Αποτελέσματα Αναζήτησης
For patients recovering from major surgery or dealing with chronic health conditions, this supervised rehabilitation can help them return home and live independently. Transitional Care gives you and your family the necessary skills to make a home-based recovery as safe and effective as possible.
TCM services can be provided to Medicare beneficiaries by their primary care physician or clinical team when discharged from an appropriate facility defined by CMS. TCM services require moderate or high-complexity medical decision making by the receiving provider.
We developed an intervention with the following components: inpatient pharmacist-led medication reconciliation and patient counseling, coordination of care and patient education from an inpatient discharge advocate and the PCMH responsible outpatient clinician, a structured visiting nurse intervention, structured postdischarge phone calls, timel...
Transitional Care Management: Practical Processes for Your Practice. Helping patients safely bridge the gap from acute care to ambulatory care is good for patients and practices too. care...
The goal of the IDEAL Discharge Planning strategy is to engage patients and family members in the transition from hospital to home, with the goal of reducing adverse events and preventable readmissions.
The TPOC template created a focal point for transition care planning in the SNFs and clearly articulated core domains of transitional care. The TPOC template replaced the “Discharge Summary” form in the SNFs, which did not include specific nursing, rehabilitation therapy, and advanced care planning goals or recommendations.
Use this fillable worksheet of key elements from the Transitions of Care Planning Guide to create and execute a strategy for collaborating with other providers to identify the barriers to smooth transitions and to identify,
