Background Health and care services are becoming increasingly strained and healthcare
authorities worldwide are investing in integrated care in the hope of delivering higher-quality …

Background There is widespread interest in programs aiming to reduce spending and
improve health care quality among “superutilizers,” patients with very high use of health care …

Multiple chronic conditions (MCCs) are more common and costly than any individual health
condition in the United States. The growing workforce of nurse practitioners (NPs) plays an …

Importance Medically complex patients are a heterogeneous group that contribute to a
substantial proportion of health care costs. Coordinated efforts to improve care and reduce …

Background Patient-centered care reflecting patient preferences and needs is integral to
high-quality care. Individualized care is important for psychosocially complex or high-risk …

Interest in high users of acute care continues to grow as health care organizations look to
deliver cost-effective and high-quality care to patients. Since “super-utilizers” of acute care …

Background Homelessness has emerged as a public health priority, with growing numbers
of vulnerable populations despite advances in social welfare. In February 2020, the United …

While an emerging body of evidence suggests that medical homes may yield more benefits
than traditional care models do, the role of social workers within medical homes has yet to …

Predicting clinical risk is an important part of healthcare and can inform decisions about
treatments, preventive interventions, and provision of extra services. The field of predictive …

ABSTRACT OBJECTIVES: Although use of the Medicare Annual Wellness Visit (AWV) is
increasing nationally, it remains unclear whether it can help contain healthcare costs and …