Home healthcare nurse
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Home healthcare nurse · Mar 2012
Reflections of a hospice physical therapist: patient-centered care bringing quality toward end of life.
When discussing hospice care with physical therapy (PT) students, other healthcare professionals, patients, and families, they often ask: What do you do with a hospice patient? What goals can they actually achieve? What rehab potential do they actually have? My answer is: What does the patient want to be able to do? How does he or she want to improve his or her mobility? Hospice PT is all about the quality of the end of a patient's life.
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Home healthcare nurse · Mar 2012
Review Case ReportsAdults with sickle cell disease: an interdisciplinary approach to home care and self-care management with a case study.
The complexity of caring for adults with sickle cell disease (SCD) strains the confines of a care-segregated medical system. As treatment protocols have dramatically improved since 1990, many patients with SCD are now living well beyond their 6th decade of life. ⋯ In addition, the home healthcare nurse serves as patient advocate for the transition from acute care to home, as well as advocate for healthcare maintenance of vision, musculoskeletal involvement, and social and psychological support. This article seeks to provide a viable network for home healthcare nurses to establish self-care management and support of the adult patient with SCD.
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Home healthcare nurse · Mar 2012
A community-wide quality improvement project on patient care transitions reduces 30-day hospital readmissions from home health agencies.
Approximately 1 in 5 Medicare patients are rehospitalized within 30 days of discharge. The Harlingen Hospital Referral Region, an area defined by the Dartmouth Atlas as 35 ZIP codes in South Texas, reduced 30-day hospital readmission rates and associated costs through its participation in the Centers for Medicare & Medicaid Services Care Transitions project. The project emphasized a community-wide focus on 4 quality improvement areas: (a) the problem of rehospitalization, (b) improving cross-setting collaboration, (c) access to performance data, and (d) implementation of best practice interventions to reduce avoidable hospitalizations.
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To reduce avoidable hospital readmissions and improve transitions between healthcare settings, Virtua Home Care implemented a Transitions of Care Program based on the Transitional Care Model developed at the University of Pennsylvania School of Nursing. Home care nurses were educated to be transitional care nurses and provided intensive education and follow-up for patients with chronic diseases who were identified as having a high risk of readmission. This program, which provides services to patients enrolled in fee-for-service (FFS) Medicare and who are eligible to receive the home health benefit, has successfully reduced hospital readmissions. This article describes Virtua Home Care's journey in adapting and implementing an evidence-based care transitions model.