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Related Concept Videos

Documentation in Long-Term and Home Healthcare Setting01:29

Documentation in Long-Term and Home Healthcare Setting

Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Discharge Summary Forms01:31

Discharge Summary Forms

The discharge summary is crucial as it enables a smooth transition from a healthcare facility to a patient's home or another care setting. This critical document facilitates seamless continuity of care, ensuring patients receive the necessary support and attention.
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
Restorative Care01:19

Restorative Care

Restorative care is provided once a patient has been discharged from a healthcare facility and requires additional services. The additional services include home care, rehabilitation programs, and extended care. Restorative care centers help the patient regain their previous level of functioning or acquire a new level of functioning due to the incapacitating effects of a disease or a disability. It aims to assist patients in enhancing their quality of life by encouraging independence,...
Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Planning Nursing Care I01:21

Planning Nursing Care I

The planning phase of the nursing process helps nurses set priorities, outline patient-centered goals and expected outcomes, and tailor nursing interventions to align with the aligned care plan. Through the planning phase, the nurse applies critical thinking skills to align and develop interventions according to the patient's needs. It provides continuity of care allowing patients to receive the maximum benefit from treatment. It serves as a pilot plan for allocating individual staff to a...

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Related Experiment Video

Updated: Jun 23, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
06:52

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Transitional Care Management Associated With More Healthy Days At Home, Lower Spending After Hospital Discharge.

MacKenzie L Hughes1, Wen Hu2, Jackie Soo3

  • 1MacKenzie L. Hughes (hughes-mackenzie@norc.org), NORC at the University of Chicago, Chicago, Illinois.

Health Affairs (Project Hope)
|June 2, 2025
PubMed
Summary

Transitional care management (TCM) services improve patient health and reduce costs. These benefits are amplified when patients are enrolled in population-based Alternative Payment Models (APMs).

Related Experiment Videos

Last Updated: Jun 23, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
06:52

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Area of Science:

  • Health Services Research
  • Healthcare Policy
  • Geriatric Medicine

Background:

  • Medicare incentivizes Transitional Care Management (TCM) services post-discharge.
  • Population-based Alternative Payment Models (APMs) promote coordinated, patient-centered care.
  • Understanding the interplay between TCM and APMs is crucial for optimizing healthcare delivery.

Purpose of the Study:

  • To evaluate the impact of TCM on quality and cost outcomes.
  • To assess how participation in population-based APMs influences the TCM-outcome association.
  • To identify potential synergistic effects between TCM and APMs.

Main Methods:

  • Analysis of Medicare data from 2017-20.
  • Comparison of outcomes for patients receiving TCM versus those who did not.
  • Stratification of analyses based on alignment with population-based APMs.

Main Results:

  • TCM was linked to increased healthy days at home and decreased total spending post-discharge.
  • These positive effects were more significant for patients aligned with APMs.
  • TCM reduced readmissions but did not impact mortality rates, irrespective of APM alignment.

Conclusions:

  • TCM services demonstrate significant benefits for patient health and healthcare spending.
  • The advantages of TCM are potentially enhanced when patients are integrated within population-based APMs.
  • Findings suggest complementary effects, advocating for coordinated implementation of TCM and APMs.