Best Practice Intervention Package - Kansas Foundation for Medical ...

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INSIGHTSWhat resources can help the patient transition from home health servicesto independent living? How do you address both patient safety, providedisease management monitoring, and promote patient self-management atthe same time?Medi Home Health & Hospice in Pittsburgh PA uses small emergency call devices.Disease Management/Self-management:• Units provide cordial reminders to assist with disease management process. Forexample: a HF patient can have reminders set to take medications or obtainhis/her weight.• Units are provided when the patient is on service as a part of the diseasemanagement education and support for self-management. At discharge thepatient is given the option to rent the unit through a monthly rental fee.• Promotes transition from home health to independence at home by providing thecontact to the agency when on home care and to patient identified contact (familyor neighbor) upon discharge from home carePatient Safety:• Units are easy to use with color coded buttons that plugs into the wall and can beworn as a pennant or velcroed to a wrist band. They are water safe and can beused in the shower—where many falls occur!• Unit can become a speaker phone (to regular phone) so patient doesn’t have tocome to the phone to answer an incoming call or to call for help.• Alert goes to first point of contact if patient doesn’t respond to cordial reminderswithin 20 minutes.Carol Gevaudan RN, BSN, Director of Coordinated ServicesMedi Home Health & HospicePittsburgh PA- 32 -
Tools/Resources available through Web linksWeb site:Agency for Healthcare Research and QualityGuides for Patients and Consumers: Short, plainlanguageguides — tailored to clinicians, consumers, orpolicymakers — summarize research reviews’ findingson the benefits and harms of different treatmentoptions. Consumer guides provide useful background onhealth conditions. Several consumer guides are alsoavailable in Spanish.Clinician Guides summarize research review findings onthe benefits and potential harm for different treatmentoptions and rate the strength of evidence of the review’sconclusions.Direct links to some of the guides are in the nextcolumn.Examples/Descriptions:Patient Guides:Comparing Two Kinds of BloodPressure Pills: ACEIs and ARBsACE Inhibitors and ARBs to ProtectYour Heart?Pills for Type 2 Diabetes: A Guide forAdultsClinician Guides:Comparing Oral Medications forAdults With Type 2 DiabetesACEIs or ARBs for Adults withHypertensionAgency for Healthcare Research and QualityIntegrating Chronic Care and Business Strategies in theSafety Net: A Toolkit for Primary Care Practices andClinicsImproving care for chronically ill is one of the mostpressing health needs of our time. To help moresafety net organizations implement the ChronicCare Model effectively and sustainably, the Agency forHealthcare Research and Quality (AHRQ) contractedwith the Group Health’s MacColl Institute, RANDHealth, and the California Health Care Safety NetInstitute (SNI) to develop a toolkit. The toolkit informssafety net providers on how to develop a toolkit. Thetoolkit informs safety net providers on how to redesigntheir systems of care along the lines of the Chronic CareModel while attending to their financial realities. Apractice coaching manual is available as a companionpiece to this toolkit.American College of Cardiology (ACC)Integrating Chronic Care andBusinessStrategies in the Safety Net (Toolkit --PDF version)Integrating Chronic Care andBusiness Strategies in the Safety Net:A Practice Coaching Manual(Toolkit—PDF)Full text articles focusing on PracticeGuidelines & Quality StandardsAmerican Association of Diabetes Educators- 33 -Includes the AADE7 Self-CareBehaviors for diabetes.Patient resources are available foreach of the self-care behaviors.
Page 1: Best PracticeIntervention PackageCr
Page 5 and 6: Quick Start GuideQUICK START GUIDE:
Page 7 and 8: Source: Wu, Shin-Yi and Green, Anth
Page 9: CHRONIC CAREIt may assist leadershi
Page 13 and 14: The Bottom LineLeaders must create
Page 15 and 16: DIABETESCenters for Disease Control
Page 17 and 18: SELF-MANAGEMENT: EMPOWERING THE PAT
Page 19 and 20: What is Patient Activation? How Doe
Page 21 and 22: TELEHEALTHTelehealth encompasses a
Page 23 and 24: Focus Section: Improving Care Trans
Page 25 and 26: Checklist for Agency LeadershipHow
Page 27 and 28: CHECKLIST FOR AGENCY LEADERSHIPASSI
Page 29 and 30: CHECKLIST FOR AGENCY LEADERSHIPASSI
Page 31: Motivational Interventions (CMI) Pa
Page 35 and 36: The four conceptual areas (referred
Page 37 and 38: and steps toward them.Self-Efficacy
Page 39 and 40: 1. Goals: Something you WANT to do:
Page 41 and 42: Conviction Ruler0 1 2 3 4 5 6 7 8 9
Page 43 and 44: Partnering with Patients and Famili
Page 45 and 46: Are You at Risk for Going to the Ho
Page 47 and 48: Call Me First!Stay safe and well at
Page 49 and 50: SUCCESS STORIESThere are three succ
Page 51 and 52: Promoting Telehealth as part of a C
Page 53 and 54: TRACKING DATA AND MEASURING PROGRES
Page 55 and 56: Best Practice Intervention Package
Page 57 and 58: Therapy Track: Focus on Improving C
Page 59 and 60: Home Health Aide Track: Focus on Im
Page 61 and 62: Coleman, E.A. (2003). Falling throu
Page 63: http://www.fda.gov/downloads/Medica

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