Disease Management Programs Improve Adherence to Evidence-Based Processes and Outcomes by Targeting Sickest Patients and Working Closely With Physicians
A hospital-based outpatient disease management program serves patients with asthma, chronic heart failure, and diabetes and offers smoking cessation services to smokers. Unlike traditional disease management programs, this initiative heavily involves physicians in the initial referral and throughout the process and targets services toward the sickest patients (rather than to all patients with the condition).
Information Technology-Facilitated Identification of At-Risk Primary Care Patients Combined With In-Office Automated Measurement Significantly Reduces Undiagnosed Hypertension
Primary care practices leverage information technologies to identify patients at risk of undiagnosed hypertension and schedule them for automated office blood pressure measurement, reducing the likelihood of remaining undiagnosed by more than 70 percent.
Nurse-Led Program Increases Provision of Cessation Counseling to Inpatients Who Smoke
With support from a unit-based nurse champion, stroke unit nurses encourage inpatient smokers to quit through bedside counseling, referral to an outpatient counseling program, and followup with the primary care provider.
Peer Coaching Combined With Nurse Outreach Improves Adherence to Medical Recommendations Among Elderly Cardiac Patients Who Live Alone Following Discharge
A nurse-guided, patient-centered approach combines ongoing peer support from a trained elder with home visits and followup phone calls from an advanced practice nurse for unpartnered, elderly patients who are discharged from the hospital after a heart attack or bypass surgery. The program is intended to encourage compliance with medication regimens and recommended lifestyle changes, with the goal of reducing hospital readmissions. A 247-patient randomized controlled trial found that the program improved adherence to medical recommendations and reduced hospitalizations due to cardiac-related complications but failed to reduce overall hospital readmissions.
Personal Health Record Generates Little Use, Has no Impact on Blood Pressure Control; Utilization; or Patient Activation, Empowerment, and Satisfaction
A personal health record for hypertensive patients to monitor blood pressure and other health data had no impact on blood pressure control; health services utilization; and patient activation, empowerment, and satisfaction.
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Prehospital Medical Information System
The Prehospital Medical Information System (PreMIS) is a State-mandated, Internet-based emergency medical services (EMS) information system that collects data on each EMS call report made within Mississippi, North Carolina, South Carolina, and West Virginia.
Diabetes Tools & Resources
These tools are a set of instruments to help patients create personalized action plans to lead a healthier lifestyle.
Mission: Lifeline Tools and Resources
Heart Attack Risk Calculator
This Web site provides hospitals and health systems tools and resources to improve their systems of care when responding to a patient with STEMI or out-of-hospital cardiac arrest.
This risk assessment tool, for people age 20 or older, provides information to assess a person’s risk for heart disease, heart attack, or other future heart problems.
My Life Check
This online assessment tool can help consumers learn the state of their heart and what they can do to live a better life.