Annals of Family Medicine

NOVEMBER 20, 2024

Study Design and Analysis: We used information gathered from site visits and team meetings to understand how Compass Rose was being utilized across sites. Setting or Dataset: We used data from Epic on social needs screening and Compass Rose utilization.

Referral 130

Referral Community Transportation Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Objective: We describe the adoption, implementation, and impact on hemoglobin A1c of a primary-care-based Diabetes Navigator program that aimed to re-engage patients with uncontrolled diabetes into care. Study Design and Analysis: Adoption and implementation of the program is described using descriptive statistics.

Primary Care 130

Primary Care Diabetes Referral Integrated Care 130

Annals of Family Medicine

NOVEMBER 20, 2024

Early identification and intervention in behavioral aspects of chronic diseases leads to improved function with decreased healthcare utilization, yet we know little about referral patterns for behavioral support of chronic disease. 88% (n= 11,483) of BH referrals were created for the management of a mental health condition.

Referral 130

Referral Chronic Condition Medical Chronic Disease 130

Minnesota Academy of Family Physicians

FEBRUARY 20, 2025

Streamline Referrals: Utilize technology like the Hunger Vital Signs tool and the Minnesota Food Helpline to connect patients directly to mobile food units, emergency food programs or Supplemental Nutrition Assistance Program (SNAP) enrollment services. Park Nicollet Health Services combines nutrition education with SNAP referrals.

Family Physician 52

Family Physician Community Family Families 52

GeriPal

FEBRUARY 15, 2024

It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. So what we found is up to 30% of people would call 911 again for a fall, and of those calls, some people became very high-utilizers and so they would call 911 over and over again.

Community 114

Community Transportation IT PCP 114

GeriPal

JUNE 5, 2025

The obstacles hindering referrals to palliative care services. Practical strategies to overcome these barriers and enhance care. We also take a dive into these 2 articles that Connie first authored: Palliative care in nursing homes: A qualitative study on referral criteria and implications for research and practice.

Referral 78

Referral Nurse Practitioner Consulting Board-Certified 78

New South Family Medicine and MedSpa

NOVEMBER 24, 2022

Direct primary care offers you and your family top-notch health care, and so much more.like a high patient and provider satisfaction with an improved quality of care. Specialty referrals can be reduced or eliminated. Instead, they establish a direct patient-provider relationship, for a flat fee.

Family Medicine 40

Family Medicine DO Family Families 40