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Does transitional care management improve outcomes after discharge from the hospital?

Common Sense Family Doctor

Chronic conditions that frequently lead to readmissions, such as heart failure, have been targets of transitional care interventions that may include self-care education, home visits, telephone contacts, and office visits.

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Nurse Practitioners Critical in Treating Older Adults as Ranks of Geriatricians Shrink

Physician's Weekly

” Laura Wagner, a professor of nursing and community health systems at the University of California-San Francisco, stressed that nurse practitioners are not trying to replace doctors; they’re trying to meet patients’ needs, wherever they may be. “For those still in their private homes, there’s such a huge need.”

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Guiding an Improved Dementia Experience (GUIDE) Model: A Podcast with Malaz Boustani and Diane Ty

GeriPal

This model will give participating programs a per-member-per-month payment to offer care management, care coordination, and other services such as caregiver training, disease education, and respite. I had the tenacity and education to try to figure this out. This money allow me to take care of the caregiver, educate them, support them.

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Hospital-at-Home: Bruce Leff and Tacara Soones

GeriPal

If you are interested in learning more and meeting a community of folks interested in hospital-at-home, check out the hospital-at-home user group at hahusersgroup.org or some of these publications: Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. How is it financed and what comes next?

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