학술논문
Implementation of a Workflow Initiative for Integrating Transitional Care Management Codes in a Geriatric Primary Care Practice
Document Type
Periodical
Author
Source
Journal of Nursing Care Quality. Oct, 2018, Vol. 33 Issue 4, p348, 6 p.
Subject
Language
English
ISSN
1057-3631
Abstract
Byline: Julia Steckbeck, Section of General Internal Medicine (Mss Steckbeck, McBain, and Terrien and Drs Stadler, Stahl and Batsis) and Department of Medical Informatics (Mr Isom), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire (Drs Stadler, Stahl, and Batsis); Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire (Drs Stadler and Batsis); and Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire (Dr Batsis).; Christi McBain; Kerry L. Terrien; David Isom; Daniel Stadler; James E. Stahl; John A. Batsis Abstract We implemented a transitional care management service led by a nurse care manager. An interdisciplinary team developed a workflow using a Plan-Do-Study-Act cycle for contacting patients. Of the 146 (97.9%) eligible patients, 143 (97.9%) had a phone call within 48 hours. There were 84 of 120 (70.0%) and 117 of 120 (97.5%) attendance rates of those attending visits within 7 and 14 days. A care manager-led workflow was successfully and easily implemented within a primary care practice.