care transitions
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Community Health
Bridging the Gap: The Vital Role of Community Health Workers in Transforming Care
BY DEBRA COOPER, SUNFLOWER HEALTH PLAN A community health worker (CHW) is someone who works directly with the community to support…
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CMSA Foundation
The Pathway Home™ Program Revisited: Update on the Recipient of the 2019 CMSA Foundation Award for Case Management Practice Improvement
BY BARRY GRANEK, LMHC, PAMELA MATTEL, LCSW, AND GERALDO RAMOS, MSW, MPA Introduction Pathway Home™ was launched in 2014 with…
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Transitions of Care
A Road Less Traveled: Bridge to Home
BY JENNIFER CLINE, PT, DHSC, MS, AND SHONA METCALF, RN, BSN, MSN, CCM, IQCI Carolinas Medical Center (CMC) in Charlotte, North Carolina,…
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Social Determinants of Health
CalAIM — A Lesson in Transition
BY SUSANE HAO, RN, MSN, CLCP, AND THERESA HERNANDEZ, CCM Healthcare providers and case managers encounter patients who experience a combination of…
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Care Coordination
Case Management Leads the Team in Transitions with Patients with Substance Abuse Disorder and Infective Endocarditis
BY BETSY STOVSKY, RN, MSN, AND MARY McLAUGHLIN DAVIS, DNP, NEA-BC, ACNS-BC, CCM Patients with infective endocarditis (IE) due to opioid substance…
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Care Corner
Have You Heard About a Hospital at Home Program?
BY SANDRA ZAWALSKI, MSN Ed, RN, CRRN, CCM, ABDA, MSCC A new level of care has emerged in the healthcare…
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COVID-19
Covid Waivers 1135 in the Year 2023: Will They Continue?
BY JENNY QUIGLEY-STICKNEY, RN, MSN, MHA, MA, CCM, ACM-RN, CPHM, CMAC CMS 1135 pandemic waivers give healthcare providers throughout the…
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Telehealth
Innovations in Telehealth for Care Teams
BY BARBARA ROBBINS, RN, BSN, MB The COVID-19 pandemic led to great growth in virtual collaborative care teams with telehealth tools.…
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Care Coordination
Collaboration, Communication, Coordination: Moving to Build Consensus for Change
BY CHERI LATTIMER, RN, BSN The issues today surrounding changing healthcare models, diversity, equity and inclusion, technology advancement, policy directives, performance…
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Care Coordination
COVID-19: Impacting Hospital Readmission With Focused Care Transition Calls
BY KATHLEEN (KATHY) PARRY, BSN, RN, CCM The past 2 years have turned the healthcare industry upside down. The COVID-19 epidemic…
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