The AIMS Model
An Evidence-Based Practice
Description
The Ambulatory Integration of the Medical and Social (AIMS) model seeks to address social and environmental barriers that affect plans of care by embedding a master's prepared social worker into primary and specialty care teams. The AIMS model follows a five step process including: patient/caregiver engagement, assessment and care plan development, telephonic or in-person case management, goal attainment, and ongoing care.
Goal / Mission
The Ambulatory Integration of the Medical and Social (AIMS) model aims to address social and environmental factors patients face that may prevent them from following their plan of care, thus impacting their health.
Impact
The AIMS model helps create better supported, less stressed, and better informed consumers and caregivers. There is also evidence to suggest that this model reduces ED usage and 30-day readmissions in participants.
Results / Accomplishments
The model was tested at Rush University Medical Center where it demonstrated success. Providers (n=28) noted they were able to spend more appointment time on medical issues (73%), and that people seemed less distressed (82%), showed a better sense of well-being (82%), and exhibited better self-management (73%).
Evidence also suggests that this model has an impact on emergency department usage, and 30-day readmissions. A retrospective analysis at Rush University that compared national averages to individuals in the study showed a statistically significant reduction in 30-day readmissions (mean of participants=0.15 vs. national=2.45, p=0.000) and ED visits ( mean of participants=0.10 vs national=0.26, p=0.000). However, the study failed to support that AIMS participants have lower hospital readmissions (mean=0.51) compared to national populations (mean=0.16, p=0.000).
Evidence also suggests that this model has an impact on emergency department usage, and 30-day readmissions. A retrospective analysis at Rush University that compared national averages to individuals in the study showed a statistically significant reduction in 30-day readmissions (mean of participants=0.15 vs. national=2.45, p=0.000) and ED visits ( mean of participants=0.10 vs national=0.26, p=0.000). However, the study failed to support that AIMS participants have lower hospital readmissions (mean=0.51) compared to national populations (mean=0.16, p=0.000).
About this Promising Practice
Organization(s)
The AIMS Model
Primary Contact
Topics
Health / Older Adults
Organization(s)
The AIMS Model
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Target Audience
Adults, Older Adults