Chronic care


EPITOME (Enhanced Patient Safety Intervention to Optimize Medication Education) Tools 07/10/08

EPITOME (Enhanced Patient Safety Intervention to Optimize Medication Education) is an evidence-based, multi-modal patient medication education program. It draws on health behavior change theory and utilizes a multidisciplinary approach, including structured medication education, administrative support and staff training, established quality improvement techniques, and consistent use of adjunctive and supportive information technology and automated systems, to maximize the impact of...

Chronic Obstructive Pulmonary Disease Population Screener 06/25/08

This screener can help patients determine if they are at risk for chronic obstructive pulmonary disease (COPD). It asks five questions about the patient, their breathing, and what they are able to do. Once complete, patients are encouraged to share the results with their doctor.

This site also provides a doctor-patient discussion guide. It includes information and tools to help patients prepare for, and make the most of, their next doctor visit.

Inner-City Asthma Study Questionnaires 06/24/08

These questionnaires were used in the Inner City Asthma Study (ICAS) to evaluate the effectiveness of two types of interventions to reduce asthma morbidity and severity among inner-city children, ages 5-11, with moderate to severe asthma.

Questionnaires include:

  • Adult baseline clinical evaluation form–Completed at study enrollment by the adult caretaker of the child
  • Child baseline clinical evaluation form–Completed at study enrollment by the...
Patient Self-Management Support Programs: An Evaluation 06/18/08

This report identifies and examines the factors that purchasers and builders of patient self-management support programs should consider when they are deciding on program components. It is based on a literature review and interviews with self-management support experts to identify and evaluate a range of program models and their features. Key findings and recommendations for developing a self-management support program are discussed.

Designing and Implementing Medicaid Care Management Programs: A User's Guide 05/30/08

The Medicaid Care Management Guide helps States design, implement, and evaluate care management programs for the chronically ill. The guide addresses five stages of care management program development, supplemented by three key topics that should be considered at every development stage.

The guide includes information on the following topics:

  • Planning a care management program
  • Engaging stakeholders in a care management program
  • Selecting and...
HIV/AIDS: A Manual for Faith Communities 05/19/08

This training manual for leaders of African American faith communities can be used to educate community members about the health threat of HIV/AIDS.

Topics include:

  • HIV-prevention training in your faith community
  • Personal risk pretest
  • What is HIV/AIDS?
  • Three ways to get HIV
  • Three ways to prevent it
  • HIV testing and treatment
  • Personal risk post-test
  • Program/course evaluation questionnaire
Toolkit for Implementing the Chronic Care Model in an Academic Environment 05/13/08

This toolkit provides materials that explain the concepts, change strategies, tools, and resources to teach medical residents and improve care for patients with chronic illness in an academic setting. It can assist academic health care environments in implementing the Chronic Care Model.

Depending on one's knowledge of the Chronic Care Model, the site can be easily navigated to advance an organization's progress. The lessons learned by the organizations involved in the Academic...

Lower Extremity Amputation Prevention (LEAP) 05/06/08

Lower Extremity Amputation Prevention (LEAP) is a comprehensive program that can dramatically reduce lower extremity amputations in individuals with diabetes mellitus, Hansen’s disease, or any condition that results in loss
of protective sensation in the feet.

The LEAP program consists of the following:

  • The five-step LEAP program
    • Annual foot screening
    • Patient education
    • Daily self inspection of the foot
    • Appropriate footwear...
Diabetes Recipe and Meal Planner Guide 05/05/08

The Diabetes Recipe and Meal Planner Guide offers steps to healthy eating and a healthy lifestyle to control and manage diabetes.

The guide includes:

  • How to create a healthy meal plan
  • What is the diabetes food pyramid?
  • What is the right number of servings for you?
  • Recipes
  • Spanish guide
  • References
Chronic Dry Eye Toolkit 05/02/08

This toolkit presents information about chronic dry eye. It includes the following:

  • Dry eye hot jobs fact sheet
  • Chronic dry eye overview
    • What is chronic dry eye?
    • What causes dry eye?
    • How do I know if I have dry eye?
    • How is chronic dry eye diagnosed?
    • How can I treat my dry eyes?
    • When should I talk to my eye doctor about my dry eyes?
  • Fast facts
    • The basics of dry eyes
    • What causes chronic dry eye...


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