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Chronic Care Model

Ambulatory care practice: Providers (e.g. Physicians, PA, NP) Ambulatory care practice: Nurse/Nurse Managers, Medical Assistants Ambulatory care ...

Sep 17,2011

 

Partnering With Patients and Families to Design a Patient and Family-Centered Health Care System: Recommendations and Promising Practices

ambulatory programs, medical and nursing schools, funders of health care, patient- and family-led ...

Aug 01,2011

 

The Process of Guided Care

Ghided Care is a practical, interdisciplinary model of health care designed to improve the quality of life and efficiency of resource use for persons with medically complex health conditions.  In Guided Care, a registered nurse, who is based in a primary care office, works closely with 2-5 ...

Nov 14,2011

 

2012 Heart Failure Calendar Spanish

The  corresponding pocket guide  was created to help nurses educate heart failure patients about ... are two sections – “what the nurse needs to know” and “what the patient needs to know.”   ...

Dec 12,2011

Resource Type: Tool/Utility
 

2012 Heart Failure Calendar English

The  corresponding pocket guide  was created to help nurses educate heart failure patients about ... are two sections – “what the nurse needs to know” and “what the patient needs to know.”   ...

Dec 12,2011

Resource Type: Tool/Utility
 

Creating Regional Partnerships to Improve Care Transitions: Identifying and Recruiting Patients for Participation

Needs of Patients Discharged to Skilled Nursing Facilities .   ...

Jul 15,2014

Resource Type: Primer/Brief
 

Creating Regional Partnerships to Improve Care Transitions: Tracking Performance Metrics

the Needs of Patients Discharged to Skilled Nursing Facilities . ...

Jul 15,2014

Resource Type: Primer/Brief
 

Creating Regional Partnerships to Improve Care Transitions: Creating a Behavioral Health Intervention

Discharged to Skilled Nursing Facilities . ...

Jan 07,2015

Resource Type: Primer/Brief
 

Creating Regional Partnerships to Improve Care Transitions: Supporting Patients Who Are Nearing the End of Life

Skilled Nursing Facilities . ...

Jan 07,2015

Resource Type: Primer/Brief
 

Creating Regional Partnerships to Improve Care Transitions: Hiring Care Transition Coaches

Patients Discharged to Skilled Nursing Facilities . ...

Jan 07,2015

Resource Type: Primer/Brief
 

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