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Challenges Running a Program

Challenges Working with Patients


Improving Patient Recovery Through Cardiac Rehab

With the help of a supportive and progressive cardiologist as our medical director, the outpatient program started in 1978, work that continues today. We wanted to provide patients with the best care by starting rehab at the right time. However, there is limited research on the ideal time to start cardiac rehab. Without research to guide action, the team decided to start rehab immediately following hospital discharge because we felt there was no benefit in waiting.


Connecting with Families: Turning Interest into Action

University of Illinois at Chicago’s Division of Specialized Care for Children (DSCC) has a regional office in Peoria, a city that is home to a well-known children’s hospital that cares for many children eligible for DSCC’s programs. Many of these children are referred to DSCC for assistance but often not until the child is older. DSCC’s care coordination teams believe it is vital that these children are referred to our programs as soon as soon after birth as possible, especially those with critical cardiac conditions. DSCC’s Peoria staff had developed relationships with the hospital’s nurses and s...


Meds to Bed Program: A Medication Concierge Service

Tamblyn and colleagues found that nearly a third of patients fail to fill first-time prescriptions.1 Other studies have found that e-prescriptions are 65% more likely to be left abandoned at a retail pharmacy by patients than hand-written prescriptions. 3 Mount Sinai Hospital (MSH) recognizes that the issue of medication adherence is challenging. MSH strives to become the national model for the delivery of urban healthcare and develops innovative and effective ways to accomplish its mission.

In the communities served by MSH, the percentage of citizens living below the poverty line...


Building a Care Coordination Program: Addressing Determinants of Health and Well-being

In 2013, Medical Center Health System, located in Odessa, Texas, embarked on a journey to create a healthier community. We knew we had a long way to go. Our county health rankings weren’t favorable according to the County Health Rankings from the Robert Wood Johnson Foundation, and we didn’t yet have a department at our hospital to address our community’s many health needs. We knew we wanted to approach the issues from the community angle but also from the hospital perspective. Our hospital understood that to build a “Culture of Health” we needed to be innovative and think beyond the traditional four...


State Policy as an Opportunity to Evaluate Current Discharge Processes

Effective Jan. 1, 2016, Indiana enacted the Caregiver Advise, Record, and Enable Act, or the CARE Act. The CARE Act requires hospitals to offer each admitted patient who will be discharged home an opportunity to: (1) identify a lay caregiver, (2) communicate with the lay caregiver regarding discharge and (3) offer education and training to the lay caregiver to ensure he or she understands how to care for the patient post-discharge, among other things. This required Riverview Health to evaluate its current processes and implement strategies to ensure compliance with the CARE Act.


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