Melissa Jones-Holley, D.N.P., director of disease management and population health at Carroll Hospital, explains a new program designed to help patients living with chronic conditions.
What is the Care Solutions program? Why was it created?
Care Solutions is a disease management program that provides patients, health care providers and the community with resources to assist in the care of patients with chronic conditions, such as congestive heart failure (CHF), diabetes and chronic obstructive pulmonary disease (COPD). The aim of the program is to improve the patients’ quality of life and reduce unnecessary hospital stays through a series of coordinated health care interventions, such as education about their conditions and how to manage them, care coordination and improved access to care.
How do patients benefit?
Care Solutions offers patients an individualized care plan while working in collaboration with their health care providers.
As a part of the program, patients can receive follow-up care once discharged from the hospital, assistance with scheduling provider visits, education on their conditions, and assistance with understanding and managing their treatment plans including medications, referrals to health care and community resources, and telemonitoring services if needed.
Who is eligible for Care Solutions?
The Care Solutions program is available to patients with chronic conditions such as CHF, COPD and diabetes. Many patients are referred to our program from providers, case managers, nurse health navigators and community agencies, such as home health agencies and Access Carroll.
How is telemonitoring used?
Telemonitoring is one of the ways the Care Solutions program is helping patients understand and manage their chronic conditions at home. We are currently offering patients with CHF and COPD a chronic care management program that includes telemonitoring services. In this program, patients are provided with Bluetooth-enabled equipment that allows patients to obtain and record their vital signs each day, such as blood pressure, heart rate, oxygenation and weight, for use in their home. With this program, we are able to quickly identify and address abnormal patient vital signs and connect patients with a nurse or health care provider 24/7 for early intervention as needed. Patients who could benefit from telemonitoring are being recommended to the program during a hospital stay or by their primary care provider, cardiologist or pulmonologist.
Learn more about the Care Solutions program by calling 410-871-7000.