% reported they were fully coordinated. (11/131/6)]&lt;br /&gt;
* [http://pediatrics.aappublications.org/content/early/2016/07/20/peds.2015-4182 Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. (7/2016)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/09/difficult-transition-hospital-nursing-home.html The difficult transition between the hospital and nursing home (9/5/13)]&lt;br /&gt;
* [http://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/ One of the most dangerous junctures in medical care: patients leaving the hospital. Nearly a quarter had inadequately reviewed or tracked medications, sometimes even causing fatal events. (5/2/16)] &lt;br /&gt;
* [https://psnet.ahrq.gov/primers/primer/11 Nearly 20% of patients experience adverse events within 3 weeks of hospital discharge, nearly three-quarters of which could have been prevented or ameliorated. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/post-discharge-risks-persist-for-elderly-patients The transition from hospital to home poses significant risks to patients, especially the elderly, and gaps persist in care during this crucial time. (7/11/16)]&lt;br /&gt;
&lt;br /&gt;
Coordinated Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/nov/healthcare-fragmentation-frequency-diagnostic-tests Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, linked to high rates of hospitalization and emergency department visits as well as lower satisfaction. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients. (11/28/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/on-lok Program of All-Inclusive Care for the Elderly (PACE) cares for frail elders in the community (8/12/16)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2015/12/poor-interoperability-affects-patients.html How poor interoperability affects patients. It often requires duplicate testing that is not only costly (e.g., CT scans), but also invasive and not without risk to the patient (e.g., bronchoscopy, biopsies). (12/17/15)]&lt;br /&gt;
* [http://www.jhsph.edu/news/news-releases/2015/four-in-ten-older-adults-burdened-by-demands-of-health-care-system.html Four in Ten Older Adults Burdened by Demands of Health Care System] (10/14/15)&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2014/nov/international-survey-of-older-adults International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care (11/19/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/special-report/5-pieces-care-coordination-puzzle 5 pieces of the care coordination puzzle (6/11/14)]&lt;br /&gt;
* [http://www.healthcare-informatics.com/news-item/lack-coordinated-care-problem-older-patients-survey-says Lack of Coordinated Care is a Problem for Older Patients, Survey Says (4/3/14)]&lt;br /&gt;
* [http://medcitynews.com/2013/10/coordinated-care-critical-reducing-u-s-health-spending/ Coordinated care critical for reducing U.S. health spending  (10/8/13)]&lt;br /&gt;
&lt;br /&gt;
Managing [http://www.patientdeterminants.org/index.php?title=Health_Insight#High_Need.2C_High_Cost_Patients_Insight High Cost High Need Patients] &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? (8/7/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/care-high-need-high-cost-patients Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis (10/29/15)] &lt;br /&gt;
&lt;br /&gt;
Palliative Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/44.abstract Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities (1/2016)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2014/12/29/the-challenge-of-financing-sustainable-community-based-palliative-care-programs/ The Challenge Of Financing Sustainable Community-Based Palliative Care Programs (12/29/14)]&lt;br /&gt;
&lt;br /&gt;
Partnering With Community &amp;amp; Social Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/what-organizations-do-hospitals-partner-with-for-population-health.html What Organizations do Hospitals Partner With for Population Health? (12/5/13)]&lt;br /&gt;
* [http://thehealthcareblog.com/blog/2014/12/28/the-trouble-with-home-health-care-care-coordination/ The Trouble with Home Health Care &amp;amp; Care Coordination (12/28/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2104.abstract Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Coordinating care and communicating with specialists, hospitals, home care and social service providers. (12/2015)]&lt;br /&gt;
&lt;br /&gt;
===Health Strategy Activities ''Insight''===&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Health_Interventions_Determinants Health Strategy Activities Determinants] that can decisively affect a patient's overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
====Medical Interventions Activities ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Medical_Interventions_Determinants Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being. [[Medical Interventions]] Activities are impacted by:&lt;br /&gt;
&lt;br /&gt;
* [[Medical Intervention Access|Access]]&lt;br /&gt;
* [[Medical Intervention Diagnosis|Diagnosis]]&lt;br /&gt;
* [[Medical Intervention Efficacy|Efficacy]]&lt;br /&gt;
* Testing&lt;br /&gt;
* [[Medical Intervention Treatments|Treatments]]&lt;br /&gt;
&lt;br /&gt;
====Non-Medical Interventions Activity ''Insight''====&lt;br /&gt;
Insights into [http://www.patientdeterminants.org/index.php?title=Health_Determinants#Non-Medical_Interventions_Determinants Non-Medical Interventions Determinants] that can decisively affect a patient's overall health and well-being.&lt;br /&gt;
&lt;br /&gt;
Cardiac Rehabilitation &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/cardiac-rehab-improves-health-but-cost-and-access-issues-complicate-success/amp/ Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (8/31/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/07/18/485871530/cardiac-rehab-works-great-so-why-don-t-people-do-it Despite research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer; fewer than a third do. (7/18/16)]&lt;br /&gt;
&lt;br /&gt;
Employee Wellness Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/ Large firms (at least 200 employees) are more likely to offer Employee Wellness Programs than smaller firms (81% vs. 49%) in an effort to promote employee health and productivity and reduce health related cost (5/19/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/71.abstract Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study (1/2016)]&lt;br /&gt;
&lt;br /&gt;
Fall Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/hospitals-step-up-to-help-seniors-avoid-falls/ Hospitals Step Up To Help Seniors Avoid Falls (1/12/16)]&lt;br /&gt;
&lt;br /&gt;
Health Coaching &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/the-underrated-value-of-coaching-in-healthcare-4-thoughts-from-population-health-expert-dr-william-appelgate.html The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William Appelgate (1/25/17)]&lt;br /&gt;
&lt;br /&gt;
Legal Counseling &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/legal-regulatory-issues/ku-kansas-hospital-to-offer-free-legal-counsel-to-low-income-patients.html Kansas hospital offers free legal counsel to low-income patients (8/18/16)]&lt;br /&gt;
&lt;br /&gt;
Obesity Counseling &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://khn.org/news/few-seniors-benefitting-from-medicare-obesity-counseling/ Few Seniors Benefiting From Medicare Obesity Counseling (2/23/15)]&lt;br /&gt;
* [http://khn.org/news/seniors-obesity-counseling-benefit-goes-largely-unused/ Seniors’ Obesity-Counseling Benefit Goes Largely Unused (11/20/14)]&lt;br /&gt;
&lt;br /&gt;
Opioid Alternative&lt;br /&gt;
* [http://www.denverpost.com/2016/11/30/battling-opioid-epidemic/ How a Colorado health care provider is battling the opioid epidemic with non-pill pain treatments (11/30/16)]&lt;br /&gt;
&lt;br /&gt;
Virtual Services &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fastcompany.com/3047894/the-future-of-work/how-to-turn-your-smartphone-into-your-personal-therapist Smartphone As A Personal Therapist. Could the technology that causes so much of our stress and anxiety also be the cure? (6/30/15)]&lt;br /&gt;
&lt;br /&gt;
====Health Strategy Activity Changes &amp;amp; Adherence Insight====&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/What_Works%3F</id>
		<title>What Works?</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/What_Works%3F"/>
				<updated>2019-07-16T20:54:41Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Accountable Care Organizations - What Works? */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Everyday we get a new understanding of which [[Non-Medical Interventions]] work to impact patient health.  With most healthcare research, sites and journals primarily dedicated to which [[Medical Interventions]] work, this page will now duplicate it.  This page will begin to catalog the [[Non-Medical Interventions]] that work. While these are typically not peer reviewed articles, links are provided for people or organizations interested in further evaluating their efficacy and context to managing health.&lt;br /&gt;
&lt;br /&gt;
==[[Care Management Programs]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Behavioral_Health_.26_Primary_Care_Integration Behavioral Health &amp;amp; Primary Care Integration] - ''What Works?''=== &lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/intermountain-cuts-costs-improves-care-by-integrating-mental-health-into-primary-care Intermountain cuts costs, improves care by integrating mental health into primary care (8/25/17)]&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/alaskan-health-center-model-to-integrate-mental-health-into-primary-care Alaskan health center integration of mental health into primary careh as lowered hospital admissions and visits to the emergency room by more than a third between 2000 and 2015 (8/10/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/montefiore-health-system-sees-improvement-anxiety-depression-patients-using-valera-healths Montefiore Health System integrated mental health treatment with primary care and used the Valera Health smartphone app and platform to improve treatment of anxiety and depression. (5/24/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/integrating-behavioral-and-primary-care-can-improve-care-quality-study-finds.html Patients who received integrated primary care and behavioral health treatments had fewer emergency department visits, hospital admissions, ambulatory care sensitive visits and primary care physician encounters. (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/8/1487.abstract UCLA Health combines primary care with behavioral health to reduce emergency room use by 13% for patients in program. (8/16/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/newsletters/transforming-care/2016/june/profile Care Oregon has a Health Resilience Specialist program that increased behavioral health visits by 16 percent, while E.D. visits and hospitalizations dropped by roughly 20 percent. (6/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/ny-health-system-s-collaborative-care-program-helps-patients-battle-depression NY health system's collaborative care program helps patients battle depression through screening and outreach (5/25/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/04/intermountain-behavioral-health-primary-care/ It costs Intermountain Health’s SelectHealth insurance subsidiary $22 per member per year to embed mental health workers in primary care clinics and processes, and SelectHealth gets an annual return on investment of $115 per member. (4/12/16)]&lt;br /&gt;
&lt;br /&gt;
Binge Eating Disorder (BED) &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.theatlantic.com/health/archive/2017/08/how-therapy-can-cure-overeating/537537/ Nearly 80 percent of patients abstain from bingeing after 20 sessions of cognitive behavioral therapy (8/23/17)]&lt;br /&gt;
Dementia Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/613.abstract?rss=1 A memory care clinic for older adults suffering from dementia and depression generates an annual net cost savings of up to $2,856 per patient (4/2014)]&lt;br /&gt;
Suicide Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1672 Zero Suicide, a model for better identification and treatment of patients at risk for suicide. (6/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Chronic_Care_Management Chronic Care Management] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
&lt;br /&gt;
Asthma &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/value-based-care-alone-wont-reduce-health-spending-and-improve-patient-outcomes Nemours Children’s Health System pilot program to improve asthma outcomes saw a 60% reduction of asthma-related ER visits, a 44% reduction in asthma-related hospital admissions, and more than a $2,100 reduction in annual medical costs per child after three years. (6/16/17)]&lt;br /&gt;
* [http://mobihealthnews.com/47153/smart-inhaler-boosts-medication-adherence-144-percent-in-small-study/ Smart inhaler boosts medication adherence 144 percent in small study (9/30/15)]&lt;br /&gt;
&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jama/fullarticle/2630810 Study of Memorial Sloan Kettering Cancer Center cancer patients demonstrated a Patient Reported Outcome (PRO) group had a better quality of life and lived an average of 5.2 months longer than an randomly assigned usual care group. The PRO group self-report 12 common symptoms at and between visits via a web-based PRO questionnaire platform. (6/4/17)]&lt;br /&gt;
&lt;br /&gt;
Elderly &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.rand.org/news/press/2014/03/17/index1.html Improving Continuity of Care for Elderly Patients with Chronic Diseases Cuts Costs and Complications (3/17/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.full Medicare Coordinated Care Demonstration reduced hospitalizations by 8–33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches were: telephone calls to patients; meeting with providers; acting as a communications hub for providers; delivering education to patients; providing medication management; and comprehensive transitional care after hospitalizations. (6/2012)]&lt;br /&gt;
&lt;br /&gt;
End-Stage Renal Disease &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://khn.org/news/preventive-care-specialists-key-to-controlling-kidney-failure-treatment-costs/amp/ Preventive Care, Specialists Key To Controlling Kidney Failure Treatment Costs (8/22/16)]&lt;br /&gt;
&lt;br /&gt;
Hypertension &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/6-ways-to-improve-hypertension-control.html 6 best practices for managing hypertension under population health models (5/27/14)]&lt;br /&gt;
&lt;br /&gt;
Pediatrics&lt;br /&gt;
* [https://healthitanalytics.com/news/chronic-care-management-improves-pediatric-outcomes-by-20 Chronic care management program at Cincinnati Children's Hospital helped care teams improve pediatric outcomes for certain conditions by up to 20 percent. (2/28/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Episode_Management Episode Management] - ''What Works?''===&lt;br /&gt;
* [https://healthpayerintelligence.com/news/population-health-approach-to-prenatal-care-cuts-payer-costs Taking a population health approach to prenatal care and high-risk pregnancies can cut costs for payers and improve outcomes, AHIP says. (4/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/how-10-more-hospitals-upgraded-their-total-joint-replacement-programs-and-saved-300k.html How 10 more hospitals upgraded their total joint replacement programs and saved $300k+ (11/4/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/bpci-hospitals-drove-down-medicare-payments-for-lower-extremity-joint-replacement-by-1-166.html BPCI hospitals drove down Medicare payments for lower extremity joint replacement by $1,166 (9/20/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2016/aug/baptist-health-bundled-payment Baptist Health System generate $6.1 million in savings on joint replacement with a bundled payment program that creates incentives for physicians, hospitals, and post-acute care providers to collaborate to drive down costs and improve quality. (8/3/16)]&lt;br /&gt;
* [http://www.ihatoday.org/uploadDocs/1/raisingthebar2014.pdf Illinois hospitals participating in the Hospital Engagement Network (HEN) from January 2012 through March 2014 prevented 15,887 patient harms, with an associated cost savings of $161.8 million. (10/2014)]&lt;br /&gt;
&lt;br /&gt;
Navigators &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.healthcareitnews.com/news/patient-navigators-track-social-determinants-through-ehrs-positive-results 'Patient navigators' track social determinants through EHRs with positive results. 98/7/17)] Kaiser uses a [http://res.cloudinary.com/bdy4ger4/image/upload/v1499804346/Patient_Questionnaire_for_OPB_ckqqld.pdf Current Life Situation Form]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-patient-centered-care-helped-arkansas-hospital-cut-readmissions-by-90 CHI St. Vincent's readmission rate fell by 90%, due largely to the heightened scrutiny of individual patients' processes of care and needs such as transportation gaps, lack of social support or financial obstacles. (11/25/15)]&lt;br /&gt;
* [http://www3.ccc.uab.edu/index.php/newsroom/preliminary-uab-study-shows-dramatic-trend-of-cost-savings-in-lay-navigation-program-for-cancer-patients/ Preliminary UAB study shows dramatic trend of cost savings in lay navigation program for cancer patients. (7/7/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-navigators-reduced-readmissions-overuse-er-pilot-program 'Patient navigators' reduced readmissions, overuse of ER in pilot program (1/27/15)]&lt;br /&gt;
&lt;br /&gt;
Patient Education about Procedures &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/educate-patients-and-they-have-better-surgical-outcomes-study-finds Informed patients have better surgical outcomes. Only 36% of patients met the criteria for an informed patient-centered decision. Informed patients were significantly more likely to report being extremely satisfied with their treatment. (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#ER_Case_Management ER Case Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/presbyterian-healthcare-services-finds-success-patient-navigation Presbyterian Healthcare Services patient navigation program screens all emergency department patients, they transfer non-emergency patients to a more appropriate setting, like an urgent care center or primary care facility. Program helped drop ER overuse, improved patient engagement and decreased in treatment or diagnosis delays. (3/21/17)]&lt;br /&gt;
* [http://m.startribune.com/state-deploys-powerful-tool-to-rein-in-medicaid-waste-costly-er-use/404506396/ Minnesota system flags patients who visited hospital ERs as much as 150 times in a single year and people who routinely hop from one physician to the next searching for prescription painkillers. By limiting these “high use” patients to a single primary care provider, along with a hospital and one pharmacy, the program is saving taxpayers at least $7 million a year in unnecessary medical costs (12/3/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/kaiser-permanente-s-takes-new-approach-to-redirect-er-superusers Patient Navigators in the ER helps reduce returns by 55% among the 254 patients that navigators are managing. Navigators help with non-medical problems sucah as housing, food insecurity and lack of transportation. (6/17/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/frequent-flyer-er-visits-drop-coordinated-care 'Frequent flyer' ER visits drop with coordinated care (7/11/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Exercise_.26_Nutrition Exercise &amp;amp; Nutrition] - ''What Works?'' ===&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/diabetes-prevention-how-one-ymca-program-is-changing-the-game.html A small diabetes prevention program based out of a YMCA in Indianapolis (3/31/16)]&lt;br /&gt;
* [http://www.reuters.com/article/us-health-diabetes-prevention-idUSKCN0PN2K720150713 Organized programs help prevent or delay diabetes (7/13/15)]&lt;br /&gt;
* [http://circ.ahajournals.org/content/125/9/1157.short Participants in a lifestyle intervention of reduced calorie, low-fat diet of conventional foods and 150 min/wk of physical activity (typically brisk walking), with the goal of losing 7% of initial weight. After an average of 2.8 years, participants in the lifestyle intervention lost 5.6 kg in comparison to 0.1 kg in the placebo group. The risk of the lifestyle group developing type 2 diabetes was reduced by 58% in comparison with placebo group. (3/5/12)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Health_Coaching Health Coaching] - ''What Works?''===&lt;br /&gt;
Care Goal Setting and Motivational Interviewing &lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-virtas-monitoring-app-plus-low-carb-diet-reverses-diabetes-progression Monitoring app, health coaching plus low-carb diet reverses diabetes progression by lowering average HbA1c from 7.6% to 6.3% and weight reduction of 12% (2/8/18)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/johns-hopkins-study-coaching-app-sweetch-can-increase-weight-loss-activity-prediabetes Johns Hopkins study: coaching app can increase weight loss, activity in prediabetes patients (3/8/18)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481661/ Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction. Participants lost an average of 3.23% total body weight (TBW) at 4 months of coaching. (6/8/17)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/oby.21723/full Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. (1/26/17)]&lt;br /&gt;
* [http://www.annfammed.org/content/14/3/200.full Health coaching is effective for chronic disease self-management in the primary care safety-net setting. Most clinical outcomes improvements persisted 1 year after the completion of the health coaching intervention. (5/2016)]&lt;br /&gt;
* [http://medcitynews.com/2014/03/patient-navigators-helped-diabetics-improve-blood-glucose-control-32-cleveland-clinic-pilot/ Diabetics + patient navigators improved blood glucose control by 32% in Cleveland Clinic pilot (3/18/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2016/05/your-patient-should-get-a-health-coach-heres-why.html Health coaching improves the management of chronic diseases. It is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care. (5/15/16)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=The+effects+of+health+coaching+on+adult+patients+with+chronic+diseases:+a+systematic+review Health coaching improves the management of chronic diseases (11/2014)]&lt;br /&gt;
Diabetes Prevention&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/417.abstract YMCA Of The USA Diabetes Prevention Program saved $278 per member per quarter during the first three years of the intervention period. Nine fewer ED visits per 1,000 participants per quarter. (3/2017)]&lt;br /&gt;
&lt;br /&gt;
Virtual Programs&lt;br /&gt;
* [http://mhealth.jmir.org/2017/6/e80/ App-based health coaching program demonstrated an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% of the participants achieved a clinically significant weight loss of 5% (7/2017)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-shows-seniors-risk-diabetes-and-heart-disease-lose-weight-reduce-healthcare-costs Digital behavioral health coaching program from Omada Health has been shown to reduce overweight and obese seniors' risk of developing type 2 diabetes and heart disease by helping them lose weight and adopt healthier behaviors. (10/13/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-health-coaching-app-nooms-weight-loss-outcomes-comparable-traditional-diabetes 64% of the 43 overweight or obese adult participants, with a diagnosis of prediabetes, people using health coaching app during 24 week program lost more than 5 percent of their weight, which is comparable to the Centers for Disease Control’s findings from traditional diabetes prevention programs. (9/8/16)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-canary-health%E2%80%99s-digital-diabetes-management-program-helpful-across-five-key Digital health diabetes program that help people with diabetes self-manage their health through online workshops, coaching, and medication adherence and emotional support showed improvement across five key indicators – blood sugar levels, medication adherence and exercise all improved, hypoglycemic symptoms decreased in frequency, and depression symptoms improved. (8/31/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mhn-2016-how-ochsner-used-connected-devices-text-messages-bring-two-thirds-hypertension  Ochsner used connected devices, text messages, health coaching and medication management assistance to bring two-thirds of hypertension patients within range (6/22/16)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#High_Need_High_Cost High Need High Cost] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/441.abstract Initiative to reduce avoidable hospitalizations among nursing facility residents reduced per resident average of $60–$2,248 for all-cause hospitalizations and by $98–$577 for potentially avoidable hospitalizations. (3/2017)]&lt;br /&gt;
* [http://khn.org/news/tackling-patients-social-problems-can-cut-health-costs/amp/ Houston’s Patient Care Intervention Center program has reduce patient costs in program by 83% and hospital visits by 70%. The program developed by the Camden Coalition led by Dr. Jeffrey Brenner uses social workers who seek out high-need-high-cost patients to address social needs such as securing stable housing. (1/23/17)]&lt;br /&gt;
* [http://m.startribune.com/apartment-job-it-s-just-what-the-doctor-ordered/408873365/ Hennepin Health's outreach efforts helps clients find a job or an apartment — the project has shown it can improve patients’ health while saving money and greatly reducing the number of times they turn up at the ER in crisis. (12/30/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/coordinated-care-clinic-cuts-super-user-hospitalizations-by-a-quarter A strategy focused on team-based care and listening to “super-users” helped a Florida health system cut hospitalizations of such patients by a quarter while also driving down uninsured admissions (8/24/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/care-coordinators-work-high-needs-patients-medical-practices  Intensive Outpatient Care Program (IOCP), which embeds care coordinators in medical practices. Care coordinators work with high-needs patients in medical practice where patients, emergency room visits declined 59 percent and admissions declined 29 percent. (8/22/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/project-echo Complex Care Initiative: Building Capacity to Help “Superutilizers” in Underserved Communities. Number of hospitalizations among participants fell by 27% and emergency department visits dropped by 32%. (8/9/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2014/aug/high-need-high-cost-patients  Study compares the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. (8/7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/intensive-care-coordination-saves-14m-super-user-costs 'Intensive care coordination' saves $14M in superuser costs (6/27/16)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/02/02/using-the-intensive-outpatient-care-program-to-lower-costs-and-improve-care-for-high-cost-patients/ Intensive Outpatient Care Program (IOCP) in commercial populations show a reduction in costs among the medically complex by up to 20 percent. (2/2/16)]&lt;br /&gt;
* [http://www.usatoday.com/story/news/nation/2014/09/16/focus-on-super-utilizers-cuts-costs/14648069/ Programs focus on high-risk patients to reduce spending (9/16/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/31/6/1156.abstract Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients (6/2012)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Home_Care Home Care] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/member-engagement/paramedic-house-calls-help-blue-cross-and-blue-shield-new-mexico-reduce-er-usage How paramedics helped Blue Cross Blue Shield of New Mexico reduce ER usage, readmissions (8/9/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/aug/hospital-at-home Hospital at Home Model: Bringing hospital-level care to the patient results in lower readmissions, better outcomes and lower costs. 92% of patients offered the service took it. It has high patient satisfaction, as patients remained close to their support networks and had less disruption to their lives. (8/22/16)]&lt;br /&gt;
* [http://www.healthleadersmedia.com/quality/front-loaded-home-care-and-office-visits-may-reduce-heart-failure-readmissions A new study finds that front-loaded home care combined with physician office visits shows promise in reducing HF readmissions. (8/11/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-at-home-model-gains-steam-as-mt-sinai-program-cuts-costs-readmissions Mt. Sinai Hospital's Mobile Acute Care Team (MACT) program delivers hospital-quality home care for patients who are at high risk for readmission. The pilot program cut costs by nearly 20 percent (6/6/16)]&lt;br /&gt;
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Aging in Place &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/sep/sweden-senior-alert-case-study Senior Alert program resulting in 30% reduction in falls, decline in pressure ulcers from 14.3% to 9.4%, and a decline in the incidence of weight losses greater than 5 percent of total body weight from 14.3% of patients to 12.5%. (9/15/16)]&lt;br /&gt;
* [http://khn.org/news/study-finds-benefits-when-seniors-call-shots-to-help-them/amp/ Aging in place program asks low-income seniors with disabilities how their lives at home could be better. At the end of the program, 75% of participants were able to perform more daily activities than they could before and symptoms of depression also improved. (9/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/minnesota-health-systems-telehealth-program-seniors-leads-better-outcomes-engagement Telehealth program for seniors leads to better outcomes (86.7% reduction in realized versus expected hospitalization rates) and better engagement (94% of patients interact with the technology and report in their vital signs every day, compared to less than 25% percent in a 2014 national survey of patients in telehealth programs). (8/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/9/1558.abstract?=right Home-Based Care Program Reduces Disability And Promotes Aging In Place. 75% of participants improved their performance of activities of daily living (ADLs)after completing the five-month program. (9/2016)]&lt;br /&gt;
* [http://www.pbs.org/newshour/updates/coordinated-care-gives-patients-freedom-stay-home/ How coordinated care gives patients the freedom to stay at home (7/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2013/11/spain-offers-telemedicine-connect-elderly-population-medical-care/ The Basque region of Spain saved $55 million and eliminated 55,000 visits with a telemedicine program aimed at the elderly. (11/15/13)]&lt;br /&gt;
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Falls Prevention &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/6/971.abstract In the three years after The LIFT (Living Independently and Falls-free Together) Wellness Program, that included a comprehensive in-home assessment by a registered nurse, participants had a 33% lower incidence of claims for long-term care services and supports (6/2015)]&lt;br /&gt;
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Home-Based Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/overview-home-based-primary-care Medicare’s Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program (6/7/17)]&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/425.short Study finds 5 innovative Home Visit models associated with reductions in costs, hospitalizations, and emergency department use (3/2017)]&lt;br /&gt;
* Home Visits - [http://www.fiercehealthcare.com/healthcare/hospital-workers-visit-patient-homes-to-reduce-er-visits?utm_source=feedly Children's Hospital of Philadelphia (CHOP) sends home visitors to high-risk asthma patients in inner-city Philadelphia (7/29/13)]&lt;br /&gt;
*  [http://content.healthaffairs.org/content/35/1/28.abstract House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care (1/2016)]&lt;br /&gt;
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Medical House Calls &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/case-studies/2016/jul/medstar-washington-hospital-center Medical House Call Program reduced Medicare spending by 20 percent relative to expected spending for that population ($4,060 vs. $5,076) (7/27/16)]&lt;br /&gt;
* [http://khn.org/news/doctors-house-calls-saving-money-for-medicare/ Doctors’ house calls saving Medicare an average of almost $13,600 for each patient in a pilot project. (5/23/16)]&lt;br /&gt;
* [http://www.npr.org/2015/11/08/448406540/doctor-treats-homebound-patients-often-unseen-even-by-neighbors Doctor Treats Homebound Patients, Often Unseen Even By Neighbors (11/8/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/12/2138.abstract Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits (12/2015)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2014/08/07/338393136/house-calls-keep-people-out-of-nursing-homes-and-save-money House Calls Keep People Out Of Nursing Homes And Save Money (8/7/14)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medical_Home Medical Home] - ''What Works?''===&lt;br /&gt;
Ensuring followup on referrals and recommended preventive screening completed based on [https://www.uspreventiveservicestaskforce.org/BrowseRec/Index USPSTF] recommendations.&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/medical-home-model-improves-care-but-not-costs-among-safety-net-providers.html Medical home model improves care, but not costs among safety-net providers (6/27/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/blog/2017/mar/review-of-medical-homes Review of Medical Homes Shows Reduction in Spending for High-Risk Patients, But Design and Implementation Matter (3/28/17)]&lt;br /&gt;
* [http://www.startribune.com/health-care-homes-save-minnesota-1-billion/368187001/ Health care 'homes' save Minnesota $1 billion (2/9/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/11/1985.abstract A “medical village” of providers and community-based resources for patients with diabetes, asthma, and congestive heart failure reduced ED visits by 29.7% percent and hospitalizations by 28.5% (11/2014)]&lt;br /&gt;
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Care Gaps &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://www.healthcareitnews.com/news/population-health-done-three-ways?single-page=true 3 Healthcare systems explain the technology, process and grit they used to close care gaps needed to improve patient care. (11/3/15)]&lt;br /&gt;
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Care Plan Development &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1627.abstract?rss=1 Moving paradigm from determining “what is the matter?” to discovering “what matters to you?” improves health outcomes (9/2014)]&lt;br /&gt;
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Oncology &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/433.abstract?=right Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending (3/2017)]&lt;br /&gt;
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Preventive Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.cdc.gov/prevention/index.html If everyone in the country received recommended clinical care, we could save over 100,000 lives a year. (5/31/17)]&lt;br /&gt;
* [http://m.startribune.com/don-t-smoke-get-your-shots-minnesota-researchers-say-in-influential-study/410159785/ Comparing 28 recommended preventive services, HealthPartners researchers found that tobacco counseling and pediatric immunizations outranked the others in cost-effectiveness and the potential to save lives. (1/9/17)]&lt;br /&gt;
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Patient Centered Medical Homes (PCMH) &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/report-pcmh-programs-cut-costs-improve-quality-but-collaboration-key-to-success PCMH programs cut costs and improve quality. Collaboration is the key to their success (7/11/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/patient-centered-medical-homes-systematic-differences A study of 11 PCMH initiatives showed little improvement in costs, utilization, or quality. (3/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/bcbs-michigan-marks-further-expansion-pcmh-model Blue Cross Blue Shield of Michigan's Patient Centered Medical Home (PCMH) program for primary care practices reduced medical costs by $427 million, in part due to lower healthcare utilization. 2016 data show BCBSM-designated PCMH practices had a 15.2% lower rate of adult emergency department visits and 21.4% lower rate of hospital admissions for certain conditions. (9/13/16)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/study-patient-centered-medical-homes-reduce-er-visits-among-chronically-ill/ Study: Patient-centered medical homes reduce ER visits among chronically ill (9/3/14)]&lt;br /&gt;
* [https://ehrintelligence.com/news/pcmhs-produce-21-lower-healthcare-costs-for-chronically-ill/ Patient-centered medical homes (PCMH) can cut more than 20% off the treatment cost for a chronically ill patient (7/24/13)]&lt;br /&gt;
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Primary Care Practices &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/study-primary-care-continuity-could-help-reduce-hospital-admissions.html Patients with high continuity of care were admitted to the hospital 12.49% fewer times than those with low continuity of care (2/2/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/greater-primary-care-involvement-leads-to-lower-end-of-life-care-costs-study-finds.html Patients who resided in regions with the most primary care involvement accrued roughly $4,000 less in Medicare spending in their last two years of life, spent nearly 1.4 fewer days in the intensive care unit in their last six months of life and were less likely to be enrolled in hospice. (1/9/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/study-continuity-care-reduces-risk-ed-visits Seniors that consistently see the same physician in an outpatient setting are 20% less likely to go to the emergency department (8/25/16)]&lt;br /&gt;
* [https://www.bostonglobe.com/business/2015/05/03/iora-health-pioneers-new-primary-care-model/kc7V4W5V8OJ0gxFqY4zBrK/story.html Primary Care Physicians deliver 12% lower healthcare costs, 37% lower hospitalization at one site (5/4/2015)]&lt;br /&gt;
* [http://www.annfammed.org/content/13/3/206 Increasing family physician comprehensiveness of care is associated with decreasing Medicare costs and hospitalizations. (5/2015)]&lt;br /&gt;
* [http://www.prnewswire.com/news-releases/new-primary-care-model-delivers-20-percent-lower-overall-healthcare-costs-increases-patient-satisfaction-and-delivers-better-care-300021116.html Primary Care Physicians deliver 20% lower overall healthcare costs, increase patient satisfaction (1/15/2015)]&lt;br /&gt;
* [http://medcitynews.com/2014/09/how-an-aco-led-by-doctors-helped-cut-the-cost-of-care-in-texas-town/ How an ACO led by doctors helped cut the cost of care in Texas town (9/24/14)]&lt;br /&gt;
* [http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf Evidence shows that primary care helps prevent illness and death (2005).]&lt;br /&gt;
Virtual Primary Care &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/population-health-lessons-from-banner-health-s-telemedicine-program When Banner Health launched its iCare telemedicine program, patients didn't use it because it required them to replace their primary care physician. Once they changed that rule, very few patients have left the program voluntarily, and Banner Health saw costs per beneficiary drop by 27% while hospitalizations were reduced by 45%. (12/5/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Medication_Management Medication Management] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/3-ways-to-improve-patients-medication-adherence 3 ways to improve patients’ medication adherence (8/25/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/childrens-health-uses-ingestible-sensor-improve-adherence-adolescent-transplant-patients Children's Health uses ingestible sensor to improve adherence in adolescent transplant patients (2/22/17)]&lt;br /&gt;
* [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170905 Pharmacogenetic testing of polypharmacy home health patients aged 50 and older considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare. (2/2/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/walgreens-pill-reminder-activity-tracking-both-improved-medication-adherence-study Walgreens pill reminder, activity tracking both improved medication adherence in study (9/12/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/finance/study-quantifies-healthcare-costs-for-medication-adherence-and-non-adherence Patients with multiple medical conditions who adhered to their prescription schedules who had diabetes saved $5,341 annually in medical costs; those who had hypertension saved $4,423, while those who had high cholesterol saved $2,081  (8/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/interventions-to-keep-chronic-illness-patients-on-their-meds-could-save-billions.html  Interventions to keep chronic illness patients on their meds could save billions (8/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2016/08/medacheck-double-medication-adherence/ The study of 35 patients aged 12-20 with a baseline medication adherence of 42-43%. After 6 months, those with mobile app only increased to 60% and those with the app and reminder calls 85.4% (8/22/16)]&lt;br /&gt;
* [http://khn.org/news/syncing-up-drug-refills-a-way-to-get-patients-to-take-their-medicine/amp/ Syncing Up Drug Refills: A Way To Get Patients To Take Their Medicine (8/8/16)]&lt;br /&gt;
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* [https://ehrintelligence.com/news/how-pharmacy-patient-engagement-boosted-medication-adherence Study shows that the use of a high-touch pharmacy patient engagement system made patients 2.57 times more likely to stay adherent to their medications. (10/27/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/8/1444.abstract Pennsylvania Pharmacist Project significantly improved adherence for all medication classes, from 4.8% for oral diabetes medications to 3.1% for beta-blockers. It also helped reduce per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). (8/2014)]&lt;br /&gt;
During Care Transitions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/study-medication-reconciliation-programs-halve-hospital-readmissions-6.html Hospital readmission decreased 50 percent when pharmacists reviewed patients' medication regimens and provided counseling during transitions from hospital to home (7/15/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1222.abstract Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs. The program saved $2 for every $1 spent. (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/prescription-assistance-programs-lead-to-drop-er-visits Prescription assistance programs lead to drop in ER visits (4/7/16)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Palliative_Care Palliative Care] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/pre-hospice-saves-money-by-keeping-people-at-home-near-the-end-of-life/amp/ ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life (3/27/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/community-based-palliative-care-may-decrease-ed-visits-study-finds.html Dying patients who received community-based palliative care visited the emergency department half as much in their last year of life, according to a study. (2/22/17)]&lt;br /&gt;
* [http://www.managedcaremag.com/archives/2016/7/palliative-care-improves-quality-care-lowers-costs Aetna’s Compassionate Care Program resulted in improved member satisfaction, an 81% decrease in inpatient days, and net savings of $12,000 per participating member (7/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/early-palliative-care-can-save-money-reduce-patient-stay-hospital Early palliative care can save money, reduce patient stay in hospital (7/1/15)]&lt;br /&gt;
* [http://healthleadersmedia.com/page-3/LED-283076/Hospitals-Opting-for-Palliative-Care University of Rochester Medical Centers in 2007 found the palliative care intervention saved about 1,400 ICU patient days, at an average of about $450 a day. (8/6/12)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Care_Management_Programs#Transitional_Care_Management Transitional Care Management] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/it/christiana-care-uses-analytics-for-better-care-coordination-post-discharge Christiana uses its CareLink CareNow infrastructure to help coordinating care for close to 75,000 Medicare beneficiaries beyond discharge. The system has seen a 30% reduction in 90-day readmission rates. (6/19/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/involving-patient-s-family-in-discharge-process-linked-to-25-reduction-in-hospital-readmissions.html Involving patient's family in discharge process linked to 25% reduction in hospital readmissions (4/4/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/a-focused-primary-care-visit-after-hospital-stay-lowers-risk-readmission Patients who had one or more primary care visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician. (11/22/16)]&lt;br /&gt;
* [http://khn.org/news/gaps-in-care-persist-during-transition-from-hospital-to-home/amp/ San Diego County program saved Medicare an estimated $13.8 million (reduced hospital readmissions) over a two-year period with a care transition program that sends nurses and social workers into homes to ensure transitions go smoothly, checking medications one by one, making sure they know how to take them, walking through the house looking things that could cause a fall, asking about caregivers to help with bathing and dressing. (9/6/16)]&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20151205/MAGAZINE/312059995 Hospitals with the lowest readmission rates. Roper St. Francis Healthcare's Care Transitions Program helps elderly patients recognize symptoms of health decline and assists them in managing their medications.  University of Colorado Health's Memorial Hospital assigns a case manager to follow up with patients at risk of heart failure, stroke, pneumonia or heart attack. Hospital for Special Surgery in New York City is developing a mobile application that will allow staff to interact with patients remotely post-discharge. (12/5/15)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-intervention-cuts-readmissions-for-patients-at-risk-for-delirium-suicide Hospital intervention cuts readmissions for patients at risk for delirium, suicide (7/1/15)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/9/1531.abstract?rss=1 Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses (9/2014)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/10-recent-stories-studies-on-reducing-readmissions.html 10 stories, studies on reducing readmissions (8/18/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/how-ritz-carlton-helped-one-hospital-reduce-readmissions-to-74-percent How Ritz-Carlton helped one hospital reduce readmissions to .74 percent for knee and hip replacements (7/15/14)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=1868538 JAMA Studies 18 Activities That Are Preventing 30-Day Hospital Readmissions (7/2014)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/beth-israel-deaconess-lowers-readmissions-post-discharge-program Beth Israel Deaconess lowers readmissions with post-discharge program (4/4/14)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/study-social-work-interventions-reduce-readmission-rates-half/2013-07-05?utm_source=rss&amp;amp;utm_medium=rss study] demonstrated high risk patients being discharged from the hospital that receive social work interventions reduce readmission rates to 7% as compared to the 15 percent readmission rate for the control group--patients discharged (7/5/13)&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/reduce-readmissions-by-giving-transitional-care-a-personal-touch Three nonprofit hospitals in the Bronx, N.Y. significantly dropped readmission rates thanks to personal contact with patients before and after discharge (6/28/13)]&lt;br /&gt;
* A [http://www.fiercehealthcare.com/story/hospital-community-collaboration-reduced-readmissions-4570/2013-05-30?utm_source=rss&amp;amp;utm_medium=rss collaborative initiative involving 83 hospitals and 93 community partners in Minnesota] saw 4,570 fewer avoidable hospital readmissions over 24 months, saving more than $40 million by using comprehensive discharge planning, medication management, patient engagement, transition care support, and transition communications. (5/30/13)&lt;br /&gt;
* [http://circoutcomes.ahajournals.org/content/6/4/444.full Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure (5/15/13)]&lt;br /&gt;
Post Surgical Follow-up &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-app-based-visits-seem-viable-post-surgical-follow-ups App-based visits seem viable for post-surgical follow-ups (3/23/17)]&lt;br /&gt;
&lt;br /&gt;
==[[Health Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Consumer_Diagnostic_Services Consumer Diagnostic Services] - ''What Works?''===&lt;br /&gt;
DNA Testing &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Convenient_Access Convenient Access] - ''What Works?''===&lt;br /&gt;
24x7 Managing Health Services &amp;lt;br&amp;gt;&lt;br /&gt;
Hot Spotters&lt;br /&gt;
* [http://www.newyorker.com/magazine/2011/01/24/the-hot-spotters Dr. Jeffrey Brenner analyzed data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million. Dr. Brenner secured funding and approvals to begin a Wellness Program at Northgate II tower that housed the high cost high need patients. (1/24/11)]&lt;br /&gt;
&lt;br /&gt;
Mental Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://apps.bostonglobe.com/spotlight/the-desperate-and-the-dead/series/solutions/ San Antonio built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless that resembles a community college. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/11/16)]&lt;br /&gt;
* [http://www.khi.org/news/article/leader-of-kck-mental-health-center-touts-savings-from-care Mental health crisis center saved $6 million last year by stabilizing people in crisis who otherwise would have ended up in state hospitals, local emergency rooms or jails and prisons. (11/15/16)]&lt;br /&gt;
Same Day Appointments &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/01/toby-cosgrove-cleveland-clinic-felt-urgency-day-appointments/ In 2016, Cleveland Clinic had 1.3 million same-day appointments. CEO Toby Cosgrove stated that every patient who calls the Clinic is asked whether he or she would like to see a doctor that same day. 98% of the people who asked to be seen the same day was successful in doing so. (1/10/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Education Education] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/west-virginia-hospital-system-sees-readmission-reductions-patient-education-initiative Charleston Area Medical Center was able to reduce readmission rates for Congestive Heart Failure by over 22% and COPD by almost 30% with educational videos to help patients self-manage their health. (2/9/17)]&lt;br /&gt;
* [http://www.choosingwisely.org/doctor-patient-lists/ '''Choosing Wisely'''] provides decision making education for physicians and patients on over 135 tests and treatments that they say are overused or inappropriate.&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/holistic-education-led-to-dramatic-improvements-for-diabetes-patients Holistic education led to dramatic improvements for diabetes patients (8/11/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/south-carolina-initiative-cuts-readmissions-through-cooperation-education South Carolina initiative cuts readmissions through cooperation, education (7/8/15)]&lt;br /&gt;
&lt;br /&gt;
Behavioral&lt;br /&gt;
* [http://oregonstate.edu/ua/ncs/archives/2015/nov/changing-habits-improve-health-new-study-indicates-behavior-changes-work More than 80 percent of the randomized clinical trials that included a behavioral intervention reported a significant improvement for the targeted behavior and a significant physiological impact such a reduction in weight or blood pressure. (11/10/15)]&lt;br /&gt;
&lt;br /&gt;
Self-Administer &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care Parkland Health &amp;amp; Hospital System trained over 1,000 patients to self-administer IV antibiotics in their homes. In the first four years of this effort, these patients experienced a 47% lower 30-day hospital-readmission rate than those receiving treatments in an outpatient facility while the mortality rates of both groups were similar. (6/2/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Decision_Making Decision Making] - ''What Works?''===&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/patient-engagement/shared-decision-making-improves-outcomes-satisfaction-for-orthopedic-patients Study: Shared decision-making boosts patient outcomes, leads to higher satisfaction rates (3/15/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Home Home] - ''What Works?''===&lt;br /&gt;
Home Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/home-visits-help-new-parents-overcome-tough-histories-raise-healthy-children/amp/ Home Visits Help New Parents Overcome Tough Histories, Raise Healthy Children (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
Housing and Healthcare Integration &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/new-integrated-model-care-for-seniors-lowers-hospitalizations-readmissions-emergency Clinical outcomes of an integrated model of care for frail seniors that bridges housing and healthcare. 50% lower inpatient hospitalization rates, 80% lower readmission rates, 15% lower rate of emergency department use (3/23/17)]&lt;br /&gt;
Medication Reconciliation &amp;lt;br&amp;gt;&lt;br /&gt;
Paramedic Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1111/jgs.14484/full Only 22% of Paramedic responses required transport; 78% were evaluated and treated in the home. Paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals’ homes. (8-30-16)]&lt;br /&gt;
Passive Data Analysis &amp;lt;br&amp;gt;&lt;br /&gt;
Passive Data Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
*  [http://www.cnn.com/2014/08/25/tech/innovation/alzheimers-smart-home/ Sensors let Alzheimer's patients stay at home, safely (10/12/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Therapeutic_Services Therapeutic Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
Behavioral Health&amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/05/valera-health-app-shows-boost-in-engagement-from-patients-with-depression-anxiety/ Study using Valera Health app shows boost in engagement from patients with depression, anxiety (5/25/17)]&lt;br /&gt;
* [http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs/ 8-week behavioral health intervention delivered by a licensed clinical social worker and a behavioral coach via phone or secure video helped reduce all-cause hospital admissions in 6 months (2/27/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/06/telepsychiatry-reduces-wait-times-psyciatric-exams-4-days-10-hours-sc-hospital/ In rural SC, telepsychiatry cuts wait times for mental health exams from 4 days to 10 hours (6/27/14)]&lt;br /&gt;
* [http://khn.org/news/telephone-therapy-helps-older-people-in-underserved-rural-areas-study-finds/ Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds (8/5/15)]&lt;br /&gt;
Cancer &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/study-real-time-symptom-reporting-helps-cancer-patients-live-longer Study: Real-time electronic symptom reporting helps cancer patients live longer (6/5/17)]&lt;br /&gt;
Cardiac Rehab &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/veterans-respond-well-home-based-cardiac-rehab-app-va-study-shows Veterans respond well to home-based cardiac rehab app, VA study shows. 80% retention rate 90 days later. 20% improvement in functional capacity and a reduced systolic blood pressure of 10 mmHg from baseline. Considering low turnout for other cardiac rehab programs, the investigators were impressed with the apps response. (4/6/17)] &lt;br /&gt;
* [http://www.eurekalert.org/pub_releases/2016-03/acoc-dht032216.php Digital health tool helps cardiac rehab patients shed more pounds (3/23/16)]&lt;br /&gt;
* [http://newsnetwork.mayoclinic.org/discussion/cardiac-rehab-patients-who-use-smartphone-app-recover-better-mayo-clinic-research-shows Mayo Research Shows Cardiac Rehab Patients Who Use Smartphone App Recover Better (3/29/14)]&lt;br /&gt;
&lt;br /&gt;
Depression &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.wsj.com/articles/to-treat-depression-try-a-digital-therapist-1498227092 To Treat Depression, Try a Digital Therapist. Studies suggest online tools do just as well—if not better—than traditional therapy for some patients (6/23/17)]&lt;br /&gt;
&lt;br /&gt;
Diabetes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.nytimes.com/2017/04/11/well/live/tackling-weight-loss-and-diabetes-with-video-chats.html Virta Health program to prevent, control or reverse diabetes uses video chat with remote Virta physician who consults with primary care physician, reviews blood tests and medical history and makes diet and drug recommendations. Study of 241 Type 2 diabetics found that 56% lowered their blood sugar to non-diabetic levels in 10 weeks. (4/11/17)] &lt;br /&gt;
* [http://www.mobihealthnews.com/content/one-drop-shares-data-showing-app-reduces-a1c-1-percent One Drop Mobile analyzed at least two A1C values in their patient app between two and twelve months apart. The average starting A1C was 8.2 percent, while the average second A1C was 7.2 percent, which represents a one percent reduction. (4/3/17)]&lt;br /&gt;
* [https://www.imedicalapps.com/2017/04/omada-humana-diabetes-study/ Study of 501 patients had high participation (92%) and high engagement, with patients using app frequently as 19 times per week. Participants lost 7.5% of body weight, improved A1c by 0.14%, and reduced total cholesterol by 7 mg/dL. (4/3/17)]&lt;br /&gt;
* [http://www.imedicalapps.com/2017/03/diabetes-online-intervention-study/ Online intervention for type II diabetes helped reduce hemoglobin A1c and weight for a small study group (3/15/17)]&lt;br /&gt;
* [http://medcitynews.com/2016/09/mississippi-telehealth-remote-monitoring/ Mississippi Diabetes Telehealth Network program trial for 100 diabetic patients resulted in 96% medication compliance, hemoglobin A1c levels decreasing by 1.7% and compliance with scheduled health sessions reaching 83%. Not a single program participant was hospitalized or visited an emergency room due to complications of their diabetes, saving payers $339,184. (9/13/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article116582423.html Monitoring diabetes is hard, but mobile apps make the process easier (11/22/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/mobile-diabetes-intervention-reduced-hba1c-2-percentage-points-more-standard-care Mobile diabetes intervention reduced HbA1c 2 percentage points more than standard of care (1/26/16)]&lt;br /&gt;
Parkinson &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.mobihealthnews.com/content/nhs-study-finds-mobile-app-improves-management-quality-doctor-visits-people-parkinsons NHS study finds mobile app improves management, quality of doctor visits for people with Parkinson's Disease (1/19/17)]&lt;br /&gt;
Physical Therapy &amp;lt;br&amp;gt; &lt;br /&gt;
* [http://medcitynews.com/2017/03/virtual-rehab-gain-ground-orthopedics-bundled-payments-take-hold/ Virtual rehab to gain ground in orthopedics as bundled payments take hold (3/14/17)]&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.healthaffairs.org/do/10.1377/hblog20170823.061630/full/ Over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population (8/23/17)]&lt;br /&gt;
Weight Loss &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0454-y Multi-component interventions appear to be more effective than stand-alone app interventions to improve diet, physical activity and sedentary behaviours can be effective. (12/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/webmds-app-enabled-weight-loss-pilot-helped-800-verizon-employees-lose-weight App-enabled weight loss pilot helped 800 Verizon employees lose weight (3/23/16)]&lt;br /&gt;
* [http://medcitynews.com/2015/11/medicare-patients-lose-weight/ A study by Omada Health and Humana to evaluate the effectiveness of digital health tools to achieve weight loss among Medicare Advantage members showed an average 8.7 percent reduction in body weight for the 491 participants over a six month period. (11/13/15)]&lt;br /&gt;
* [http://medcitynews.com/2015/06/pwc-infograph-virtual-care-cuts-down-diabetes-costs/ Virtual care reduces diabetes costs by 9% (6/26/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Services#Virtual_Medical_Services Virtual Medical Services] - ''What Works?''===&lt;br /&gt;
Tele-Health Visits &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://medcitynews.com/2017/04/how-to-measure-roi-of-telemedicine/ INTEGRIS reduced cost of treating low acuity, non-emergent medical conditions such as upper respiratory infections (URI). In 2016, the cost for onsite visits to treat URIs was $383,702. During the first three months of 2017, costs to treat URI patients virtually was only $9,744. It is expected to save hundreds of thousands of dollars annually (4/20/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jama-study-shows-telemedicine-can-improve-screening-access-efficiency-diabetes-caused JAMA study shows telemedicine can improve screening access, efficiency for diabetes-caused blindness in LA County safety net populations (4/11/17)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2017/03/26/519543337/telehealth-doctor-visits-may-be-handy-but-arent-cheaper-overall Telehealth Doctor Visits May Be Handy, But Aren't Cheaper Overall (3/26/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/how-mercy-created-a-54m-virtual-hospital-in-st-louis.html Virtual Care Center has led to a more than 33 percent decrease in Mercy's emergency room visits and hospitalizations. (9/15/16)]&lt;br /&gt;
Virtual Second Opinions &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.imedicalapps.com/2016/11/whatsapp-second-medical-opinion-diagnosing/ 20 oral pathologists gathered virtually using the WhatsApp Broadcast functionality to get a second opinions. The accuracy of the 4,940 second opinion diagnoses (SOD) was 98% correctly diagnosed. (11/22/16)]&lt;br /&gt;
&lt;br /&gt;
==[[Digital Health Technology]] - ''What Works?''==&lt;br /&gt;
[[Digital Health Technology]] that enable [[Medical Interventions]] and [[Non-Medical Interventions]] to more efficiently and effectively help improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Devices Devices] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-finds-wearables-may-help-detect-serious-illness Study finds wearables may help detect serious illness (1/12/17)]&lt;br /&gt;
* [http://www.healthcareitnews.com/news/va-study-wearables-ai-shows-promise-heart-failure-patients VA study of heart failure patients demonstrated how AI-based personalized physiology analytics could be applied to wearable biosensor data to predict when a patient might be at risk of hospitalization. (3/12/18)]&lt;br /&gt;
Activity Trackers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://mobihealthnews.com/content/study-walkadoo-increased-employee-activity-nearly-1000-steps-day Activity platform with adaptable, tailored reminders and activity trackers increased employee activity by an average of 970 steps per day compared to control group with just the trackers. (2/9/16)]&lt;br /&gt;
Continuous Glucose Monitoring &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.mobihealthnews.com/content/study-dexcom-finds-cgms-can-benefit-type-2-patients-too A study published in Annals of Internal Medicine and sponsored by Dexcom shows that a continuous glucose monitor could lower the HbA1c scores of people with Type 2 diabetes (8/21/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Communications Digital Communications] - ''What Works?''===&lt;br /&gt;
* [http://www.mercurynews.com/2016/11/28/elders-who-use-tech-tools-feel-less-lonely-more-physically-fit-stanford-study-finds/ Use of computers and cell phones is linked to higher levels of mental and physical well-being among those over age 80 (11/28/16)]&lt;br /&gt;
* [http://stateofreform.com/wp-content/uploads/2015/12/AJMC_12_2015_Reed-final.pdf Patients with chronic conditions sent secure e-mail messages to their providers as a first method of contacting the healthcare delivery, nearly one-third of respondents reported that e-mailing their healthcare providers had improved their overall health, and more than 1 in 3 reported that e-mailing their provider decreased their phone calls to their providers or their in-person doctor’s office visits. (12/21/15)]&lt;br /&gt;
* [http://www.cityam.stfi.re/230372/digital-health-wearables-and-apps-9-in-10-brazilian-doctors-use-whatsapp-to-talk-to-patients?sf=vkrgwp 9 in 10 Brazilian doctors use WhatsApp to talk to patients (12/7/15)]&lt;br /&gt;
* [http://medcitynews.com/2014/12/mobile-health-company-offers-way-to-improve-interactions-between-medicaid-care-managers-and-patients/ Mobile health company offers way to improve interactions with Medicaid patients, care managers by demonstrating a 12% increase in prescription refills, a 40% increase in attending health appointments and a 22% increase in their knowledge of the recommended lifestyle changes for their care plan. (12/5/14)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-blog/the-doctor-will-email-you-now.html Physicians at Kaiser Permanente received approximately 13 million secure emails from patients in one year. (4/9/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/8/1361.abstract Electronic Communication Improves Access, But Barriers To Its Widespread Adoption Remain (8/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Digital_Regulating_Therapies Digital Regulating Therapies] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Mobile_Apps Mobile Apps] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Patient_Provided_Data Patient Provided Data] - ''What Works?''===&lt;br /&gt;
* [http://careathand.com/assets/attachments/Avalere-18Nov2015.pdf Three-minute surveys on mobile device by frontline personnel helped detect clinically relevant alerts for intervention. Medicare beneficiaries with 3 or more admissions in the prior year had 29.2% decrease in inpatient admissions and $28,656 reduction in Medicare A inpatient expenditures per beneficiary per year. (11/18/15)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/07/28/century-house-call/tdupWvOQI6b3dKdKcEgdGM/story.html Partners HealthCare allows patients to upload information from their medical devices into their electronic records in doctors’ offices. (7/29/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Monitoring_and_Management Monitoring &amp;amp; Management] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Text_Messaging Text Messaging] - ''What Works?''===&lt;br /&gt;
* [http://www.mobihealthnews.com/content/study-texting-improve-medication-adherence-shows-high-engagement Study: Texting to improve medication adherence shows high engagement (5/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/practices/using-patient-engagement-strategies-to-increase-colon-cancer-screenings Ochsner Health System used automated text messages to patients’ cell phones. Patients could touch a link to connect to a live person to schedule appointment or answer questions. 578 patients scheduled colon cancer screenings, pre-cancerous polyps found in an estimated 145 patients (11/15/16)]&lt;br /&gt;
* [http://www.denverpost.com/2016/10/13/denver-health-text-messages/ Patients who got texts made it to their appointments 73% of the time, compared to a 66% attendance rate for those who didn’t (10/13/16)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2495276%20 A text-based smoking cessation intervention improve outcomes among young people. (3/2016)]&lt;br /&gt;
* [http://archinte.jamanetwork.com/article.aspx?articleid=2484905 Mobile phone text messaging increases medication adherence rates from 50% to 67.8% (3/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/study-patients-who-receive-texts-from-physicians-more-likely-to-exercise.html Study: Patients who receive texts from physicians more likely to exercise (12/14/15)]&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/?term=Feasibility+of+a+Text+Messaging+Intervention+to+Promote+Self-Management+for+Patients+Prescribed+Oral+Anticancer+Agents. Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. (11/2015)]&lt;br /&gt;
* [http://jama.jamanetwork.com/article.aspx?articleid=2442937 Text messaging can help improve patient risk factors in patients with coronary heart disease (9/22/15)]&lt;br /&gt;
* [http://talkspace.com/online-therapy/wp-content/uploads/2015/06/Talkspace-Preliminary-Research-Study.pdf 90% of those who received text-based Psychotherapy were doing better on average than those who received no treatment 6/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Digital_Health_Technology#Virtual_Visits_Technology Virtual Visits Technology] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
==[[Support Services]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Caregiver_Support Caregiver Support] - ''What Works?''===&lt;br /&gt;
* [http://khn.org/news/boot-camp-helps-alzheimers-dementia-caregivers-take-care-of-themselves-too/ ‘Boot Camp’ Helps Alzheimer’s, Dementia Caregivers Take Care Of Themselves, Too (5/9/17)]&lt;br /&gt;
* [http://khn.org/news/teaching-in-home-caregivers-seems-to-pay-off/amp/ Teaching In-Home Caregivers results in emergency room visits declining by 24% in the first year after caregivers were trained and 41% in the second year (8/11/16)]&lt;br /&gt;
* [http://in.reuters.com/article/us-dementia-caregivers-stress-idINKBN0GJ21920140819 More evidence adult daycare eases stress on dementia caregivers (8/20/14)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/605.abstract?rss=1 North Dakota Assistance Program For Dementia Caregivers Lowered Utilization, Produced Savings, And Increased Empowerment (4/2014)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/33/4/596.abstract?rss=1 Enhanced support services for caregivers of people with dementia have been shown to improve caregivers’ capabilities and well-being and delay patients’ institutionalization (4/2014)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_Health_Worker Community Health Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.uphs.upenn.edu/news/News_Releases/2014/02/kangovi/ Penn's Innovative Community Health Worker Model Improves Outcomes for High-Risk Patients (2/10/14)]&lt;br /&gt;
* [http://medcitynews.com/2014/04/new-idea-extending-reach-care-team-hiring-training-grandparents/ A not-for-profit trains grandparents to work as grand-aides, helps reduce readmissions by over 50% and get medication adherence of 91%. (4/8/14)]&lt;br /&gt;
* [http://www.latimes.com/nation/la-na-healthcare-collaboration-20140319-dto-htmlstory.html#ixzz2wQzyYytp Northern Maine - coordination among businesses and health workers helped to improve health outcomes. (3/19/14)]&lt;br /&gt;
* [http://khn.org/news/volunteers-assist-seniors-by-taking-notes-during-medical-appointments/ Note Takers Help The Elderly At The Doctor (2/28/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Community_and_Social_Services Community &amp;amp; Social Services] - ''What Works?''===&lt;br /&gt;
* [http://www.dispatch.com/content/stories/local/2016/08/07/medicaid-insurer-provides-life-services-to-connect-clients-with-education-jobs.html Medicaid insurer provides ‘life services’ to connect clients with education, jobs (8/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/hospitals/faithhealthnc-offers-spiritual-emotional-support-after-discharge Faith Health program has helped to reduce readmissions through a volunteer initiative aimed at helping patients get the emotional support they need after discharge. (6/27/16)] &lt;br /&gt;
* [http://content.healthaffairs.org/content/35/5/760.abstract States with a higher ratio of social to health spending (social spending divided by Medicare and Medicaid spending) had better subsequent health outcome, including for: adult obesity, asthma, mentally unhealthy days, days with activity limitation, mortality rates for lung cancer, acute myocardial infarction and type 2 diabetes. (5/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/how-one-health-system-addressed-2-000-patients-social-needs-in-2-years.html  Health system addressed 2,000 patients' social needs in 2 years. Undergraduate students from local universities, called advocates, connect patients with resources for food stamps, subsidized child care or housing or payment plans and discounts for their electricity bills. (6/2/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/32/3/544.abstract Strong Social Support Services, Such As Transportation And Help For Caregivers, Can Lead To Lower Health Care Use And Costs (3/2013)]&lt;br /&gt;
* [http://www.spokesman.com/stories/2014/may/19/hospitals-say-online-language-services-help-reduce/ Providence turns to online interpreters to improve health outcomes (5/19/14)]&lt;br /&gt;
* [http://www.communityplans.net/LinkClick.aspx?fileticket=wcPKMzqiacQ%3d&amp;amp;tabid=214&amp;amp;mid=718&amp;amp;forcedownload=true Positively Impacting Social Determinants of Health - How Safety Net Health Plans Lead the Way (6/2014)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2015/02/12/oregon-bridges-the-gap-between-health-care-and-community-based-health/ Oregon is showing success in integrating of health care with social services and public health (2/12/15)]&lt;br /&gt;
* [http://healthyamericans.org/report/110/ 79 evidence-based disease and injury prevention programs that have saved lives and improved health. (11/2013)]&lt;br /&gt;
* [https://uwphi.pophealth.wisc.edu/programs/match/healthiest-state/what-works-rural-report-july-2015.pdf What Works? Strategies to Improve Rural Health (7/2015)]&lt;br /&gt;
* [https://www.icsi.org/_asset/pvr9ot/lessonslearned.pdf Lessons Learned: Leaders Successfully Stepping Out to Transform Health and Health Care (4/2015]&lt;br /&gt;
* [http://www.bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Research provide evidence that addressing social determinants of health can improve health and reduce health care costs. Study describes effective interventions 7 Housing examples, 5 Nutrition Assistance examples, 2 Income Support examples, public safety and education examples. (6/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Employment_Support Employment] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1098.abstract Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives. Yet funding is lacking. (6/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Financial_Counseling Financial Counseling] - ''What Works?''===&lt;br /&gt;
* [http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ Insured patients can save money by pretending to be uninsured (1/3/14)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Home_Support Home Support] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Housing_Support Housing Support] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-physician-relationships/this-hospital-is-giving-free-housing-to-frequent-er-patients.html Hospital provides free housing to frequent ER patients. $3,000 per day to care for patients who frequently visit the emergency room or approximately $33 per day for an apartment. (6/30/16)]&lt;br /&gt;
* [http://khn.org/news/old-motels-get-new-life-helping-homeless-heal/amp/Old Motels Get New Life Helping Homeless Heal (6/29/16)]&lt;br /&gt;
* [http://www.npr.org/2015/12/10/459100751/utah-reduced-chronic-homelessness-by-91-percent-heres-how Utah Reduced Chronic Homelessness By 91 Percent; HUD estimates that annual cost of homelessness is between $30,000 and $50,000 per person because of services like emergency room visits and jail time. (12/10/15)]&lt;br /&gt;
* [http://www.leadingage.org/Affordable_Senior_Housing_Plus_Services_Program_Slows_Growth_in_Medicare_Costs.aspx Affordable Senior Housing Plus Services Program Slows Growth in Medicare Costs (12/15/14)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/homeless-navigators-help-reduce-er-use-readmissions?utm_source=feedly 'Homeless navigators' help reduce ER use, readmissions (10/25/13)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/1/20.abstract Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing (1/2016)]&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Housing First program for people experiencing chronic homelessness in Seattle and Boston results in $29,388 per person per year in net savings, and $8,949 per person per year in net savings, respectively (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf Special Homeless Initiative (HI) Adults with serious mental illness in Boston results in 93% reduction in hospital costs, $18 million reduction in health care costs annually (6/2015])&lt;br /&gt;
* [http://bluecrossfoundation.org/sites/default/files/download/publication/Social_Equity_Report_Final.pdf 10th Decile Project for high-need homeless in Los Angeles 72% reduction in total health care costs; positive rate of return as every $1 invested in housing and support was estimated to reduce public and hospital costs by $2 the following year and $6 in subsequent years (6/2015])&lt;br /&gt;
* [http://www.communityplans.net/Portals/0/Fact%20Sheets/ACAP_Plans_and_Social_Determinants_of_Health.pdf UPMC developed a “shelter plus care” program through a multi-party partnership including primary care practice, local government and community services. A 23% reduction in overall per-member-per-month (PMPM) claims costs. Roughly $4,100 before program to roughly $3,200 while in program (6/2014)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Legal_Support Legal Support] - ''What Works?''===&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Medication_Support Medication Support] - ''What Works?''===&lt;br /&gt;
* [http://www.bizjournals.com/washington/news/2017/05/08/the-simple-way-medstar-just-found-to-get-patient.html MedStar and CVS Health may have found a simple solution. The pharmacy pre-packages and labels patients' medications in multi-dose pouches. A group of 10 primary care offices recently improved medication compliance among patients taking six or more drugs a day from 60% to more than 90%. (5/8/17)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Nutrition_Support Nutrition Support] - ''What Works?''===&lt;br /&gt;
* [https://www.beckershospitalreview.com/finance/study-advocate-hospitals-saved-nearly-4-9m-by-implementing-nutrition-care-program.html Advocate Health Care saved nearly $4.9 million dollars by reducing readmission rates and shortening inpatient stays after implementing a nutrition care program at four Chicago hospitals (8/11/18)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2016/09/20/how-community-partnerships-can-help-end-food-insecurity-part-1/ How Community Partnerships Can Help End Food Insecurity - Part 1 (9/20/16)] [http://healthaffairs.org/blog/2016/09/21/how-community-partnerships-can-help-end-food-insecurity-part-2/ Part 2 (9/21/16)]&lt;br /&gt;
* [http://www.marketplace.org/2015/06/22/health-care/new-math-healthcare-make-money-saving-money Healthy foods delivered to 5% of the patients spending 50% of money can save money (6/22/2015)]&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001076/ Study found that if every state were to provide home-delivered meals to an additional 1 percent of its population of adults ages sixty-five and older, would save state Medicaid programs over $109 million for the country. (10/2013)]&lt;br /&gt;
* [http://www.bostonglobe.com/lifestyle/health-wellness/2013/06/09/hospitals-reach-into-patients-homes-deliver-healthy-smoked-tofu-but-also-bbq-shrimp-scampi/QSqNQiycZUNxa9qbRWzs8I/story.html Steward Health Care] delivers three low-sodium meals and two snacks to selected heart failure patient's home each day hoping healthy food will reduce trips to the hospital. (6/10/13)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Prison_to_Community_Transitions Prison to Community Transitions] - ''What Works?''===&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1006.abstract People returning to communities from prison that were referred by correctional partners to an enhanced primary care Transitions Clinic Network (TCN) had fewer acute care visits than people referred later. (6/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Social_Workers Social Workers] - ''What Works?''===&lt;br /&gt;
* [http://www.ncbi.nlm.nih.gov/pubmed/27119772 Social-work conducted transitional care reduced all cause readmissions among all home-going Medicare FFS beneficiaries by 20%. (5/2016)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/hospital-based-clinic-helped-reduce-ed-super-user-visits Hospital-based clinic used social workers to reduce ED super-users risk of ED use by 22% and hospitalizations by 30% (5/9/14)]&lt;br /&gt;
* [http://www.bloomberg.com/news/articles/2013-09-26/obamacare-incentives-push-hospitals-to-keep-medicare-patients-healthy Social workers are the new frontline of the accountable-care model (9/26/13)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2015/10/23/451154605/a-hospital-reduces-repeat-er-visits-by-providing-social-workers Hospital Reduces Repeat ER Visits By Providing Social Workers. In four months, visits by 39 people to the ER fell by 68 percent, cost fell from $1.5 million to $440,000. (10/23/15).]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Support_Services#Support_Communities Support Communities] - ''What Works?''===&lt;br /&gt;
* [http://www.imedicalapps.com/2016/08/web-based-support-group-tbi-caregivers/ Online-video support group could aid in the care of patients with traumatic brain injuries (TBI). (8/5/16)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/167056/mhealth-comes-patient-support-groups Mobile Health Comes to Patient Support Groups (6/3/14)]&lt;br /&gt;
* [http://www.healthworkscollective.com/joan-justice/152556/one-one-cancer-support-empowers-patients One-on-One Cancer Support Empowers Patients (3/10/14)]&lt;br /&gt;
* [http://www.kevinmd.com/blog/2013/08/5-advantages-online-patient-communities.html 5 advantages of online patient communities (8/2/13)]&lt;br /&gt;
* [http://davidleescher.com/2013/07/11/why-online-patient-communities-are-better-than-real-life-support-groups/ Online Patient Communities] can provide many potential benefits, such as improving coping skills, reducing anxiety, depression, isolation, ignorance about the condition and finding others that are experience common conditions. (7/11/13)&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Support_Services#Transportation Transportation] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/patient-flow/caremore-lyft-collaboration-reduces-medical-transportation-waits-by-30.html CareMore, Lyft collaboration reduces medical transportation waits by 30% (9/6/16)]&lt;br /&gt;
* [http://www.theatlantic.com/amp/article/495476/ Hospitals Are Partnering With Uber to Get Patients to Checkups (8/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] - ''What Works?''==&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions Patient/Caregiver Interventions] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Caregiver_Activity Caregiver Activity] - ''What Works?''===&lt;br /&gt;
* Caregivers - [http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/22/in-some-states-a-new-focus-on-family-caregivers States are focusing on activating them (6/22/2015)]&lt;br /&gt;
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===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activation Patient Activation] - ''What Works?''===&lt;br /&gt;
* [https://www.usatoday.com/story/news/2017/06/22/these-few-things-may-stave-off-dementia-scientists-say/103119512/ There is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (6/22/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/22/well/live/back-pain-try-yoga.html A study of people with low to moderate lower back pain found they could use yoga to reduce back pain and functional limitations (6/22/17)] &lt;br /&gt;
* [http://www.hhnmag.com/articles/8230-Patients-increasingly-providing-self-care-improving-outcomes-reducing-cost DIY Medicine Helps Improve Outcomes, Reduce Cost. Patients avoid long inpatient stays by learning to self-administer care for chronic conditions (5/16/17)]&lt;br /&gt;
* [http://khn.org/news/with-chronic-illness-you-are-your-own-best-friend/amp/ What patients with chronic illnesses do outside the doctor’s office affect their health conditions (exercise, diet, taking their medication). Diabetic patients who participated in a online self-management program had lower blood sugar levels and took their medication more regularly (9/7/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-activation-influences-readmission-rates?utm_source=feedly Patient activation influences readmission rates (10/11/13)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Activity Patient Activity] - ''What Works?''===&lt;br /&gt;
* [http://www.latimes.com/science/sciencenow/la-sci-sn-brain-training-dementia-20160724-snap-story.html Specialized brain training can help prevent Alzheimer’s Disease and other afflictions, including normal aging, that sap memory and reduce function. (7/24/16)]&lt;br /&gt;
* [http://www.miamiherald.com/living/health-fitness/article129829184.html Simple activities, such as playing games, making crafts, socializing and reading books held off mental decline in older adults, according to a Mayo Clinic study (1/31/17)]&lt;br /&gt;
&lt;br /&gt;
Gamification &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://venturebeat.com/2017/03/08/heart-study-says-pokemon-go-makes-you-twice-as-likely-to-hit-10000-steps-a-day/ Heart study says Pokémon Go makes you twice as likely to walk 10,000 daily steps (3/8/17)]&lt;br /&gt;
&lt;br /&gt;
Nutrition &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://fortune.com/2017/07/13/healthy-diet-longevity-study/ Improving Your Diet Just a Little Bit Can Help You Live Longer, Says Study (7/13/17)]&lt;br /&gt;
* [http://mashable.com/2016/09/29/mediterranean-diet-health-benefits.amp Study suggests a Mediterranean diet could prevent over 19,000 deaths a year in the UK. (9/29/16)]&lt;br /&gt;
&lt;br /&gt;
Physical Activity &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://khn.org/news/these-preventive-measures-might-help-delay-dementia-or-cognitive-decline/ Scientists endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure. (7/20/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/06/16/magazine/losing-fat-gaining-brain-power-on-the-playground.html In children, exercise may help to improve cognition and improve waistlines. (6/16/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/05/24/well/move/a-1-hour-walk-3-times-a-week-has-benefits-for-dementia.html A 1 hour walk 3 times a week has benefits for dementia (5/24/17)]&lt;br /&gt;
* [https://www.nytimes.com/2017/04/12/well/move/an-hour-of-running-may-add-seven-hours-to-your-life.html An hour of running may add up to seven hours on your life (4/12/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/patients-can-save-2-500-on-medical-costs-just-by-walking.html Patients can save $2,500 on medical costs annually just by walking (9/8/16)]&lt;br /&gt;
* [https://www.nih.gov/news-events/news-releases/increased-physical-activity-associated-lower-risk-13-types-cancer Increased physical activity associated with lower risk of 13 types of cancer (6/16/16)]&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/06/23/483245084/a-protein-that-moves-from-muscle-to-brain-may-tie-exercise-to-memory When muscles work, they release a protein that appears to generate new cells and connections in a part of the brain that is critical to memory (6/23/16)]&lt;br /&gt;
* [http://www.health.harvard.edu/blog/after-hip-fracture-exercise-at-home-boosts-day-to-day-function-201402197041 After hip fracture, exercise at home boosts day-to-day function (2/19/14)]&lt;br /&gt;
* [http://www.fastcompany.com/3045862/fast-feed/sitting-all-day-will-kill-you-but-a-2-minute-walk-could-change-that New research: Breaking up your sedentary day with some light activity can prolong your life. (5/1/15)]&lt;br /&gt;
* [http://www.mhealthtalk.com/replace-sitting-with-walking/ Replace sitting with walking – it’s key to decreasing early death rate. (10/27/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Patient_Lifestyle Patient Lifestyle] - ''What Works?''===&lt;br /&gt;
* [http://www.beckershospitalreview.com/hospital-management-administration/why-retiring-after-age-65-could-help-you-live-longer.html Most people retire around age 65. But when people retire at age 66 instead, their mortality rates drop by 11 percent. (9/13/16)]&lt;br /&gt;
Healthy Lifestyle &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/05/02/476209760/whats-good-for-the-heart-is-good-for-the-brain What's Good For The Heart Is Good For The Brain. 7 factors known to benefit the heart and blood vessels: maintaining a normal body weight, good nutrition, not smoking, getting exercise regularly and keeping blood pressure, cholesterol and blood sugar levels under control. (5/2/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/study-a-healthy-lifestyle-could-prevent-half-of-all-deaths-attributed-to-cancer.html A healthy lifestyle could prevent half of all deaths attributed to cancer. 41% of cancer cases and 59% of cancer deaths were potentially preventable in women. 63% of cancer cases and 67% of cancer deaths were preventable, among men. (5/20/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Patient/Caregiver_Interventions#Personal_Achievement Personal Achievement] - ''What Works?''===&lt;br /&gt;
Smoking &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.npr.org/sections/health-shots/2016/03/15/470124189/to-quit-smoking-its-best-to-go-cold-turkey To Quit Smoking, It's Best To Go Cold Turkey (3/15/16)]&lt;br /&gt;
&lt;br /&gt;
==[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models Health Insurance Payment Models] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Accountable_Care_Organizations Accountable Care Organizations] - ''What Works?''===&lt;br /&gt;
* [https://www.fiercehealthcare.com/healthcare/medicare-shared-savings-program-acos-show-promise-cost-reduction-quality-improvement-oig Medicare Shared Savings Program ACOs show promise in cost reduction, quality improvement, OIG finds (8/30/17)]&lt;br /&gt;
* [https://www.beckershospitalreview.com/lists/110-acos-to-know-2017.html 110 ACOs to know | 2017 (6/12/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/study-finds-acos-reduce-hospitalizations-spending Study found an association between participation in an accountable care organization (ACO) and reduced rates of hospitalizations, as well as Medicare spending. (5/9/17)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2601418 Medicare Shared Savings Program was associated with a 9% differential reduction in postacute spending by 2014, driven by reductions in discharges to facilities, length of facility stays, and acute inpatient care. (2/15/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/1/74.abstract Two-sided financial risk model that encourages population health management significantly narrowed the care disparity gaps between different socioeconomic groups, according to a study from Harvard Medical School. (1/2017)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/payer/anthem-blue-cross-acos-realize-70m-savings Anthem Blue Cross through its 17 ACO partners accrued savings of $70.4 million over a 12-month period. (11/1/16)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-the-literature/2017/jan/aco-hospitals-reduced-rehospitalization-faster ACO-Affiliated Hospitals Reduced Rehospitalizations from Skilled Nursing Facilities Faster Than Other Hospitals (1/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/medicare-aco-hospitals-faster-at-reducing-readmissions-study-finds.html Medicare ACO hospitals faster at reducing readmissions, study finds. (1/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/cms-unveils-2015-medicare-aco-quality-financial-performance-12-things-to-know.html ACOs saved Medicare $466M in 2015. (8/26/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Episode-Based_Payments Episode-Based Payments] - ''What Works?''===&lt;br /&gt;
Commercial Health Plans &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://healthpayerintelligence.com/news/unitedhealthcare-adopts-bundled-payment-model-for-surgeries UnitedHealthcare’s bundled payment model for hip, knee and back surgery pilot program has shown an average savings of $10,000 or more among employers for each episode of care when compared against overall median costs for the same procedures in the same region. (1/19/17)]&lt;br /&gt;
&lt;br /&gt;
Medicare &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2594805 Study of 3942 patients who received joint replacement surgery, there was a decrease of $5577 (20.8%) in total spending per episode. Most of the hospital savings came from implants and supplies and most of the postacute care savings came from decreased use of institutional care. (1/3/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Care_Services Care Services] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient-Centered_Medical_Homes Patient-Centered Medical Homes] - ''What Works?''===&lt;br /&gt;
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071295/ CareFirst Patient-Centered Medical Home Program lowered annual adjusted total claims payments by $109 per participating member (95 % CI: −$192, −$27), or 2.8 % lower than before the program and compared to those who did not participate. 42% of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. (7/29/16)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/healthcare/patient-centered-medical-homes-lower-costs-reduce-healthcare-overuse Patient-centered medical homes lower costs, reduce healthcare overuse (1/30/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Patient_Incentives Patient Incentives] - ''What works?''===&lt;br /&gt;
* [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1455 Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage (8/2017)]&lt;br /&gt;
* [https://healthpayerintelligence.com/news/patient-incentives-from-payers-encourage-preventive-care-visits Patient Incentives from Payers Encourage Preventive Care Visits. MinuteMember Wellness Rewards program offer $50 incentive for members to visit their In-Plan PCP during the calendar year. “In its first year, approximately 9300 members (or 40 percent) received an incentive check. (5/10/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/population-health/financial-incentives-may-be-effective-for-smoking-cessation-study-finds.html Financial incentives may be effective for smoking cessation, study finds. After six months, 36% of participants who received cash and about 6% of the control group had quit smoking. (9/9/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/aetna-pays-employees-up-to-500-per-year-for-sleeping.html Aetna pays employees up to $500 per year for sleeping. Wellness and wellness program responsible for 69 minutes more a month of worker productivity. (4/7/16)]&lt;br /&gt;
* [http://mobihealthnews.com/content/small-study-risk-losing-reward-works-better-reaching-activity-tracking-goals Small study shows risk of losing reward works better for reaching activity tracking goals (2/16/16)]&lt;br /&gt;
* [http://www.nejm.org/doi/full/10.1056/NEJMoa1414293#t=articleBackground Financial incentives were proven effective in smoking cessation (5/28/15)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Performance_Based_Pricing Performance-Based Pricing] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Provider-Based_Health_Plans Provider-Based Health Plans] - ''What works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Care_Programs Value-Based Care Programs] - ''What Works?''===&lt;br /&gt;
* [http://www.fiercehealthcare.com/regulatory/study-value-based-care-programs-reduce-readmissions Study finds participation in voluntary federal programs that push for quality improvements has a greater impact on reducing readmissions than financial penalties levied against hospitals for high rates alone (4/11/17)]&lt;br /&gt;
* [https://news.umich.edu/voluntary-value-based-health-programs-dramatically-reduce-hospital-readmissions/ University of Michigan Study Links Value-Based Care Programs to Lower Readmission Rates and $32 Million in Medicare Savings in 2015 (4/10/17)]&lt;br /&gt;
* [http://www.commonwealthfund.org/publications/in-brief/2017/mar/sustained-participation-payforvalue-high-need-patients Blue Cross Blue Shield of Michigan members with two or more chronic diseases, including mental health problems, assigned to PCP's participating in the pay-for-performance program for at least four years to outcomes for members assigned to PCPs had almost 20% fewer 30-day hospital readmissions and 27.5% fewer 90-day readmissions. However, total spending did not decline. (3/15/17)]&lt;br /&gt;
* [http://healthpayerintelligence.com/news/anthem-cut-er-costs-by-3-with-value-based-care-reimbursement Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement (2/1/17)]&lt;br /&gt;
* [https://www.uhc.com/content/dam/uhcdotcom/en/ValueBasedCare/PDFs/VBC-Nov2016-Online-Report.pdf UnitedHealthcare expanded value-based care programs such as accountable care organizations, which led to 16.8% fewer acute inpatient admissions among mature Medicaid ACOs in Tennessee, 12.2% fewer ER visits among the longest-running Medicare ACOs and 10% fewer hospital admissions and ER visits among top performing commercial ACOs (11/2016)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/accountable-care-organizations/4-strategies-bcbs-used-to-save-1b-through-patient-centered-programs.html 4 strategies BCBS used to save $1B through patient-centered programs. These programs include BCBS' accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs — emphasize prevention, wellness and coordinated care, in conjunction with reducing waste in the healthcare delivery system. (6/2/15)]&lt;br /&gt;
&lt;br /&gt;
Hospital-Acquired Condition Reduction Program &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.modernhealthcare.com/article/20161212/NEWS/161219985 HHS report shows hospitals are paying off, preventing 3.1 million harmful hospital-acquired conditions and the deaths of some 125,000 people. Those improvements saved close to $28 billion in healthcare costs from 2010 through 2015. (12/12/16)]&lt;br /&gt;
&lt;br /&gt;
Readmission Penalties &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/fiscal-penalties-for-low-performing-hospitals-linked-to-improved-readmission-rates.html Fiscal penalties for low-performing hospitals linked to improved readmission rates for heart failure, pneumonia and acute myocardial infarction (heart attack). For every 10,000 patients discharged annually, the lowest performing hospitals avoided 95 readmissions they would have seen before readmissions were penalized under the ACA. (12/27/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/quality/every-state-but-1-lowered-hospital-readmissions-since-2010-cms-data-shows.html Every state but 1 lowered hospital readmissions since 2010, CMS data shows (9/13/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/7/1294.abstract Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Attributed to Medicare's penalties for re-admissions. (7/2016)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Value-Based_Insurance_Design Value-Based Insurance Design] - ''What Works?''===&lt;br /&gt;
Health plan benefit design to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices&lt;br /&gt;
* [http://khn.org/news/health-insurers-try-paying-more-upfront-to-pay-less-later/amp/ Enhanced insurance benefit that pays for all patients Type 1 diabetes maintenance is paying off. The state has saved about $1 million on medical services since its inception almost 10 years ago. (7/17/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/3/516.abstract Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan (3/2017)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/payer-issues/horizon-calls-its-6-premium-increase-proof-tiers-work.html Horizon Blue Cross Blue Shield of New Jersey declared its Omnia health plans, which uses Tier 1 — or preferred — hospitals and providers for services, have some of the lowest premium rate increases nationally next year. (10/26/16)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/study-finds-eliminating-drug-co-payments-leads-to-cost-savings-among-chronically-ill.html Study finds eliminating drug co-payments leads to cost savings among chronically ill (2/17/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/4/637.abstract Connecticut’s Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence (4/2016)]&lt;br /&gt;
&lt;br /&gt;
Tiered Provider Network &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/5/870.short Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5% (5/2017)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Health_Insurance_Payment_Models#Wellness_Payment_Models Wellness Payment Models] - ''What Works?''===&lt;br /&gt;
* Wellness Screenings - [http://khn.org/news/medicare-payment-changes-lead-more-men-to-get-screening-colonoscopies/ Medicare Payment Changes Lead More Men To Get Screening Colonoscopies (12/24/15)]&lt;br /&gt;
&lt;br /&gt;
==[[Organization Interventions]] - ''What Works?''==&lt;br /&gt;
[[Non-Medical Interventions]] that can improve a patient's health care outcome, overall health and [http://www.patientwell-being.org/general/what-is-personal-well-being/ well-being].&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Communities Communities] - ''What Works?''===&lt;br /&gt;
* [https://www.statnews.com/2017/02/28/health-disparities-community-action/ Decisive action by communities can reduce health disparities and improve lives (2/28/17)]&lt;br /&gt;
* [https://www.bostonglobe.com/metro/2016/12/10/the-san-antonio-way-how-one-texas-city-took-mental-health-community-and-became-national-model/08HLKSq1JdXSTZppaECk2K/story.html San Antonio has built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. (12/10/16)]&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/role-food-systems-community.html West Oakland, one of the city’s poorest areas, improved healthy food access and economic opportunity. 640,000 lbs of produced distributed in food insecure area, 55% sourced locally and 76% of shoppers increased consumption of fruits and vegetables (11/28/16)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Community_.26_Social_Services_Organizations Community &amp;amp; Social Services Organizations] - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Employers Employers] - ''What Works?''===&lt;br /&gt;
Employee Wellness Programs &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/human-capital-and-risk/study-suggests-wellness-programs-boost-worker-productivity-by-more-than-5.html Study shows wellness program boosted average worker productivity by more than 5% (8/9/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/human-capital-and-risk/nearly-60-of-employees-say-wellness-programs-have-improved-their-health-study-shows.html Nearly 60% of employees say wellness programs have improved their health, survey shows (6/1/17)]&lt;br /&gt;
* [http://m.content.healthaffairs.org/content/29/2/304.full Study of Workplace Wellness Programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent (2/21/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/2/229.abstract Comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees’ health risks, disease prevalence, and medical expenditures. (2/2017)]&lt;br /&gt;
* [http://www.rand.org/content/dam/rand/pubs/research_briefs/RB9700/RB9744/RAND_RB9744.pdf Disease management drives return on investment from workplace wellness programs. Two component programs reduced employer’s average health care costs by about $30 per member per month(PMPM). Disease management was responsible for 87% of those savings. Employees participating in the disease management program generated savings of $136 PMPM, with a nearly 30% reduction in hospital admissions. Only 13% of employees participated in the disease management component, compared with 87% for the lifestyle management component. (1/1/14)]&lt;br /&gt;
On-Site Health Centers &amp;lt;br&amp;gt;&lt;br /&gt;
* [http://www.beckershospitalreview.com/finance/premise-health-a-threat-or-opportunity-for-hospitals.html Coushatta Casino Resort partnered with Premise in 2011 to manage its onsite health center and improve the overall health status of Coushatta's employees and their families. The resort has seen better outcomes and has saved nearly $4 million in healthcare costs. (6/8/17)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Governments Governments] - ''What Works?''===&lt;br /&gt;
* [https://journals.lww.com/epidem/Citation/2017/11000/Longitudinal_Associations_of_Local_Cigarette.15.aspx A $1 increase in price was associated with a 3% reduction in risk of current smoking (11/2017)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/36/6/1016.abstract HUD Housing Assistance Associated With Lower Uninsurance Rates And Unmet Medical Need (6/2017)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamacardiology/article-abstract/2618359 Study using data from the New York State Department of Public Health (2002-2013) found 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in counties with vs without trans-fatty acid restrictions. (4/12/17)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2017/03/13/520008877/un-sweetened-how-a-maryland-county-cut-soda-sales-without-a-soda-tax A Maryland County Cut Soda Sales Without A Soda Tax. The Unsweetened campaign led to a 20% decrease in sales of soda and a 15% decline in fruit drink sales between January 2013 and December 2015. (3/13/17)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/early/2017/02/16/hlthaff.2016.1231 Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. (2/2017)]&lt;br /&gt;
* [http://healthaffairs.org/blog/2017/01/31/marylands-all-payer-model-achievements-challenges-and-next-steps/ The state of Maryland launched a bold approach to improve care with an All-Payer Model to slow the growth of healthcare costs.  Maryland has achieved an estimated $429 million in total Medicare hospital savings to date, exceeding the model’s five-year hospital savings requirement of $330 million (1/31/17)]&lt;br /&gt;
* [http://www.rwjf.org/en/library/collections/signs-of-progress-in-reducing-childhood-obesity.html Some cities, counties, and states have started to see their childhood obesity rates go down by taking a comprehensive approach. (10/2016)]&lt;br /&gt;
* [http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2553293 A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants (9/19/16)]&lt;br /&gt;
* [http://www.npr.org/sections/thesalt/2016/08/23/491104093/berkeleys-soda-tax-appears-to-cut-consumption-of-sugary-drinks Soda Tax Appears To Cut Consumption Of Sugary Drinks (8/23/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/35/6/1045.abstract State prescription drug monitoring programs are sssociated with 30% reductions in opioid prescribing by physicians (6/2016)]&lt;br /&gt;
* [http://onlinelibrary.wiley.com/doi/10.1002/hec.3336/full Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers (4/4/16)]&lt;br /&gt;
* [http://content.healthaffairs.org/content/34/11/1932.abstract Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement - (1) sugar-sweetened beverage excise tax, (2) elimination of tax subsidy for advertising unhealthy food to children, (3) nutritional standards for food and beverages in schools outside of meals (11/2015)]&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Health_Insurers Health Insurers]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Advocacy_Organizations Healthcare Advocacy Organizations]===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Healthcare_Provider_Organizations Healthcare Provider Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Support_Services_Organizations Support Services Organizations]  - ''What Works?''===&lt;br /&gt;
&lt;br /&gt;
===[http://www.patientdeterminants.org/index.php?title=Organization_Interventions#Vendor_Partners Vendor Partners]  - ''What Works?''===&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Virtual_Medical_Services</id>
		<title>Virtual Medical Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Virtual_Medical_Services"/>
				<updated>2019-07-16T20:52:25Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;* [https://www.darkdaily.com/kaiser-permanente-announces-that-virtual-visits-with-providers-have-surpassed-face-to-face-appointments-at-meeting-of-nashville-health-care-council-members/ Kaiser Permanente Announces that Virtual Visits with Providers Have Surpassed Face-to-Face Appointments (8/30/17)]&lt;br /&gt;
* [http://www.healthcareitnews.com/news/comparing-11-top-telehealth-platforms-company-execs-tout-quality-safety-ehr-integrations Comparing 11 top telehealth platforms: Company execs tout quality, safety, EHR integrations (8/2/17)]&lt;br /&gt;
* [https://www.fiercehealthcare.com/mobile/washington-health-system-launches-virtual-hospital-augment-care-seven-facilities  Tacoma, Washington-based health system has launched a virtual hospital where 200 doctors and nurses assist in caring for patients in surrounding communities exclusively through telemedicine. (7/26/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/3-ways-usc-using-virtual-care-to-capture-a-broader-range-patients USC is using virtual care to capture a broader range of patients with Mobile Apps, Virtual Care and Behavioral Health (6/16/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/how-two-new-york-presbyterian-pharmacists-tapped-into-telehealth-to-improve-care-for NewYork-Presbyterian Hospital has two pharmacists seeing transplant patients virtually to maintain continuity of care after discharge from the hospital.  while expanding the hospital's service to patients that would otherwise end up in the emergency department. (5/24/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/intermountain-joins-american-wells-telemedicine-exchange Salt-Lake City-based Intermountain Healthcare has nurse practitioners and physician assistants available for patient telehealth visits on American Well’s online care marketplace known as “the Exchange.&amp;quot; 5/24/17)]&lt;br /&gt;
* [http://www.healthcareitnews.com/news/newyork-presbyterian-builds-out-telemedicine-psychiatry-and-express-care-services NewYork-Presbyterian builds out telemedicine psychiatry and express care services (4/24/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/rush-university-medical-center-offers-online-asynchronous-e-visits Rush University Medical Center offers online asynchronous &amp;quot;e-visits&amp;quot; via text messaging. The web-based application from Bright.md makes it possible for patients to choose an electronic consultation with a physician who will determine a diagnosis and treatment plan that may include prescriptions. The visits are for minor issues, such as bladder infection, burn or sunburn, cough, cold and allergy, ear pain, flu and rashes, sinus issues and sore throat. (4/5/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/jefferson-health-taps-teladoc-system-wide-telemedicine-platform-plans-education-and Jefferson Health taps Teladoc for system-wide telemedicine platform, plans education and innovation hub (3/30/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/how-telehealth-has-enhanced-cleveland-clinic-s-value-based-care-strategy.html  Cleveland Clinic partnered with American Well in September 2014 to deliver urgent care via telehealth to increase patient access to care, support Cleveland Clinic's transition to value-based care, improve efficiency and expand the system's reach to new patients. (3/24/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/upmc-health-plan-launches-app-based-video-visits-all-pennsylvania-residents UPMC Health Plan launches app-based video visits to all Pennsylvania residents (3/24/17)]&lt;br /&gt;
* [http://www.mobihealthnews.com/content/intouch-dignity-health-expand-telehealth-partnership-and-more-digital-health-deals Dignity Health uses telehealth provider InTouch Health's services to any patient location with a laptop, tablet or fully-integrated solution (3/15/17)]&lt;br /&gt;
* [http://www.fiercehealthcare.com/mobile/banner-health-telemedicine-program-targets-complex-chronic-patients Banner Health telemedicine program uses tools, analytics to target complex chronic disease patients (2/28/17)]&lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/how-hshs-medical-group-meets-consumer-demand-through-virtual-care.html HSHS Medical Group uses Carena as their virtual clinic into its care network to acquire and engage patients (2/28/17)] &lt;br /&gt;
* [http://www.beckershospitalreview.com/healthcare-information-technology/mercy-designing-the-nation-s-first-virtual-care-center.html Mercy: Designing the nation's first virtual care center (10/27/15)]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Services#Virtual_Medical_Services Return to Virtual Medical Services]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Convenient_Access</id>
		<title>Convenient Access</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Convenient_Access"/>
				<updated>2019-07-16T20:47:55Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: &lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;Neighborhood Stores &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.beckershospitalreview.com/facilities-management/banner-health-opens-3-clinics-at-arizona-grocery-stores.html Banner Health opens 3 clinics at Arizona grocery stores (8/2/17)]&lt;br /&gt;
* [https://www.darkdaily.com/quest-diagnostics-and-labcorp-ink-deals-to-put-patient-services-centers-in-grocery-stores-and-retail-pharmacies-but-not-for-the-same-reasons-as-theranos-802/ Quest Diagnostics and LabCorp to Put Patient Services Centers in Grocery Stores and Retail Pharmacies (8/2/18)]&lt;br /&gt;
* [https://newsroom.clevelandclinic.org/2017/07/25/cvs-health-expands-clinical-affiliation-with-cleveland-clinic-to-increase-access-to-patient-centered-care-and-improve-coordinated-health-care-delivery/ CVS Health Expands Clinical Affiliation with Cleveland Clinic to Increase Access to Patient-Centered Care and Improve Coordinated Health Care Delivery (7/25/17)]&lt;br /&gt;
* [https://healthpayerintelligence.com/news/cigna-cvs-minuteclinics-partner-for-expanded-healthcare-access Cigna and CVS Health have partnered to launch Cigna Health Works for expanded healthcare access for the payers employer-based health plan members.  Cigna Health Works will align members with routine and diagnostic care services provided by CVS Pharmacy and CVS MinuteClinics. (6/15/17)]&lt;br /&gt;
&lt;br /&gt;
Integrated Care Center &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.fiercehealthcare.com/practices/san-francisco-health-center-opens-to-provide-integrated-services-to-low-income-and This is the first facility in California to offer patients primary medical, mental health, dentistry, pharmacy, substance use disorder treatment, chiropractic medicine and acupuncture services all under one roof. (8/29/17)]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=Health_Services#Convenient_Access See Convenient Access Interventions]&lt;br /&gt;
&lt;br /&gt;
Return to [[Health Services]].&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

	<entry>
		<id>http://www.patientdeterminants.org/index.php/Health_Services</id>
		<title>Health Services</title>
		<link rel="alternate" type="text/html" href="http://www.patientdeterminants.org/index.php/Health_Services"/>
				<updated>2019-07-16T20:44:49Z</updated>
		
		<summary type="html">&lt;p&gt;Admin: /* Convenient Access */&lt;/p&gt;
&lt;hr /&gt;
&lt;div&gt;[[Health Services]] are [[Non-Medical Interventions|non-medical intervention]] services or capabilities designed to meet specific health needs of patients based on the health services' criteria. These services may or not be integrated with the patient's [[Care Plans|care plan]] or with an [[Care Management Programs]]. The criteria includes risk scores, episode, health conditions, [[Health Services]] enrollment and [[Health Determinants|health determinants]].&lt;br /&gt;
&lt;br /&gt;
See which [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Health_Services_-_What_Works.3F Health Services work.]&lt;br /&gt;
&lt;br /&gt;
==Consumer Diagnostic Services==&lt;br /&gt;
* DNA Testing&lt;br /&gt;
* Lab Testing that doesn't require a physician&lt;br /&gt;
&lt;br /&gt;
See [[Consumer Diagnostic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [http://www.patientdeterminants.org/index.php?title=What_Works%3F#Consumer_Diagnostic_Services_-_What_Works.3F What Works]&lt;br /&gt;
&lt;br /&gt;
==Convenient Access== &lt;br /&gt;
* Mental Health Clinic&lt;br /&gt;
* Integrated Care Center - One Stop Location with Mental Health And Medical Services under one roof&lt;br /&gt;
* Neighborhood Hot spotter services that addresses specific needs&lt;br /&gt;
* 24x7 Managing Health Support&lt;br /&gt;
* Retail Health Clinics&lt;br /&gt;
* Urgent Care&lt;br /&gt;
&lt;br /&gt;
See [[Convenient Access]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Convenient_Access_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Decision Making==&lt;br /&gt;
&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
Decision Aids &amp;lt;br&amp;gt;&lt;br /&gt;
Open Notes &amp;lt;br&amp;gt;&lt;br /&gt;
* [https://www.opennotes.org/ A movement dedicated to making health care more open and transparent by urging doctors, nurses, therapists, and others to share their visit notes with patients]&lt;br /&gt;
Price Transparency &amp;lt;br&amp;gt;&lt;br /&gt;
&lt;br /&gt;
Shared Decision Making &amp;lt;br&amp;gt;&lt;br /&gt;
* learn about their health and understand their health conditions&lt;br /&gt;
* recognize that a decision needs to be made and are informed about the options&lt;br /&gt;
* understand the pros and cons of different options&lt;br /&gt;
* have the information and tools needed to evaluate their options&lt;br /&gt;
* are better prepared to talk with their health care provider&lt;br /&gt;
* collaborate with their health care team to make a decision right for them&lt;br /&gt;
* are more likely to follow through on their decision&lt;br /&gt;
&lt;br /&gt;
See [[Decision Making]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Decision_Making_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Digital Regulating Therapies== &lt;br /&gt;
These are digital therapies that continuously monitor biomarkers and adjust therapy to keep biomarkers within a homeostatic range.&lt;br /&gt;
* Insulin Pump with Continuous Glucose Monitoring&lt;br /&gt;
&lt;br /&gt;
See [[Digital Regulating Therapies]] Examples&lt;br /&gt;
&lt;br /&gt;
==Education==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Online education video&lt;br /&gt;
* One on one education&lt;br /&gt;
* Programs&lt;br /&gt;
* How to use technology&lt;br /&gt;
* Health Literacy &lt;br /&gt;
&lt;br /&gt;
See [[Education Examples]]&lt;br /&gt;
 &lt;br /&gt;
See [[Education Videos]]&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Education_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Home==&lt;br /&gt;
* Home Assessments&lt;br /&gt;
* Home Visits - Physicians, Therapist, Nurse Practitioner &lt;br /&gt;
* Other visits (Community Health Worker, Social Worker, Health Coach)&lt;br /&gt;
* Other Home Healthcare Services (i.e., services that don't meet reimbursement requirements, 1. Infusion or Wound Care or Therapy, and, 2. unable to physically travel to doctors office, and 3. had a hospital stay of 3 nights or more, and 4. 60 days of prescribes Home health has not been used).  &lt;br /&gt;
* Health Technology such as blood pressure device, connected to wifi router or mobile phone&lt;br /&gt;
* Durable Medical Equipment (DME) devices such as oxygen that are not reimbursed&lt;br /&gt;
* In-home Medicine reconciliation&lt;br /&gt;
* [http://www.rwjf.org/en/culture-of-health/2016/11/home-visits-make-them-universal.html Home Visiting Evidence of Effectiveness (9/2016)]&lt;br /&gt;
&lt;br /&gt;
See [[Health Services - Home]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Home_-_What_Works.3F See what works.]&lt;br /&gt;
&lt;br /&gt;
==Therapeutic Services==&lt;br /&gt;
* App Formulary - Recommended Apps&lt;br /&gt;
* Standalone - Patient Only&lt;br /&gt;
* Chronic Condition Specific&lt;br /&gt;
* Integrated with Health Coaching&lt;br /&gt;
* Mobile Apps and user provided input&lt;br /&gt;
* Patient Provided Data&lt;br /&gt;
&lt;br /&gt;
See [[Therapeutic Services]] examples&lt;br /&gt;
&lt;br /&gt;
See [[Mobile Health Apps]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Therapeutic_Services_-_What_Works.3F See what works]&lt;br /&gt;
&lt;br /&gt;
==Virtual Medical Services==&lt;br /&gt;
* Telepsych visits&lt;br /&gt;
* Telemedicine Visits &lt;br /&gt;
* Physician or Nurse Practitioner eVisits (informed and uninformed)&lt;br /&gt;
* Telecare Nurse&lt;br /&gt;
&lt;br /&gt;
See [[Virtual Medical Services]] examples&lt;br /&gt;
&lt;br /&gt;
[http://www.patientdeterminants.org/index.php?title=What_Works%3F#Virtual_Medical_Services_-_What_Works.3F See what works]&lt;/div&gt;</summary>
		<author><name>Admin</name></author>	</entry>

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