Discharge Planning
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Successful CHW Programs Are Complex and Require Meticulous Planning
Successful community health worker programs don’t just happen by magic: Providers have to plan the initiative carefully and be clear about the roles and responsibilities.
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Who Are Community Health Workers?
If your hospital doesn’t have its own community-based workers to support at-risk patients, you should research the providers in the community and what services they can offer.
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Your New Best Friend May Be a Community Health Worker
Community health workers, lay people who live in the community they serve and understand the challenges of the people who live there, can teach at-risk patients how to navigate the healthcare system, help them obtain community services, and support them in overcoming obstacles to care.
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Most Hospitals Penalized in HRRP All Five Years
CMS penalized more than half of hospitals participating in the Hospital Readmissions Reduction Program initiated by the Affordable Care Act in all five years of the program — but penalties were less common for hospitals treating the most medically complex patients, according to a recent analysis.
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Readmissions Reduced to 7.8% with Nursing Intervention at Home
Hospitals can significantly reduce readmissions with a multilayered program tailored to the needs of individual patients, according to the experience of an Arizona health system.
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Gain Skills Through Clinical Nurse Leader Program
As the healthcare system changes and roles evolve, case managers should look for opportunities like the clinical nurse leader program to gain the skills they need to succeed.
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Multipronged Initiative Cuts Readmission Rate
Lee Health, a four-hospital health system in southwest Florida, takes a multipronged approach to reducing readmission for patients with chronic conditions.
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Case Managers in All Settings Work Together in a Health Home Program
Case managers across the continuum work closely to coordinate care in New York state’s health homes, aimed at improving care for high-cost Medicaid beneficiaries.
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Communication Is Key to Good Patient Outcomes
Communication is one of the biggest shortcomings of today’s health system — and it’s getting worse, experts say.
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There Are Care Coordinators Everywhere, but Who Is in Charge?
New jobs with titles like care manager, care coordinator, navigator, patient progression nurse, and transition coordinator are popping up in various settings including hospitals, home health agencies, post-acute facilities, insurance companies, or community organizations.