Designed for the Unique Needs
of Homecare Providers

This site provides homecare clinicians with access to chronic care management models, best practices and downloadable resources for homecare patients.

Heart Failure
Hypertension and Angina
Diabetes

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"The body of knowledge that serves as the rationale for nursing practice determines the areas of specialty to develop as well as the manner in which that knowledge is organized, tested and applied." -Carper, 1978
level 2

Heart Failure > Monitoring > Implement

Implement

When implementing a Monitoring program for a patient with heart failure, consider individualized signs and symptoms of fluid overload, co-morbidities, left ventricular function (ejection fraction), type of heart failure- systolic vs diastolic and risk factors for re-admission.
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What Does "Medically Necessary" Mean to my Medicare Coverage? (Web Page) - Feb 8th, 2011
A great breakdown of what the term “Medically Necessary" means, a great resource from The Medicare and Medicaid Center.

Keep Your Teeth and Gums Healthy (Web Page) - Feb 8th, 2011
An easy to read 20 page booklet from NIDDK, updated in 2008. Too much glucose in the blood for a long time can cause diabetes problems.

Take Care of Your Heart Manager Your Diabetes (pdf) - Feb 3rd, 2011
Two page handout from NDEP, updated 2002, explains the link between diabetes and heart disease and the important of working with individual's healthcare team to set target blood glucose, blood pressure and cholesterol goals.

AHA/ASA Releases Updated Secondary Stroke Prevention Guidelines (Web Page) - Nov 5th, 2010
(Released 10/25/10)- New recommendations on metabolic syndrome treatment and acknowledgement of a place for stenting in the management of symptomatic carotid stenosis are among the changes seen in updated secondary stroke prevention guidelines.

What's The Evidence for the Link Between ARBs and Cancer? (Level 2) (Web Page) - Nov 1st, 2010
VIDEO - Dr. Ileana L. Pina talks with Ilke Sipahi both a part of the part of the Heart Failure faculty at Case Western Medical Center University Hospitals in Cleveland.

Podcasts from Medscape - Cardiology (Level 2) (Web Page) - Nov 1st, 2010
Latest medical news and features from Medscape Cardiology, including a podcast from Dr. Lleana Pina, MD, (dated 7/19/10) about What's The Evidence for the Link Between ARBs and Cancer?.

Heart 360 (Level 2) (Web Page) - Oct 25th, 2010
Record health data with online trackers, access information and resources on how to be heart healthy and more.

Heart Failure: Patient Self-Care Work Book - Level 2 (doc) - Sep 1st, 2010
Patient workbook describing how an effective combinantion of nutrition, exercise and medicine can help patients control their condition. This material is provided by the Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization for Pennsylvania.

What are High Blood Cholesterol and Triglycerides? - Level 2 (pdf) - Aug 1st, 2010
Handout explaining the negative impact of high cholesterol and triglycerides.

Heart Failure Zones for Management - Level 2 (doc) - Aug 1st, 2010
Patient handout categorizing heart failure symptoms and steps the patient should take.

Spanish Translation of HF Zone Management - Level 2 (doc) - Aug 1st, 2010
Patient handout categorizing heart failure symptoms and steps the patient should take if they do recognize these symptoms.

The Borg Scale - Level 1 (doc) - Aug 1st, 2010
The Borg Scale is used to measure patient sensation of breathlessness during various activities. Monitoring breathlessness can help patients safely adjust thier activity by speeding up or slowing down their movements.

Education for Self-Care Plan - Level 3 (pdf) - Aug 1st, 2010
Patient handout discussing causes, signs and symtpoms of heart failure, and steps patients can take to stay healthy.

Decision Support Tool: Heart Failure - Level 2 (doc) - Aug 1st, 2010
This decision support tool was developed to help improve home health patient and agency outcomes by supporting standardized and evidence-based practice. This material is provided by the Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization for Pennsylvania.

Heart Failure: Phone Monitoring Assessment Guide - Level 2 (pdf) - Aug 1st, 2010
Phone monitoring questions to assess patients' current status and interventions based on assessment. This material is provided by the Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization for Pennsylvania

Heart Failure: Telehealth Monitoring System - Level 2 (pdf) - Aug 1st, 2010
Assessment tool to accompany a telehealth monitoring system. This material is provided by the Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization for Pennsylvania.

Adult Preventive Care Timeline - Level 1 (pdf) - Aug 1st, 2010
Health risk screening tool by age and gender.

Six Minute Walk Assessment - Level 2 (pdf) - Aug 1st, 2010
Objective tool done on admission and discharge. Measures distance while ambulating over a six minute time period. Patient is closely monitored during walk for physiological changes.

Lifestyle and Risk Reduction - Level 2 (Web Page) - Aug 1st, 2010
Tools available for download concerning nutrition, exercise and warning signs, etc.

Taking Control of Heart Failure - Level 2 (pdf) - Aug 1st, 2010
Patient booklet containing questions to ask about heart failure and general information.

What Do My Cholesterol Levels Mean? - Level 2 (pdf) - Aug 1st, 2010
Handout discussing HDL and LDL cholesterol levels and triglyceride levels

Tips for Doing a Pulse Check (doc) - Aug 1st, 2010
Directions for patients on how to check their own pulse.

Daily Weight Log - Level 3 (doc) - Aug 1st, 2010
Chart for patients to track their weight daily.

 


Levels of evidence
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Level 1
Systematic reviews and repeated studies, thoroughly researched.
Level 2
Experimental (Single or Quasi experimental study) and non-experimental (Exploratory or qualitative study).
Level 3
Recommendations of respected, experienced homecare authorities.
Level 4
Not Recommended.



The development of the hypertension and chronic stable angina project was made possible by a grant from the New York State Attorney General on behalf of the Attorneys General of all 50 states, DC and Puerto Rico from litigation settlement funds to benefit the healthcare needs of consumers with high blood pressure and angina. Original funding for the site was provided in part by US Congress and CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.