Fundamentals of Chronic Condition Management will prepare clinicians to form a successful partnership with their patients who are managing complex health conditions on a daily basis. This course provides an overview of chronic condition management in the United States and how it has changed over time. Chronic condition management models will be reviewed, with emphasis on patient self-management. This course provides practical tips and tools to help the patient and clinician map out a plan and successfully navigate that plan to healthier living with managed conditions.
Cathleen Armato, RN, CHC, CHPC
Cat Armato is an experienced executive with 18 years in the home care and hospice industry. She has served in various roles during that time, including VP of operations and chief compliance officer for a nationwide provider. In 2012, Cat became a consultant. She has assisted multiple organizations with their compliance and quality efforts, from…Read full bio
Tina Marrelli, MSN, MA, RN, FAAN
Tina Marrelli is the president of Marrelli and Associates, Inc., a publishing and consulting firm working in home care for more than 30 years. Tina is the author of 13 books, including the Handbook of Home Health Standards: Quality, Documentation, and Reimbursement (6th edition, 2018). Other books include A Guide for Caregiving: What's Next? Planning…Read full bio
1. Defining Chronic Condition Management and Identifying Barriers
This chapter looks at the definition of chronic condition management and how chronic conditions have changed in the last few decades. We will look at examples of chronic conditions as well as statistics about chronic conditions in the United States. This chapter also reviews patient, clinician, and system barriers. With this knowledge, the health care provider can continually assess for actual or potential obstacles to success.
2. Chronic Condition Management Models
This chapter discusses the evolution of chronic condition care and reviews chronic condition management models and best practices. Strategies to improve care of patients with multiple chronic conditions will be discussed. A patient case scenario will be introduced for review and consideration.
3. The Patient-Clinician Partnership
Patient self-management is the primary goal of the support system of caregivers and the health care team. Communication with vulnerable patients and addressing special population needs will be reviewed. Customized and personalized care that is patient centered will de discussed. The patient case scenario introduced in the prior chapter will be developed as an exemplar.
4. Tools for the Patient-Clinician Partnership
After the clinician has assessed the patient and the support system, a holistic plan needs to be developed. This chapter provides practical tools for the clinician to use to partner with the patient in his/her efforts to manage chronic conditions. This chapter will integrate information from prior chapters for clinicians to be able to apply the concepts presented to their practices and at their organizations.
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