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University of Illinois' Emergency Patient Interdisciplinary Care Project (Chicago) |
Illinois |
| The University of Illinois' Emergency Patient Interdisciplinary Care Project (EPIC) was a pilot program that used multidisciplinary care coordination teams and technologies such as health information exchanges and telehealth to identify complex patients in the ER and transition them back to primary care within 30, 60 or 90 days. Key aspects of the program included home visits by community health workers, navigators to guide complex patients through the health system, home-based medication reconciliation and online care coordination plans that directed ER staff to specific medical and social interventions. The program was developed by researchers from the university's colleges of Nursing, Medicine, Social Work and Pharmacy, and sought to address the medical, pharmaceutical and psychosocial aspects of patients' recovery after discharge. | |
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Partner Organizations |
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Target Population |
Complex patients with 2+ hospital admissions, 2+ chronic conditions, 5+ medications or 4+ ED visits within the previous year |
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Care Team |
Nurse case manager, social worker, pharmacist, two community health workers, program manager |
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Timeframe |
2013 - 2016 |
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Results/ Studies |
N/A |
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Funding |
Federal grant |
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Resources |
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